Tackling violence against aid workers Contents

2Aid under attack

Introduction

4.Every day, thousands of women and men brave dangers, threats and risks—in addition to other challenges and difficulties—to deliver essential humanitarian relief, vital health care and other development assistance to people in insecure and conflict-riven parts of the world. We concur whole-heartedly with the admiration and gratitude expressed by Ministers and so many of our witnesses, over time, for the courage, fortitude and sheer hard work of the vast majority of these workers (whether working in their own or a foreign country).

5.Our evidence, in this short inquiry as well as our regular examination of the worst humanitarian crises across the globe, is clear that the perception of risk and threat to humanitarian workers is getting more grave. There are certainly challenges to ascertaining a clear picture—especially of trends over time—due to difficulties defining aid, humanitarian and development work and workers in the first place; identifying causation between such employment status and the violence or other harm occurring; and establishing confidence in the levels of reporting (including threats of violence and reporting of sexual violence).9 Dr Andrew Murrison MP, Minister of State for International Development, told us that:

… we believe that not only are the numbers quite frightening, in terms of attacks on aid workers and … medical aid workers … but the tempo appears to be increasing.

He added, however, that:

the informatics are not brilliant.

We therefore welcome the Minister’s additional evidence that:

… the UK Government have funded a project to look at medical aid workers in particular, in pursuit of United Nations (UN) Security Council Resolution 2286 … It is £2.5 million over five years, led by the University of Manchester, with the assistance of the World Health Organization and others, to better delineate this issue.10

Definitions and sources of data

6.In this report we refer to attacks on aid and health care in conflict-affected settings. The definitions for these different types of worker and the main sources of quantitative evidence are shown in Box 1. We use the term ‘humanitarian workers’ to refer to both aid and healthcare personnel together.

Box 1: Aid and healthcare worker definitions and principal sources of data on attacks

	Aid worker	Healthcare worker
Definition	Aid workers are defined as the employees and associated personnel of not-for-profit aid agencies (both national and international) that provide material and technical assistance in humanitarian relief contexts. This includes both emergency relief and multi-mandated (relief and development) organisations: NGOs, the International Movement of the Red Cross/Red Crescent, donor agencies and the UN agencies belonging to the Inter-Agency Standing Committee on Humanitarian Affairs. The aid worker definition includes various locally contracted staff (for example, drivers, security guards, etc.), and does not include UN peacekeeping personnel, human rights workers, election monitors or purely political, religious, or advocacy organisations.11	Healthcare workers include vaccination workers, paramedics, nurses, doctors, midwives, patients, community volunteers, and drivers and guards.12
Evidence sources	Aid Worker Security Database (AWSD). The AWSD is a project of Humanitarian Outcomes. It records major incidents of violence against aid workers.13 Stoddard, A., Harvey, P., Czwarno, M., & Breckenridge, M. (2019). Aid Worker Security Report 2019. Humanitarian Outcomes, June 2019.	Safeguarding Health in Conflict Coalition. The Coalition brings together data on attacks on health care in conflict affected countries from bodies such as the World Health Organization (WHO), other United Nations (UN) agencies and Coalition members as well as from open source data.14 Safeguarding Health in Conflict Coalition, Impunity Remains: 2018 Attacks on Health Care in 23 Countries in Conflict, May 2019
	There is a degree of overlap between the AWSD and Coalition datasets. For example, some victims of attacks on health care will be affiliated to humanitarian organisations such as the International Red Cross/Red Crescent and Médecins Sans Frontières (MSF). In these instances, they may be counted in both datasets.

The changing nature of humanitarian crises

7.A significant factor in the ‘tempo’ of violence against aid and healthcare workers must be that, over last 25 years, the nature of the predominant and preoccupying humanitarian crises has changed from natural disasters to protracted man-made armed conflicts.15 Between 2006 and 2016, the number recorded for conflicts worldwide rose from 278 to 402.16 Conflict has become a major driver of displacement, poverty, poor physical and mental health and gender-based violence. The UN recently estimated that 139 million people worldwide are in acute humanitarian need, many of them because of armed conflict.17 Operating in such environments is increasingly, and inevitably, exposing humanitarian workers to risks and threats. In addition to the dangers of collateral and accidental harm from attempting to continue to work in fraught circumstances and areas, there is also clear evidence of aid and health workers being deliberately targeted by violence for a variety of reasons.

Attacks on aid and health care

Attacks on aid workers and operations

8.During 2018, the Aid Worker Security Database (AWSD) recorded 221 major incidents of violence against aid workers, resulting in 126 deaths. In the same year, 143 aid workers were wounded and 130 kidnapped.18 (Figure 1.)

The 126 aid workers killed in 2018 is the third highest recorded annual death toll behind 2017 (139) and 2013 (156).19
The European Interagency Security Forum (EISF) told us that serious incidents of violence against aid workers were largely concentrated in a small number of heavily conflict-affected countries and that: “through professionalisation and better understanding of risk in the way we work, in the majority of countries, it is hopefully getting safer.”20 During 2018, two-thirds of attacks against aid workers (146) occurred in five countries: South Sudan, Syria, Afghanistan, the Democratic Republic of Congo (DRC) and the Central African Republic.21
The tactics used by warring parties in violence-affected countries reflect the broader conflict dynamics in each setting. For example: in South Sudan, incidents involving gunfire are the most common form of violence affecting aid workers; whereas in Syria aerial bombardment by state forces is the most common type of attack (Figure 2).22
Local and locally-engaged aid workers bear the brunt of the violence. Most of the aid workers killed and injured are nationals of the country they were working in, reflecting, among other things, increased localisation of aid in high-risk, conflict-affected settings. In 2018, 370 (93%) national aid workers were victims of violence compared to 29 internationals.23

9.These data fit an ongoing pattern:

The AWSD shows that, over the decade preceding 2018 (2009 to 2018), the number of aid worker victims averaged 323 a year. On average, 110 aid workers are killed each year, 114 are wounded and 100 are kidnapped.24
Over the past 10 years, the trend in the number of violent incidents involving aid workers has edged upwards. However, the peak year occurred in 2013 when 156 aid workers were killed.25 (Figure 1.)

10.Available data on violence involving aid workers do not capture the full picture. It is likely that the recorded figures underestimate the full extent and impact of recent violence in relation to humanitarian operations. For example, sub-contractor casualties may not be fully reflected in the data and threats of hostilities are typically not recorded.

11.Also, somewhat unclear is the extent to which the incidence of deaths, injury and other harm is related to changes in, for example, the aid worker population. Obviously, one fatality is one too many but in terms of assessing trends and effective mitigations a robust view of the trajectory of risk and threat is important. In 2010, a study published by the Australian Council for International Development said aid work, at 42 fatalities per 100,000 per year, was the fourth most dangerous profession in the world.26

Attacks on health care

12.The scale of the threat to healthcare personnel and facilities in conflict-affected countries appears to be even greater than that to aid workers and their operations. According to the Safeguarding Health in Conflict Coalition there were at least 973 recorded attacks on health facilities and health personnel in 23 countries in conflict in 2018.27 At least 167 health workers died and at least 710 were injured as a result of these attacks.28 It is particularly worrying that, of the 973 attacks on health facilities and personnel in 2018, no fewer than 308 were recorded in Israel and the Occupied Territories, reflecting the sharp increase in violence that has taken place on Israel’s border with Gaza in the past year.29

13.It is difficult to determine a clear pattern for attacks on health over time as there is a lack of reliable trend data. The number of reported attacks in 2018—973—is higher than the 701 instances reported in 2017. But the Coalition is not able to determine whether this is a result of an increased number of attacks or an improvement in reporting.30

Figure 1: Violence against aid workers: Attacks and victims, 2009–2018

Note: * Live release or escape (kidnappings where victims were killed are counted in the ‘killed’ totals)

Source: Stoddard, A., Harvey, P., Czwarno, M., & Breckenridge, M. (2019). Aid Worker Security Report 2019. Humanitarian Outcomes, June 2019

Figure 2: The countries with the five highest number of attacks on aid workers—by form of attacks—between 2016 and 2018

Source: Stoddard, A., Harvey, P., Czwarno, M., & Breckenridge, M. (2019). Aid Worker Security Report 2019. Humanitarian Outcomes, June 2019

Sexual violence

14.Intuitively, humanitarian workers operating in conflict environments—including where sexual violence may be regarded as a ‘weapon of war’ by some forces and groups—are likely to be subject to heightened risks.

15.Sexual violence appears likely to have been as significantly under-reported by aid workers as it has been in other sectors). Over the 21 years that the Aid Worker Security Database has been recording incidents, there have been only 29 reported incidents of sexual violence.31 It is possible also that sexual violence occurring within the context of other forms of attack has not been explicitly reported or coded as a different category..32 Violence against aid workers with diverse profiles is not reported or recorded separately.33

Targeting of humanitarian workers

16.Vincent Cochetel, the UNHCR Special Envoy for the Mediterranean Situation, told us that the threat of violence against humanitarian workers is increasing because they have become a target.

Some 20 or 30 years ago, aid workers who lost their lives were part of the collateral damage in the conflicts where they worked. Today, [humanitarians] are a target because [they] represent the perceived humanitarian arm of political decisions taken elsewhere. […] In the last 15 years, you see that clearly.34

17.Mr Cochetel, amongst other witnesses, also said that the deliberate targeting of humanitarians has arisen because armed groups are not abiding by the “rules of war”—the body of rules under international humanitarian law (IHL) designed to protect civilians, medical staff and humanitarian aid workers in conflict settings.35 (The protections afforded under IHL are covered in Chapter 3 of this report.)

Perpetrators of attacks

18.Our evidence also drew attention to analysis performed by Humanitarian Outcomes in 2017 looking at the perpetrators of violence against aid workers.3637 This analysis found that most attacks are perpetrated by non-state armed groups (NSAGs) such as the Taliban and Islamic State; global NSAGs such as Al Qaeda; and state actors (which include host state and foreign actors).

Between 2011 and 2016, national and sub-national level NSAGs were responsible for 60% of known group-perpetrated incidents, followed by state actors (24%) and global NSAGs (7%).38
NSAGs are responsible for smaller numbers of attacks but higher fatality rates. They are more lethal in their means and often specifically target international aid workers.39
However, when measured by body count alone, states are responsible for the highest number of aid worker fatalities. In 2015 and 2016, 54 aid workers were killed by state actors. This was mainly the result of airstrikes by Russia and the US in Syria and Afghanistan and an upsurge in state-sponsored violence in South Sudan.40

19.Data on attacks on health care in countries in conflict compiled by the Safeguarding Health in Conflict Coalition reinforce these findings. In the Coalition’s most recent report, it received reports of specific perpetrators in 47% of the incidents against health workers recorded in its database. Of these incidents, 71% were attributed to state forces and 27% to non-state forces.41 In the past year, attacks on aid operations and health care by state actors appear to have been concentrated in Israel, Syria and Yemen. Figure 3 provides some examples of attacks by state actors on aid and health care that potentially violate international humanitarian law.

Figure 3: Case studies of attacks by state actors on aid and health care operations in the past year

Location	Date	Description of incident
Syria	Throughout April-June 2019	In Hama and Idlib governorates, Syrian Government and Russian airstrikes and shelling continued to damage or destroy health care facilities and schools amid what is widely considered to be a systematic assault, forcing humanitarian actors to suspend their programmes. Sources estimate that around 32 medical facilities and 64 schools were attacked from April 26 to June 15.
Yemen	2018	Three years of conflict in Yemen have led to the near total collapse of the country’s health system. In 2018, there were at least seven aerial attacks on health facilities and one further aerial attack on an ambulance, as well as 15 cases of surface shelling on health facilities and transports.
Israel and the Occupied Palestinian Territories	2018	In 2018, the Safeguarding Health in Conflict Coalition identified 308 attacks that affected health workers, facilities, and transport. Three health workers were reportedly killed, and, at least, 564 were injured. The Coalition received information regarding perpetrators in 114 of the attacks; 112 attacks were reportedly perpetrated by Israeli forces. In 2019, the UN Independent Commission of Inquiry on protests in Gaza in 2018 found reasonable grounds to believe that Israeli snipers shot at non-combatants, including health workers (of whom 3 were killed and 39 injured by live ammunition), “knowing they were clearly recognizable as such”.

Sources: Insecurity Insight; Stoddard, A., Harmer., A., Czwarno, M. (2017). Aid worker security report 2017, behind the attacks: A look at the perpetrators of violence against aid workers. Humanitarian Outcomes, August 2017; Safeguarding Health in Conflict Coalition, Impunity Remains: 2018 Attacks on Health Care in 23 Countries in Conflict, May 2019; and Report of the independent international commission of inquiry on the protests in the Occupied Palestinian Territory to the UN Human Rights Council, 02/201942

20.In oral evidence, Vincent Cochetel, emphasised a further risk dynamic, complicating the picture, involving organised crime. Referring to hostage-taking as “big business”, he told us:

That is one of the new features of many conflict and post-conflict situations, where you see much more cross-fertilisation between militant groups and criminal organisations. They co-operate with each other. They share interests and they share the knowhow on how to target humanitarian aid workers.43

In this context, we were struck also by the caution requested by the Government of the DRC over discussion of donor funding in relation to the Ebola crisis. Department for International Development (DFID) Minister Harriett Baldwin told us:

We have been told by the Government of the Democratic Republic of Congo that, because this is a very poor area and a lot of money is flowing in through some of the actors in this response, they believe that mentioning amounts of money puts a target on the head of some of the responders. I would not want to disagree with them in their assessment. We have already had the very sad loss of Dr Mouzoko Kiboung and … 119 attacks altogether on health workers.44

Impact of attacks on humanitarian operations

21.Attacks on aid are harming humanitarian relief operations. Apart from the immediate human suffering, attacks and the threat of violence can deprive those most in need from gaining access to humanitarian aid and essential health services;45 and jeopardize global efforts to stop and contain the spread of dangerous diseases.

During the Committee’s oral evidence session on Ebola in the Democratic Republic of Congo (DRC), we heard that the severity of attacks on health workers and threats of violence are having a big impact on treating people, gaining access to the populations that are being affected and preventing further spread of the disease.46
In Pakistan, efforts to eradicate Polio are being hampered by attacks on Polio vaccination workers and facilities. The attacks are being driven by ‘fake news’ about the adverse effects of polio vaccine on children.47

22.In response to rising security threats, we were told that international aid organisations have withdrawn from volatile and insecure environments or adapted their approach to shield their staff and programmes from outside threats. For example, through heightened security measures such as the use of armed protection, armoured vehicles and the construction of bunkers that aid staff can retreat to in the event of attack; and the transfer of risk to local delivery partners to maintain an aid organisation’s presence in hard to reach areas with the minimum exposure to security risks.48 However, hard security measures and remote implementation come at a cost.

It is estimated that roughly 6% of global annual expenditure on humanitarian aid is spent on protection and coordination.49 This absorbs resources that could be spent on targeting and helping aid beneficiaries who are most in need.50
Remote implementation can result in the transfer of risk to smaller, local delivery partners that have less resources and capacity to protect their staff.51
The European Interagency Security Forum (EISF) told us that the use of hard security measures, such as armed protection and convoys, can “solve the immediate issue but [create barriers] between the providers of aid and the community”.52 This can undermine the acceptance and understanding that an aid organisation has been trying to gain; make it more difficult to reach out to potentially hostile communities; and, in some cases, incite extremist rhetoric and increase the danger of attacks. Johan Eldebo, Regional Security Director for World Vision, said: “There is a difference between a doctor coming to your house by himself and a doctor coming to your house in an armoured vehicle with guns. In most parts of the world, that is not seen as a good thing.”53

Denials of humanitarian access

23.Incidents of denials of access to aid and health care are not recorded systematically. However, the incidents that have been documented, and in some cases reported to this Committee, involve both physical and administrative barriers perpetrated by both state and non-state actors. For example, we were told during our inquiry into the situation in Yemen that humanitarian access to populations in need had progressively worsened due to men with guns and power stopping relief efforts through bureaucratic and other methods.54 In our Burma, Bangladesh and Rohingya inquiry we heard that gaining humanitarian access to Cox’s Bazar and the Rohingya community on the Burmese side of the border was challenging and administratively very burdensome.55 Similarly, the core of the evidence we heard on the humanitarian crises in Gaza and in Venezuela was the politically vexed question of access for aid and relief material and workers to people in dire need.56

9 See, for example, Humanitarian security in the age of risk management, Michäel Neuman and Fabrice Weissman, 29 March 2016. Accessed on 23 July 2019

10 Q52. The project referred to is part of a programme intended to improve data collection on attacks on health care in armed conflict. Source: DFID Development Tracker, Building an evidence base on the protection of people affected by conflict (BEPAC), Business Case and Summary 30084

11 Aid Worker Security Database, About this data. Accessed on 23 July 2019

12 Safeguarding Health in Conflict Coalition, Impunity Remains: 2018 Attacks on Health Care in 23 Countries in Conflict, May 2019.

13 Aid Worker Security Database Home Page

14 Safeguarding Health in Conflict Coalition, SHiCC Database

15 Q20

16 DFID Development Tracker, Building an evidence base on the protection of people affected by conflict (BEPAC), Business Case and Summary 30084.

17 UN Security Council, 8499th meeting, 1 April 2019. Accessed 24 June 2019.

18 Stoddard, A., Harvey, P., Czwarno, M., & Breckenridge, M. (2019). Aid Worker Security Report 2019. Humanitarian Outcomes, June 2019

19 Ibid.

20 Q37

21 Stoddard, A., Harvey, P., Czwarno, M., & Breckenridge, M. (2019). Aid Worker Security Report 2019. Humanitarian Outcomes, June 2019

22 Ibid.

23 Ibid. It is not clear from the available evidence whether these figures reflect significant disparities in exposure to risk alone or to what extent they reflect the total numbers of aid and health workers ‘on the ground’ in each category

24 International Development Committee calculation based on Table 1 of Stoddard, A., Harvey, P., Czwarno, M., & Breckenridge, M. (2019). Aid Worker Security Report 2019. Humanitarian Outcomes, June 2019

25 Stoddard, A., Harvey, P., Czwarno, M., & Breckenridge, M. (2019). Aid Worker Security Report 2019. Humanitarian Outcomes, June 2019

26 Aid work one of the world’s most dangerous occupations—World Humanitarian Day, Reliefweb 19 August 2019. A brief review of current comparisons of dangerous professions does not reveal aid, development or humanitarian workers featuring prominently (but may reflect the lack of consensus over definitions of humanitarian work and workers)

27 Safeguarding Health in Conflict Coalition, Impunity Remains: 2018 Attacks on Health Care in 23 Countries in Conflict, May 2019

28 Ibid.

29 257 such attacks were perpetrated in Syria in 2018

30 Ibid.

31 Stoddard, A., Harvey, P., Czwarno, M., & Breckenridge, M. (2019). Aid Worker Security Report 2019. Humanitarian Outcomes, June 2019

32 Ibid.

33 Ibid.

34 Q2

35 Q1

36 Qq4–6, 8

38 Ibid.

39 Ibid.