The impact of explosive violence on a child’s access to healthcare

People collecting medical equipment found under the rubbles of a bombed hospital in the Idlib province People collecting medical equipment found under the rubbles of a bombed hospital in the Idlib province © Ammar Abdullah/Reuters

This article is a brief presentation of the Action on Armed Violence’s report “The impact of explosive violence on a child’s access to healthcare”

Particularly in recent years, explosive violence has seriously compromised the population’s access to healthcare in conflict areas. Healthcare facilities are civilian infrastructures protected under the Fourth Geneva Convention however, this protection seems to have been ignored both by state and non-state actors. The targeting of healthcare facilities has a tremendous impact on children’s access to medical care and on their chances of survival. Children are more vulnerable to injuries caused by explosive weapons and therefore at greater risk of losing their lives. For children with blast injuries, the so-called “Golden Hour” is the critical time which will determine their fate.  It is, indeed, essential that injured children reach the hospital within this hour to have better chances of survival. However, research on healthcare access in Syria shows that less than ten percent of child casualties arrive to the hospital within an hour of being exposed to the blast, while about a third of injured children arrive six hours or more after the impact. 

Children’s access to healthcare is severely compromised by the direct targeting of healthcare facilities. Some facilities are mistakenly targeted during bombing of urban areas where the air forces are unable to center military objectives. However, many civilian facilities are targeted intentionally, as part of a war strategy designed to destabilize and demoralize the population. This tactic has been increasingly adopted in the Syrian civil war, awarding the country the title of the most dangerous place on Earth for healthcare providers. Indeed, between 2001 and 2019, Syria has been ranked as the country with the highest number of explosive attacks on hospitals, followed by Iraq, Afghanistan and Libya.  According to a study by the “Health Policy” journal on the weaponization of healthcare in Syria, between 2016 and 2017, 204 ambulances out of the 243 available in the country have been targets of explosive violence. The bombing of healthcare infrastructure is a direct cause of lack of medical supply, including personnel, as many medical operators have either fled the country or have lost their lives on the job, causing entire towns to rely upon only few doctors. An exemplar case is that of Aleppo where the pediatric center was destroyed in 2016, leaving the town to rely upon only one pediatrician and causing a peak in child mortality rates.

Because of the targeting of hospitals and ambulances, the population fears accessing healthcare infrastructures and sometimes prefers to avoid hospitals. The avoidance of healthcare can further aggravate injuries and diseases, reducing the children’s chances of survival. The surrounding environment also functions as an obstacle to healthcare, as the ambulatory vehicles are often halted by unexploded ordinance or road blockades, prolonging the time to reach the hospitals, and possibly worsening the child’s injuries.

The damage to healthcare facilities has long-term consequences on children’s access to medical care. Reconstruction after bombing can require years and the buildings are often rebuilt in a more basic way and are not suited for severe medical emergencies. Furthermore, when public infrastructures are understaffed and not sufficiently equipped to handle emergencies, the treatments are only available through private healthcare services which most of the population cannot afford.

The data on child mortality in conflict is alarming, as evidenced by the threefold increase in attacks on children in conflict since 2010, recorded by the United Nations International Children’s Emergency Fund (UNICEF). Even more alarming is the state actors’ indifference to explosive violence. Indeed, despite the protection that children enjoy under International Humanitarian Law, the Universal Declaration of Human Rights, and the Convention on the Rights of the Child, the number of child casualties in conflict is alarming, as is the increase in the attacks against medical facilities, most of which are carried out by state actors. Action on Armed Violence has reported that about 60 percent of the airstrikes on healthcare facilities in Syria were perpetrated by the Syrian regime, while 29 percent of them were carried out by the Russian Federation. As States are parties to the above-mentioned conventions, this behavior demonstrates a general underestimation of the value of these documents. In conclusion, Action on Armed Violence appeals for an increase in research on gender, as the lack of such studies does not clarify the inequalities in access to healthcare between boys and girls.


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Author: Carla Leonetti; Editor: Francesca Mencuccini

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