key: cord-0962276-bwy14son
authors: Langlois, Etienne V; Dey, Teesta; Shah, Mehr Gul
title: More than honour, humanitarian health-care workers need life-saving protection
date: 2021-08-19
journal: Lancet
DOI: 10.1016/s0140-6736(21)01892-4
sha: 92e20d11f40bd1abc74227079f4189e4d1efa095
doc_id: 962276
cord_uid: bwy14son

nan

Honouring all humanitarian workers, including healthcare professionals, Aug 19, 2021, marks the second World Humanitarian Day since the start of the COVID-19 pandemic. Many humanitarian workers have given their lives to support and protect the communities they serve, including millions of the world's most vulnerable women, children, and adolescents.

But humanitarian workers need more than honour: they need support and protection themselves. Settings for humanitarian health care have become increasingly complex: at the crossroads of conflict, social and economic fragility, a global pandemic, and a growing climate crisis. The climate emergency, and its impact on humanitarian contexts, is the central theme of the World Humanitarian Day 2021, calling on greater action to address the needs of the people most vulnerable to the effects of climate change and the essential workers caring for them.

Even before COVID-19, humanitarian health-care workers faced considerable risks, both as inadvertent casualties of the conflicts and disasters they sought to alleviate and as deliberate victims of attacks. 1 For example, in the Central African Republic, in conflict since 2013, more than one incident against humanitarian workers is reported every day. 2 The situation has not improved during the pandemic, and attacks on health facilities, transport, and patients have become more frequent. 3 In 2020, the mortality rate among health-care professionals also increased. 3 From February to July, 2021, in Myanmar alone, 252 incidents of violence against health-care workers were reported: 190 were unfairly arrested, 37 were injured, and 25 were killed. 4 In light of this trend, protecting the safety, health, and wellbeing of the humanitarian workforce should be a key global health priority.

The difficulties facing humanitarian workers are exacerbated by inequitable distribution of COVID-19 vaccines and the innate challenges in delivering health services in humanitarian settings. 5 People working in health care have the highest risk of infection from COVID-19, yet the global community is failing to provide them with life-saving immunisation. As of Aug 11, 2021, only 1·6% of people living in lowincome countries, including health-care professionals, have received at least one dose of a COVID-19 vaccine. 6 COVID-19 has also exacerbated the humanitarian crises that health-care workers are dealing with. In 2021, one in 33 people worldwide are predicted to need humanitarian assistance and protection-a substantial More than honour, humanitarian health-care workers need life-saving protection 3 UN increase from one in 45, in 2020, which was already the highest figure in decades. 7 Over half of the countries needing humanitarian aid to deal with the pandemic were already facing another long-term humanitarian crisis in 2020. 8 Yemen, for example, was already going through civil war, drought, and an outbreak of cholera. Furthermore, movement restrictions imposed on development workers have impeded their capacity to contribute to emergency responses. 9 These humanitarian crises disproportionately affect women, children, and adolescents. In 2020, children accounted for 42% of the 82·4 million people forcibly displaced worldwide, 10 and nine of ten countries with the highest neonatal mortality rates are in conflict. 11 The health of these vulnerable women, children, and adolescents has always depended on humanitarian health-care workers, especially midwives and nurses. Midwives alone can provide 90% of essential care in sexual, reproductive, maternal, neonatal, child, and adolescent health. 12 In short, the pandemic has given humanitarian workers a bigger task than ever, and yet made their work harder and more dangerous. We must urgently prioritise their health and wellbeing, both in global initiatives and national policies, including humanitarian response plans. In response to these challenges, the Partnership for Maternal, Newborn & Child Health has made the protection and support of essential health-care professionals a central component of its Call to Action on COVID-19. 13 At the global level, preparedness and response mechanisms for dealing with future pandemics must specifically address humanitarian settings and prioritise the protection of humanitarian health-care workers, including nurses and midwives. 14 Governments must further develop and enforce national policies that explicitly protect them, as urged by the UN Security Council and mandated by international humanitarian and human rights laws. 15, 16 Policies must prioritise quality of care and the training, recruitment, retention, safety, and security of essential workers, including nurses and midwives, and their representation in senior decisionmaking positions. 17 Greater efforts are also required to support the implementation of these policies in complex humanitarian contexts. Above and beyond global agreements and celebrations, greater investments and locally led efforts are needed to strengthen systems delivering life-saving protection to humanitarian health-care professionals and the communities they serve. Only by prioritising the safety, health, and wellbeing of humanitarian workers can the goal of universal health coverage and protection of the most vulnerable be realised. 

Department of Women's and Children's Health

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Myanmar data 1

Global Dashboard for Vaccine Equity

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State of the world's midwifery 2021

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