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Published: November 21, 2023

Protecting humanitarian and health actors: a collective responsibility

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This latest blog, written by Aïda Ndiaye, delves deep into the critical issue of protecting humanitarian and health workers in the face of increasing security threats. With a sharp focus on the escalating dangers faced by these frontline workers, the blog emphasises the imperative need for collective responsibility in safeguarding their well-being.

Security threats facing humanitarian and health workers have hit record levels in recent years, with modern warfare taking a heavy toll on the sector. In 2022, the Aid Worker Security Database recorded at least 444 attacks against aid workers, killing 116 of them. Overall, 90% of health workers suffering from security threats are local workers who work outside the aid system. In 2022, the Safeguarding Health in Conflict Coalition found nearly 2,000 reported security incidents against healthcare workers and healthcare infrastructure, resulting in 232 health workers dying, 298 being kidnapped, and 294 being arrested. This marks a 45% increase from the previous year and ranked 2022 as the most violent year for attacks against healthcare workers in a decade.

The insecurity of health workers is deeply rooted in the wider issue of the shrinking humanitarian space. Improving the safety and security of health personnel requires structural, policy, and behavioural changes that involve a range of actors, not just NGOs (e.g., states, donors, the United Nations, non-state armed groups, etc.).

Proper security risk management (SRM) can prevent, mitigate, and respond to incidents facing humanitarian and health workers. However, given that violence is unpredictable and opportunistic, even the best risk assessments might be insufficient to properly protect against certain security threats. In addition to advancing practical SRM solutions across the sector, security experts should work to introduce these conversations into high-level policy discussions. Hence, the humanitarian NGO community needs to strengthen collective advocacy to both improve SRM and address the root causes of aid and health worker insecurity.

How can we promote joint action and advocacy to improve aid and health workers’ security?

To reach this goal, an NGO consortium composed of Action Against Hunger, Humanity and Inclusion, and Médecins du Monde (Doctors of the World) recently released a report entitled The risks we face are beyond human comprehension: Advancing the protection of humanitarian and health workers. This research sought to identify the NGO sector’s biggest challenges to protecting its staff. The report relies on information gathered from a consultation of 79 NGO workers, both from international NGOs (INGOs) as well as from local and national NGOs (L/NNGOs), with different areas of experience (e.g., access, security, legal, operations, advocacy professionals). The report also builds on existing initiatives and commitments, such as the European Union’s ‘Discussion Series’, to offer action-oriented recommendations for improving the security of aid and health workers.

The main priorities and challenges in tackling the insecurity aid and health workers face

The research found that the humanitarian community must identify three main priorities in ensuring the security of health workers.

  • First, the paper outlines that although INGOs have improved their SRM practices, more efforts are needed to scale up, but also to extend SRM to local and national staff who remain the least protected.

As shown in GISF’s ‘At What Cost’ campaign, a challenge in scaling up SRM and ensuring robust SRM for L/NNGOs stems in part from the fact that donors underfund humanitarian security, including as it relates to local health workers outside the aid system.

In order to improve its funding, the NGO sector needs to build powerful advocacy campaigns directed towards donor agencies that articulate the importance of safety and security funding for all actors, including development donors that fund medical programmes. This requires NGOs to understand how to calculate the costs needed to keep staff safe and advocate for greater donor funding in accordance with estimated costs.

Moreover, L/NNGOs consulted during the research reported quasi systematic refusal from donors and international partners, such as INGOs and UN agencies, to provide any SRM support to local partners. This confirms the conclusion of a GISF research article and guide, which state that L/NNGOs often lack sufficient support from their international partners on SRM.

The report finds that SRM is even poorer for health workers outside the aid sector. Health workers not affiliated with the aid sector and working for national or local health systems do not benefit from SRM as they are not NGO staff. Local health workers are overly exposed to violence and deliver life-saving services on the frontline. Yet, the security incidents and specific challenges they face are largely overlooked. Whereas NGOs are specifically prepared to operate in at-risk settings, a regular nurse or other medical practitioner is not trained in SRM. As a result, these practitioners are less likely to understand the security challenges they face, and thereby less able to reduce internal vulnerabilities and properly mitigate and defend against external threats.

The study urges the humanitarian community to extend good practices and to leverage its knowledge to support the development of adapted SRM mechanisms for health workers. Hence, the humanitarian community has a responsibility to mainstream the security language into health programming.

Next steps include developing a context-based culture of SRM within the health sector, including health practitioners in humanitarian NGO security training programmes, supporting platforms for exchanges between humanitarian workers and health care providers, and supporting Ministries of Health and other health actors to develop and provide systematic security training to health workers.

  • The second priority calls for enhanced coordination in collecting and sharing data on security incidents between the different entities collecting data (data collection NGOs and platforms, the UN, and NGO forums).

Data and information garnered from attacks against aid and health workers should be used to improve operational safety as well as to advance advocacy campaigns and trigger potential judicial investigations to fight against impunity for attacks. To ensure effective use of data for different purposes, NGOs and data collection mechanisms should use advanced data protection measures to allow safe reporting for affected humanitarian and health workers as well as the safe sharing of detailed information on attacks (including dates, location, and perpetrators).

Publicly available and detailed data on attacks against healthcare remains inconsistent and attacks often go underreported. This is due to the complexity of national reporting mechanisms, the particular reluctance of the key data collection entities, such as the World Health Organisation, to share data on violence, and the politicisation of data collection, particularly when governments are the alleged perpetrators of attacks.

Different data collection entities have different slices of the overall available data. Therefore, they must collaborate and share their data to ensure a full understanding of the scale and severity of security threats facing aid and health workers in order to foster evidence-based advocacy and efficient policy decision-making.

  • The third priority relates to the overall protection of humanitarian space and addressing the events that have been putting aid and health workers at risk.

The growing politicisation of aid, in which the political, security, and military agendas of states trump humanitarian objectives, convolutes the distinction between a state’s political/military objectives and the humanitarian mandate. It impedes the impartial delivery of aid and healthcare, and puts aid and health workers at further risk of violence as they may be seen by belligerents as being legitimate targets supporting the state.

Building bridges between the advocacy and security communities for better protection

Advocacy is necessary to secure sufficient donor funding for security costs, as well as to convince states and donors to refrain from politicising aid while respecting IHL and humanitarian principles.

Yet, we continue to observe some reluctance in information sharing within organisations between security, operations, and advocacy departments due to the belief that advocacy and speaking out when attacks occur could harm operations. The security of aid and health workers will always be the priority. We must shift the paradigm of how advocacy is perceived.

Collectively advancing the protection of health workers means supporting enhanced collaboration and regular dialogue between security, advocacy, and operations teams. This would ensure the implementation of case-by-case advocacy strategies adapted to different contexts, which meet confidentiality and security requirements. A good way forward would be to relaunch and build on GISF’s 2020 webinar, entitled, Introduction to Advocacy on Staff Safety and How Security Can be More Involved.

The sector should also work to address the disconnect between advocacy, security, and operations. More broadly, substantive change for aid and health workers protection implies that all actors interested in advancing the topic promptly come together to unpack their respective roles to define an effective collaboration framework.


About the author: 

Aïda Ndiaye has occupied several humanitarian advocacy positions. She holds a degree in humanitarian law and action from Aix-Marseille University. She started as an advocacy intern for UNICEF and Action contre la Faim. She then worked as a humanitarian advocacy advisor at Médecins du Monde before working for the Presence, Proximity and Protection ECHO-funded project jointly led by Action contre la Faim, Humanity and Inclusion, and Médecins du Monde. She currently lives in Paris but enjoys travelling. She loves dancing, going to exhibitions, and attending shows.


Image credit: UN OCHA


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