Have attacks on healthcare become the new normal? a public health call to action for armed conflicts before it is too late.

The scale of attacks on healthcare has become more visible and its impact greater in recent armed conflicts in Ukraine, Sudan and Myanmar. In these conflicts, combatants systematically target health facilities and ambulances. We need to ensure that attacks on healthcare do not become the new norm amongst governmental troops and non-State armed groups. There is limited evidence about why and how attacks on healthcare have become "normal" practice amongst many combatants, despite the likely tactical and strategic costs to themselves. We are convinced that the problem now needs to be tackled like any other public health issue by assessing: the scale of the problem; who is the most at risk; identifying risk factors; developing new interventions to prevent the risks or address the issue; and evaluating the effectiveness of these interventions.

Violence against healthcare in conflict: a systematic review of the literature and agenda for future research.

BACKGROUND: Attacks on health care in armed conflict, including those on health workers, facilities, patients and transports, represent serious violations of human rights and international humanitarian law. Information about these incidents and their characteristics are available in myriad forms: as published research or commentary, investigative reports, and within online data collection initiatives. We review the research on attacks on health to understand what data they rely on, what subjects they cover and what gaps exist in order to develop a research agenda going forward. METHODS AND FINDINGS: This study utilizes a systematic review of peer-reviewed to identify and understand relevant data about attacks on health in situations of conflict. We identified 1479 papers published before January 1, 2020 using systematic and hand-searching and chose 45 articles for review that matched our inclusion criteria. We extracted data on geographical and conflict foci, methodology, objectives and major themes. Among the included articles, 26 focused on assessment of evidence of attacks, 15 on analyzing their impacts, three on the legal and human rights principles and one on the methods of documentation. We analyzed article data to answer questions about where and when attacks occur and are investigated, what types of attacks occur, who is perpetrating them, and how and why they are studied. We synthesized cross-cutting themes on the impacts of these attacks, mitigation efforts, and gaps in existing data. CONCLUSION: Recognizing limitations in the review, we find there have been comparatively few studies over the past four decades but the literature is growing. To deepen the discussions of the scope of attacks and to enable cross-context comparisons, documentation of attacks on health must be enhanced to make the data more consistent, more thorough, more accessible, include diverse perspectives, and clarify taxonomy. As the research on attacks on health expands, practical questions on how the data is utilized for advocacy, protection and accountability must be prioritized.

Humanitarian accountability, bureaucracy, and self-regulation: the view from the archive.

This paper contains a systematic exploration of local and national archives and sources relevant to charities and humanitarian fund appeals of the late Victorian and Edwardian eras (1870-1912) in Great Britain. It shows that the charitable world and humanitarian work share the same matrix and originate from the same roots, with considerable overlap between fundraising for domestic charity and overseas relief. These campaigns engaged in crucial self-regulatory processes very early on that involved concepts such as formal accountability and the close monitoring of delivery. Far from lagging behind in terms of formal practices of auditing and accounts, charities and humanitarian funds often were in the pioneering group as compared with mainstream businesses of the period. The charitable sector, notably through the Charity Organisation Society in cooperation with the press, developed and delivered accountability and monitoring, while the state and the Charity Commission played a negligible role in this process.

A qualitative and quantitative study of the surgical and rehabilitation response to the earthquake in Haiti, January 2010.

BACKGROUND: The disaster response environment in Haiti following the 2010 earthquake represented a complex healthcare challenge. This study was designed to identify challenges during the Haiti disaster response. METHODS: Qualitative and quantitative study of injured patients carried out six months after the January 2010 earthquake in Haiti to review the surgical inputs of foreign medical teams. RESULTS: Study findings revealed a need during the response for improved medical records and data gathering for regulation, quality assurance, coordination and resource allocation; wider adherence to standard patient referral mechanisms and protocols linking surgical service provision with appropriate hospital and community based rehabilitation services; a greater recognition of the impact of non-amputation injury, and the need for patients to have a greater say in their management and to be the keepers of their medical records. Key first steps to improving the international response are a minimum dataset and uniform reporting. CONCLUSION: This study showed that challenges for emergency medical response during the Haiti Earthquake involved issues of accountability, professional ethics, standards-of-care, unmet needs, patient agency and expected outcomes for patients in such settings:

Algerian orphans and colonial Christianity in Algeria, 1866-1939.

This article considers the exceptional fate of the orphan survivors of the great Algerian demographic crisis of the late 1860s who subsequently converted to Catholicism. Using a prosopographical approach, this study seeks to highlight the complexities of national identity in France and to explore some of the racial tensions emerging in Algeria in the late nineteenth century.