The reporting of AHCC in the Syrian conflict should be used to inform the development of a global reporting mechanism that is standardized, yet flexible enough to accommodate context sensitivity and ensure accountability.
While reporting AHCC in Syria did not stop attacks from happening, it did contribute to improving the health response. AHCC reporting has built a solid base of understanding of IHL as it relates to the medical mission among field medical workers. Shared knowledge related to the impact of attacks has furthered the development of risk mitigation measures related to designing and fortifying health facilities, the creation of alarm networks and the establishment of evacuation plans. AHCC reporting has also improved systems of allocation and reallocation of health resources, and has equipped health actors with the information to make informed decisions on site selection for health facilities, and the management of delivery of medical supplies. Another benefit is that data from AHCC reporting has provided an effective evidence base for requesting funding for rehabilitation of affected health facilities after attacks.
At the regional and global level, AHCC reporting in Syria has drawn attention to the subject. Hence, the protection of health workers in Syria and the health response there have also gained greater attention. This might have helped in improving the overall resourcing of the health response in Syria, by influencing donors and humanitarian actors to respond with assistance. AHCC reporting might also have helped to secure the involvement of multilateral actors – including academia, think-tanks, state actors and the technology sector – with these actors either directly supporting the provision of health services and strengthening the health system in Syria, or conducting research to provide evidence for better health interventions.
However, there has been a lack of coordination between the health-focused reporting mechanisms, the justice-focused mechanisms and other relevant accountability measures. For example, little or no coordination was found between the WHO reporting mechanisms and the established IICI that was tasked by the UN General Assembly, in Resolution 71/248 of December 2016, to collect evidence on human rights violations. Such gaps resulted in a lack of trust from local communities in the various reporting mechanisms and an accordingly weak buy-in from local actors. The impunity that most perpetrators in Syria were still enjoying at the time of writing this paper is a major challenge for all reporting mechanisms of attacks on healthcare in the Syrian conflict.
There are some technical difficulties that can be remedied through better alignment and refining existing systems, and some political issues that will be less easy to reconcile across systems or to encompass in a single system. Technical issues should be considered as easy wins, whereas the political issues will require a stronger global strategy and collaboration if the international community is to live up to its commitments and, more importantly, if there is to be a reduction in violence against healthcare workers and the populations they serve. A series of recommendations to address these points is presented below, ordered by section and target audience.
General recommendations
- Compliance with UNSC Resolution 2286 will require continued resources and additional investment for AHCC reporting mechanisms and their use.
- WHO’s SSA should be expanded to cover more countries. This expansion should take into consideration the required levels of customization and coordination with local actors, as well as the need for more accountability-focused mechanisms in some countries.
- NGOs are advised to develop and maintain internal reporting procedures for AHCC. Having special incident reporting forms for this purpose could play a vital role in documenting AHCC, especially in remote areas where other actors, such as governmental bodies and UN agencies, might not be present. A robust internal mechanism also helps NGOs to maintain the availability and functionality of their health services.
- NGOs, think-tanks and civil society groups that are involved in campaigns promoting awareness of AHCC and justice should continue such efforts, as they have proven effective in the past. More work is needed to strengthen adherence to UNSC Resolution 2286. This will not happen without ongoing political pressure.
Specific recommendations to parties contributing to or managing AHCC reporting mechanisms
Purpose (for those who contribute to or manage reporting mechanisms)
- While unifying health-focused and accountability-focused mechanisms and ensuring the buy-in of the various health and political actors could be challenging, there is a need for more coordination between the two types of mechanisms. Accepting that one perfect system will be difficult to attain given differences in objectives, actors should:
- Encourage deep collaboration between systems with differing purposes; and
- Harmonize practices where possible to facilitate sharing and cross-verification of data.
- It should be recognized that, for health-focused mechanisms, some elements of justice-related data have to be considered to facilitate buy-in and inclusion among local actors, recalling that objectivity is more important than the perception of political neutrality.
- Health-focused mechanisms should aim to support the availability and functionality of health services. They require better guidance for impact measurement, particularly in terms of long-term studies of system/population impact of AHCC.
- Studies should be conducted, and guidance developed, on best approaches to methodology and study design.
- Accountability-focused mechanisms should aim to mobilize political will to protect healthcare, and contribute to bringing perpetrators of AHCC to justice.
- A good understanding of context is a key factor in implementation. In particular, it should drive the customization of reporting tools and engagement with new actors. Removing data from its context could lead to its misuse. AHCC reporting should include data that describes the context in which an attack has happened – e.g. information related to basic political, social and economic determinants.
Taxonomy (for those creating and operating reporting mechanisms)
- Agree on a simple, clear definition of attacks across mechanisms and tend towards a broader definition of what constitutes an attack.
- Agree on precise categories of violence, paying specific attention to those that can obscure reality if left too broad.
- Recognize that contextualization is required for data to have sense.
- Each conflict will have features that require fine-tuning of data for the most accurate representation of events.
- Include local actors in the design of systems.
- Agree on general data structure or tagging system with a degree of flexibility to allow for context-specific customization, which will make datasets interoperable, yet context-sensitive.
Data collection and verification (for actors working with and governing reporting mechanisms)
- Harmonize and ensure rigour of collection processes.
- Consider engagement with non-traditional reporters (e.g. NSAGs) and other actors, as per contextual requirements, to capture a maximum number of data points.
- While secondary data are essential in identifying potential incidents, they cannot be enough as a sole source of information and should be complemented by primary data.
- Partnerships are essential for strengthening data collection and verification.
- Since some warring parties seek to justify their attacks on health facilities (and to make them legal or probable) by accusing health providers of using their facilities for military purposes, AHCC reporting could include indicators related to the status of the attacked facilities prior to such incidents. These indicators could be derived from the type of services provided, assets and supplies held, and actors running and financing the facility. Structured research is needed to develop such indicators in consultation with current reporting actors.
- Use, publish and promote technological innovations that help with reporting for all engaged actors. These could include those addressing verification through satellite imagery and mobile applications that assist in gathering primary data.
