1. Sofer, Dalia


Respect for international humanitarian law is sorely lacking.


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Earlier this year, the International Committee of the Red Cross (ICRC) issued a plea on behalf of Louisa Akavi, a New Zealand nurse who was abducted in 2013 by Islamic State in Iraq and Syria (ISIS) gunmen while transporting medical supplies in Idlib, Syria.

Figure. New Zealand ... - Click to enlarge in new window New Zealand nurse Louisa Akavi is shown here in 1996 after surviving a massacre in Chechnya in which six of her colleagues were killed. Akavi was abducted in 2013 while transporting medical supplies in Idlib, Syria. Photo by Ross Land / Getty Images.

Dominik Stillhart, ICRC director of operations, said in a statement that Akavi was believed to be alive, based on credible information received in December 2018. But the recent liberation of Syrian territories from ISIS has made the ICRC fearful of losing track of her, though it hopes new information as to her whereabouts will emerge. The organization's public appeal, coming on the heels of the 2018 execution of two ICRC midwives, underscores the dangers health care workers face when deployed in conflict zones.


The absence of a global data collection system has made it challenging to track attacks on health care facilities and staff deaths and injuries. Several organizations, however, have undertaken to compile reports from multiple sources. An ICRC report documented 2,398 attacks on health services in 11 countries from 2012 to 2014; of these, 1,222 were directed at health care facilities. Another report by the Safeguarding Health in Conflict Coalition found that in Syria alone, 108 attacks were perpetrated against medical facilities in 2016.


"The single greatest thing that can be done to improve health care in war zones is for all parties to respect international humanitarian law, or the Law of Armed Conflict," Anna K. Nelson, the ICRC's head of communication for the United States and Canada, told AJN. She noted that the ICRC has developed six recommendations to reduce threats to health care facilities and workers: that governments ensure that international legal frameworks be implemented on a national level; that the protection of health services be integrated into the operational practice of armed forces (for example, factoring the proximity of hospitals into the planning and conduct of military operations); that armed groups likewise factor the protection of health services into their operations; that the "Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies" (available at be respected; that governments and health care facilities have plans in place to ensure the security of staff and patients; and that responders on the front lines, including first aid providers and ambulance drivers, be protected through proper communication and coordination.


In 2016, the United Nations Security Council adopted Resolution 2286, which urges all parties engaged in armed conflict to comply with international law. But little has been done to enforce the resolution, and the attacks continue. So far in 2019, there have been 403 attacks, according to the World Health Organization.


For health care workers like Akavi, who served in 17 missions before her abduction, including in Somalia and Chechnya, deployment in conflict zones can come at a high price. Of her experience in Chechnya-where in 1996 she witnessed the killing of six colleagues-Akavi said in a 2001 interview: "A lot of what has happened has made me as a person a lot stronger[horizontal ellipsis]. The risks are there and this I accept, but the work that I do is what I want to do and it comes with it, so I don't think about it anymore."-Dalia Sofer