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Violence against health workers damages public health efforts

The Guardian recently reported the death of a female volunteer in a polio vaccination program in Kapisa province, Afghanistan, who was shot six times and later died in hospital. The shooting has rightly…

An Afghan health worker gives polio vaccine drops to a child in Nangarhar, Afghanistan, 19 November 2012. EPA/Abdul Mueed

The Guardian recently reported the death of a female volunteer in a polio vaccination program in Kapisa province, Afghanistan, who was shot six times and later died in hospital. The shooting has rightly prompted concerns about violence against women in Afghanistan. But it also raises questions about respect for the independence of health workers, and the impact of such attacks on public health programs.

The report noted that Anisa, a student and volunteer with the vaccination program, had already survived one assassination attempt the day before she was killed. She was reportedly called by her killers before she left for work, and was later shot as she left her home. Anisa had not been aware that she was being targeted by an insurgent group that had already threatened other women working with the program.

The Taliban denied responsibility for the attack, and local police claimed Anisa was caught in the crossfire during an unrelated dispute.

Unfortunately, Anisa’s death is not an isolated incident. In October, unknown gunmen on motorbikes shot and killed a male volunteer working with a vaccination program in Quetta during a door-to-door polio drive.

In neighbouring Pakistan some months earlier, gunmen attacked a UN vehicle, shooting and wounding a doctor working for a polio campaign in Karachi. These deaths highlight the daily danger faced by medical personnel in the region, and the fragile nature of global health programs operating there.

Polio is a preventable disease that can cause lifelong paralysis, and it has almost been eliminated worldwide. Afghanistan has nearly eradicated polio completely, which is why vaccination efforts there are so important.

Murders of health workers are not only happening in Afghanistan and Pakistan. The deaths form part of a worrying global trend of attacks on health personnel in areas of conflict. During the Arab Spring, there were many examples of medicine being used as a weapon of persecution in Bahrain and Syria.

When the Syrian uprising started in 2011, one doctor was tortured and murdered for signing a petition calling for doctors to be allowed to treat injured demonstrators – even before fighting started.

Attacks like these undermine the safety of neutral staff and volunteers. They destroy trust in their institutions and spread fear, and they legitimise the view that such individuals are appropriate political and military targets, which has potentially devastating consequences for public health.

The Geneva Conventions – also known as the “laws of war” – say health professionals should not be harmed in armed conflict. It’s cause for grave concern that they are being ignored. In fact, the International Committee of the Red Cross has recognised that violence against health-care workers, families and beneficiaries is “one of the most serious humanitarian challenges in the world today”.

Whenever there’s a murder like Anisa’s in Afghanistan, it prompts speculation about whether it’s the direct result of the vaccination drive used by the CIA to apprehend Osama bin Laden. At the time, the Guardian reported that a Pakistani doctor was recruited to organise a hepatitis B immunisation program in Abbottabad as part of the CIA’s strategy to find bin Laden.

The vaccination drive was fake, and simply a cover for the intelligence operation to obtain DNA from the al-Qaeda leader’s family. This sparked outrage among humanitarian organisations, amid concerns that trust in vaccination schemes would be undermined in key polio elimination areas.

The effect of rumour and lack of trust in destabilising immunisation programs is already well known. In 2003, the previously successful Kick Polio Out of Africa campaign ground to a halt in Nigeria amid rumours that it may be part of a covert CIA plan to sterilise Muslim women. Within three years, more than half the world’s new cases of polio occurred in Nigeria, and it spread to half a dozen neighbouring countries.

The CIA’s use of a public health program to achieve a political objective (killing Osama bin Laden) seems to have signalled that using such tactics in conflict situations is acceptable. Earlier this year, polio vaccinations were banned by the Taliban in Southern Warziristan in an attempt to stop drone attacks in the area. Using health programs as a political bargaining chip should cause great concern.

The global outcry around Anisa’s death is a sign that many people are not prepared to accept the targeting of health workers, and stalled progress in areas such as polio eradication. But we clearly have a long way to go to ensure that medical staff – and health programs – are given the respect they deserve.

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7 Comments sorted by

  1. Chris Booker

    Research scientist

    The time factor to me suggests a definite link with the CIA fake polio vaccination program. How often did you hear of assassination of vaccine program volunteers before? Sure, on the one hand there could be increased reporting leading to the illusion of an increase in attacks on volunteer workers, but my feeling is we used to hear plenty of accounts of aid workers attacked in hostile scenarios before the bin Laden campaign, but it was always attacks on Westerners working in aid positions. There seems to be a new direction in these attacks, with locals being targeted, and a specific focus on vaccination campaigns.

    1. Dev Kevat

      School of Public Health at Monash University

      In reply to Chris Booker

      Dear Chris,

      Thanks for your comment. I agree it is difficult to get an accurate quantification of the situation. However, it certainly seems that vaccination efforts which were previously not considered high risk health work (compared with, for example, work in countries with civil conflict) is now quite dangerous in this region of the world.

      One of the reasons this is particularly troubling is because vaccines are one of the (if not the) most cost-effective ways to improve public health. It is also clear that different vaccination campaigns are likely to be "tarred" with the same issue of mistrust/fear - as I understand it Dr Afridi was offering hepatitis B vaccination and it is the polio campaign which has suffered a severe setback.

  2. Comment removed by moderator.

  3. Jens O


    The Taliban and other similar groups stated clearly (also in direct talks) that the targeting of our projects and staff involved in vaccination campaigns is caused by nothing else but the fake CIA vaccination campaign you mentioned in this article. Al-Shabab stated the same and since then it was not possible anymore to even run livestock vaccination campaigns in areas controlled by Al-Shabab.

    Yes, there is a - far too quiet - public outcry about the targeting of aid/health workers. Targeted for…

    Read more
    1. Dev Kevat

      School of Public Health at Monash University

      In reply to Jens O

      Dear Jens O,

      Thanks for your comments and the extra information you provided as an aside. You are right that Al Shabab has identified the CIA use of the vaccination campaign as a reason or justification for their own actions.

      I am unsure why there has not been more disquiet/outcry about the issue by academics etc - perhaps it seems to remote an issue in academic or geographic terms for people to give much thought to. The reality is that the action and reaction have had a great negative effect which is likely to continue to be felt for years to come.

      We do hope that in a small way our article does contribute to greater awareness of this issue.