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Experiences

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Since 2015, the ICRC has been documenting allegations about kidnapping of healthcare professionals and other types of violence against health-care personnel working in hospitals, primary health centres and clinics in Niger’s Diff a region. In May 2018, armed men stormed a hospital in the Central African Republic where an ICRC surgical team works, threatening patients, medical staff and Red Cross volunteers.1 Later that day, it was reported that an ambulance was stopped and threatened on the streets of Bangui, while on its way to the same hospital.

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ICRC and partners take action

Over the past three years, Niger has been experiencing armed violence in two main areas: the Tillabery region has been affected by the Malian conflict across the border; and the Diffa region has been affected by the non-international armed conflict between the Lake Chad countries and Islamic State in West Africa. The violence has taken its toll on people’s access to health services.

The health-care system in Niger – one of the lowest-ranked countries on the Human Development Index – faces endemic geographical, human-resource and financial challenges. The violence has exacerbated these constraints on health-care provision.

Since 2015, the ICRC delegation has been documenting allegations of attacks on health workers and facilities. Of the 62 such allegations made between January 2017 and June 2018, the most common were armed entries into health centres (29% of allegations), followed by pillaging of health centres (27% of allegations) and threats made against health-care personnel (15% of allegations).

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Over the past three years, Niger has been experiencing armed violence in two main areas: the Tillabery region has been affected by the Malian conflict across the border; and the Diffa region has been affected by the non-international armed conflict between the Lake Chad countries and hIslamic State in West Africa. The violence has taken its toll on people’s access to health services.

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NATIONAL WORKSHOP

Based on the study, the ICRC and the Ministry of Public Health decided to organize a national workshop, bringing together 33 key representatives from the Ministry, the armed and security forces (army, police, gendarmerie and national guard), the Red Cross Society of Niger, the regional authorities and health workers’ unions. The objective was to provide a forum to discuss the issue of health-care access in conflict areas, identify the causes and consequences of problems, discuss the existing framework for protecting health care, and issue recommendations

But we feel it takes many more for the essage to really stick with them, especially in the heat of the moment when confl ict breaks out. We need to do more, be on the air more often at the right times, put up more posters in hospitals and religious buildings.

We wanted to use every means possible to spread our message. Because the situation in Bangui was so tense, we started simple: “Tomorrow, your brother might need an operation.
If the hospital isn’t running, he won’t get the care he needs”; “Even enemies have the right to be cared for if they are wounded”; “Don’t interfere with ambulances, health-care personnel, patients or the running of hospitals: what if you were the one who needed treatment?” We distributed posters with these messages to hospitals, pharmacies, police stations, social clubs, and in areas where there had been fighting. In addition, Central African Red Cross volunteers handed out flyers at Bangui Community Hospital and asked people for their feedback. These discussions gave them an idea of how the messages were perceived, whether the messages had sunk in, and whether people would change their behaviour. We also ran radio spots. Radio is an important source of information in the country, given the poor state of the phone networks and roads. The spots were produced in French and Sango, the local language. We arranged to have them broadcast on local radio stations, together with a skit on HCID, and get listeners’ feedback. We also sent the spots to the subdelegations so they could be broadcast on local stations. Even though the mobile phone network is limited mostly to Bangui and the major towns, we had the four telephone networks send out a series of text messages, spread out over several weeks to maximize their impact. We also used a film that we had commissioned the previous.

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  1. Set up a select committee to follow up on the recommendations’ implementation.
  2. Activate the health and defence ministries’
    permanent commission, and expand it to include
    the Ministry of Interior, Public Safety
    and Decentralization.
  3. Advocate for the permanent commission
    to devise a contingency plan.
  4. Build the capacity of health personnel
    and communities.
  5. Step up communication and warenessraising campaigns.
  6. Devise a proposal to encourage health
    workers to work in conflict areas.

ICRC and partners take action

Over the past three years, Niger has been experiencing armed violence in two main areas: the Tillabery region has been affected by the Malian conflict across the border; and the Diffa region has been affected by the non-international armed conflict between the Lake Chad countries and Islamic State in West Africa. The violence has taken its toll on people’s access to health services.

The health-care system in Niger – one of the lowest-ranked countries on the Human Development Index – faces endemic geographical,  human-resource and financial challenges. The violence has exacerbated these constraints on health-care provision. Since 2015, the ICRC delegation has been documenting allegations of attacks on health workers and facilities. Of the 62 such allegations made between January 2017 and June 2018, the most common were armed entries into health centres (29% of allegations), followed by pillaging of health centres (27% of allegations) and threats made against health-care personnel (15% of allegations).

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