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Leonard Rubenstein, JD Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health

Mutually reinforcing mechanisms to promote adherence -- human rights model


1. Establishing norms 2. Documentation of violations 3. Prevention strategies 4. Accountability

Where we are today: 1. Norms

Powerful and explicit in international humanitarian law In non-conflict context, human right to access to health care Norms reinforce and respect ethical obligation to provide impartial care But

Norms
Anti-terror law criminalizes medical care for terrorists
Serbia prosecuti0ns

for assistance to KLA USAmaterial support Claims based on assymetrical warfare

Other norms rarely

incorporated in domestic law

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Where we are today: 2. Documentation


Only episodic reporting by human rights groups Reports on attacks on health included in reports of Special Representative of Secretary General on Protection of Children in Armed Conflict, but not a priority Limited sharing of internal security information among humanitarian organization.

Documentation promising developments


Health Care Danger report by ICRC multi-country

study US Department of State now collecting data for annual Country Reports on Human Rights Practices on attacks on health and humanitarian access Executive Board of WHO adopts resolution to provide leadership at global level on systematic collection and dissemination of data on attacks on health in complex humanitarian emergencies Will be taken up by World Health Assembly

Where we are today: 3. Prevention


Little study of causes, motives, even

what works
Information that exists not widely shared Little study of impacts on health services Sense of inevitability and powerlessness Lack of constituent engagement

Prevention promising developments


ICRC training of military and insurgent groups, negotiation activities to promote access Health Care in Danger Campaign pragmatic strategies to address potential points of attack
Military workshops

Increasing sophistication on NGO security matters Increased discussion at international level Attempts at coordination

Where we are today: 4. Accountability

Occasional diplomatic condemnation, but no teeth Little sustained advocacy Prosecutions for violations rare Most attention on humanitarian providers, not indigenous health workers and facilities

Accountability promising developments

UN Security Council includes attacks on hospitals and health personnel in mechanism for protection of children in armed conflict (2011) Perpetrators listed in report Action plan for promoting adherence required Increased documentation increases potential for diplomatic leverage

Safeguarding Health Coalition to mobilize civil society

www.safeguardinghealth.org

Medical and nursing associations Human rights, development and humanitarian NGOs

A way forward: global solutions through inter-governmental organizations


Predicates Vision of integrated approach norms, prevention, documentation, accountability Develop constituency through Health Care in Danger and Safeguarding Health Coalition

A global approach
1. Reinforcement of norms Integrate human rights and humanitarian law values Reflection in national law Rejection of anti-terror exceptions to adherence; resolution of Human Rights Council? 2. Prevention Robust program of discussion and research on causes and what works, with donor and foundation support Dissemination of findings Pressure for adherence via Human Rights Council/Security Council

A global approach
3. Documentation

Unified, coordinated approach Collaboration between WHO and other

agencies -- OCHA, UNICEF, Special Representative on Children, High Commissioner for Human Rights Collaboration with humanitarian NGOs on data

A global approach
4. Accountability UN system: Security Council should

Condemn and call for the cessation of attacks or interference

Call for compliance by parties to conflict with international law


Apply targeted measures against perpetrators Authorize commissions of inquiry and/or refer such situations to the ICC

Action by Human Rights Council/ OHCHR Prosecutions, domestically and internationally Bi-lateral and regional mechanisms of accountability
Diplomatic pressures Sanctions and related measures

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