UN Geneva - Multimedia Newsroom : WHO press conference

Hello, good morning everyone.

I think we can start first, big thanks to our colleagues in UN Information Services for hosting us today and providing technical, Technical Support.

And we can then start with a press briefing.

As we have announced in the media advisory today, we will speak about data that WTO has collected over the past three years on attacks on the healthcare.

We have been talking about this topic.

You will remember in the past we have some new data that we would like to present today.

This briefing is not under embargo.

The the the data has been posted.

It's already on our website.

I will send to you that link as well as remarks that will be made, opening remarks that will be made today by our speaker Altaf Moussani, who is our Director of the Health emergency Interventions.

Also with us is his colleague Hyo Yong Kim, who works directly on the on the attacks on healthcare initiative.

So with this, I'll give the floor to to Altaf Moussani to tell us more about the the topic as well as the as the findings of WHO data collection.

Altaf.

Thank you, Tarek, and good morning and good day to all.

As Tarek has mentioned, I'm here to share WH OS great concerns over the number of reported attacks against healthcare workers and the impact of this violence that is directly impacting the delivery of essential health services in many countries around the world.

Firstly, some background about the attacks on healthcare initiative.

WH OS attacks on healthcare initiative was rolled out in 2017.

This was directly following World Health Assembly's resolutions adopted in in 2012, whereby Member States particularly focused and stressed to WHO to provide the global leadership and collecting, disseminating and addressing the information behind the attacks on healthcare, particularly in complex emergency settings.

This need for systematic data collection was just further reinforced by the United Nations Security Council by the adoptions of a resolution called 2286 in 2016.

The Attacks on Healthcare initiative has three major pillars, the first in particular focusing on the importance around systematic and standardised data collection with the evidence.

Secondly, the advocacy to end and ultimately prevent such attacks, and thirdly, the identification and promotion of good practises to protect healthcare in such settings.

The system was formally launched in December 2017 where data collection includes attacks on the entire system with a focus on healthcare workers, on patients, medical supplies, medical assets and equally important, the health facilities.

These are the clinics, hospitals and centres.

Currently, the system is active in 17 emergency affected countries, whereby the World Health Organisation has also prioritised its emergency programme.

To date, the project has produced a first body of verified and reliable evidence which is used to generate some of the analysis Historic had referenced and is now publicly available.

Today, The Who is releasing a three-year analysis of such data under its surveillance system for attacks, which encompasses 2018 to 2020 in the 17 countries.

Allow me to share with you some of the key findings.

Firstly, it's vital that the World Health Organisation stresses its deep concern that hundreds of health facilities have been destroyed, closed, looted, damaged, healthcare workers killed or injured and millions of people have been denied healthcare in a number of countries where they need it most.

Countries such as Yemen, Syria, Mozambique, Nigeria, Ethiopia, the Occupied Palestinian Territory, Myanmar, Central African Republic and Somalia, just to name a few.

Since 2017, the initial roll out of the system, over 2700 incidents have been reported in 17 countries and territories.

In particular, 700 healthcare workers and patients have died and more than 200 have been injured.

In 2020, 333 confirmed attacks have taken place in emergency and fragile settings.

These attacks have resulted in 239 deaths among healthcare workers and patients and injuring 312 others.

This three-year analysis illustrates that one out of 6 incidents have led to a patient or healthcare workers loss of life in 2020.

The analysis further demonstrates that healthcare workers are most vulnerable and most affected.

Healthcare Workers impacted in this study represents 2/3 of all attacks in 2018 and 2019, and 50% of all recorded incidents in 2020, and this is compared to some of the other variables of attacks on the system, which includes the medical supplies, the medical assets and the facility itself.

In 2021, to date, 588 incidents of attacks on healthcare have been recorded within 14 countries that are currently impacted by security and emergencies.

This too has caused 114 deaths and 278 injuries of healthcare workers and patients.

It is important to point out that these results are highly contextual dependent, meaning the nature and the dynamics of these attacks are directly related on operational and contextual changes on the ground.

Such changes may include the emergence of new crises, the intensification of particular conflicts, ceasefires or deterioration and accepted levels within vulnerable groups.

Allow me just to give you a few more granular examples from 2020.

In Afghanistan in 2020, there have been 78 reported attacks, 41 deaths and 62 injuries.

This direct impact has had service delivery as well as has directly impacted service delivery and, equally important, affected our polio eradication programme.

These services play a vital role to communities, in particularly as we all combat the COVID-19 pandemic In the Occupied Palestinian Territories in 2020, there were reported 59 attacks, 9 deaths and 65 injuries.

These health attacks obstruct health care delivery.

Escalations of violence have directly impacted health facilities within the Gaza Strip, within the West Bank, including E Jerusalem, where health teams have been prevented to access those persons injured or exposed to physical violence.

Within that context, in 2021 alone, there have been a number of recorded attacks, 171 currently, again directly impacting the healthcare system.

Now, these impacts have a tremendous impact not only on the system but the people it aims to serve.

The World Health Organisation and its cluster partners respond daily to infectious disease outbreaks and support the vital delivery of healthcare, particularly in conflict and fragile settings.

Such attacks prevent the collective ability to serve those most vulnerable as well as increased risk to frontline and healthcare workers.

Healthcare workers and patients in these settings take enormous risk on a daily basis to provide access to healthcare.

Again in 2021, out of 6 incidents have led to a patient or healthcare workers loss of life.

The impact of these healthcare attacks goes well beyond claiming lives.

The ramification of such attacks, especially in light of COVID-19 response, is significant and alarming.

Their impact reverberates on healthcare workers, mental health and willingness to report to work equally on communities, willingness to seek healthcare and also drastically reduces resources for responding to a health crisis amongst others.

The ripple effect of a single incident is huge and has a long lasting impact on the health system at large.

So in summary, our analysis focuses on currently 17 active reporting countries.

During the pandemic, more than ever, healthcare workers must be reflect, protected, must be respected.

Health hospitals and healthcare facilities, including the transportation of ambulances, should not be used for military purposes, as essential conditions for the continued delivery of vital healthcare must be given the necessary space.

Any reduction in this capacity will interrupt services, result in the loss of resources, deprive vulnerable communities of this urgent care, as well as undermine health systems and jeopardise long term public health goals.

WHO and its partners will continue to expand its efforts to collect data on such attacks, particularly within the COVID-19 pandemic context, especially within all humanitarian, environmental, humanitarian emergency situations.

And we'll continue to work with partners to address the necessary operational research on how best we can protect healthcare workers, the patients, and the system as a whole.

WHO calls on all relevant parties in conflicts to ensure the establishment of safe working spaces for the delivery of healthcare services and equitable, safe access to healthcare free from violence, ****** or fear.

One attack is attack to many.

Thank you.

And as mentioned by Tariq, I'm joined by a senior colleague and we're ready to take on any questions.

Thank you.

Thank you, Altaf.

So I see question from German news agency Christiana Christian.

Yes.

Thank you, Tariq, and thank you, Mr Moussani for giving us this briefing.

[Missing Subtitle]

Questions.

Do you see a?

Trend between 20.

18 and 20.

20 is it?

Going up or down.

Or is it too early to say and can you talk a little bit about?

Who carries out these attacks?

What are the the?

Actors here is this.

Government.

Forces Is this rebels Who?

Who is this?

Are these disgruntled users who?

Who are the main?

Attackers here.

Thank you.

Thank you, colleague.

So these are two very important questions.

I'm going to take the first one in terms of the trend and then obviously hand over to my colleague Yujiang, which will address the aspect of attribution.

In terms of trend, it's still very early to say.

As mentioned in my opening remarks, this system has been established since 2017.

It's important to point out that the attacks on healthcare worker has many partners who've been looking at this, this aspect for quite some time.

And the data that we have pointed out looks specifically at pre COVID times.

The COVID data that we are looking into is highly contextual driven and of course our our partners as well as our system will continue to look at what we see in terms of increased frequency or reduction of the humanitarian space to be able to address the delivery of healthcare services.

And I think it's very important to understand that we have 17 countries that are currently actively using the system.

We certainly see in 2018 and 19 as the system was being expanded an increase in incidents which we're deeply alarmed about.

As I as I said in my closing remarks, one attack is too many and has a long term effect.

And so for us to start looking at each country, each emergency situation is very different contextually from another.

So it's very difficult to compare Yemen to Somalia, for example.

However, the overall concern that the analysis points out is that Healthcare is under attack.

But let me hand over to Hu Zhong in terms of the attribution.

Thank you Altaf and thank you for the question.

So on the attribution aspect, we don't look at the actual the perpetrator angle from for the from WH OS perspective as this requires a more detailed review of the situation and legal analysis etcetera, which are all capacities are really beyond the richest mandate.

However, our data does show that when conflicts intensifies, attacks on healthcare tend to occur.

So there's a strong correlation between conflict and and attacks on healthcare, which again, going back to what arts have just said, that concerns us greatly because this again prohibits access to essential healthcare services.

So of course there is a perpetrator ankle, but it also shows that we need to do more work around raising awareness and advocacy for the protection of healthcare, especially in conflict situations.

Thank you very much both.

So next question is Christophe from AFP.

Christophe, good morning.

Thank you.

For taking my question.

It's about ransomware attacks because.

Healthcare.

Facilities have been favoured by people who use ransomware in not in the countries that you that you were naming, but in other countries.

I was wondering if this is something that you might take into account at some point.

It's it's getting more and more common and it also seems to make some big things.

Thank you.

I'm going to hand over to my colleague here again, who directs the project to be able to define how we look at the type of attack and what falls within the remit of the project.

Over to you.

Thank you.

That's a very important question.

So thank you very much for the question.

Cyber attacks, ransomware attacks are indeed a type of attack that falls within the definition of attacks on healthcare that WHL uses, which is a pretty rude definition.

Everything that affects delivery of Healthcare is considered as an attack on healthcare.

Now the system, the surveillance system for attacks on healthcare doesn't necessarily collect enough data on cyber incidents, especially because, well, for two main reasons.

I think 1 is because it's very difficult to to identify an incident of a cyber cyber attack.

There are so many different layers that lead to cyber attacks or or affection affecting healthcare information systems in various settings.

It's difficult for us to quantify that as a an attack on health get out, an incident of an attack on health get out.

We can collect and document through the SSA the system that we use.

However, we are keeping a very close eye on the report of cyber incidents in especially against healthcare facilities, healthcare Information Services as well as vaccines and centres that we have been.

We have reports, some reports coming out of also a lot of these incidents as you mentioned do occur in more developed settings or conflict, non conflict settings, which is again slightly beyond the areas of focus that we currently focus on.

But again, this does affect how so we are monitoring it, but it's not necessarily reflected on the data system that we can't use.

Thank you.

Next question, Peter, Kenny.

Peter, are you still with Anatolia or it's another agency probably for Anna Doone.

Yes, I would just like to have a little bit more clarification on the framework and the time frame of this data that you have because you've mentioned 2020 and I'm just wondering, you know, you've said that it doesn't include material from the COVID era.

So could you sort of clarify a bit more on that?

Thank you.

Sorry, just having the mute button function, Hu Jong, do you want to address the time frame of the data collection?

Thank.

You sorry, I was having a bit of a problem with your function.

So yes, so the so just to give you just to reiterate the time frame that also mentioned.

So the resolution for setting up the system, the initiative was passed in 2012.

We went through several piloting phrases phases in between and in 2017 we launched the surveillance system for accessing out there and the system is running till today.

So it's a continuous system.

We did an analysis of the three-year data from 2018 to 2020 just to see what what kind of the information we can gather from the current information that we currently have.

Now it's a very short period of time to talk about trends or, you know, major analysis, but we just thought we would give it a go just to have a better understanding of what are some of the key drivers behind these attacks now.

So it does cover the COVID-19.

So we have been looking at impacts of attacks within the COVID-19.

Let's say of 2020 and late 2019.

In conflict, in context, matter and emergencies.

What we have also found is that in these kind of contexts it's been very difficult to distinguish between COVID related and non COVID related attacks on healthcare because either way they affect our delivery.

So and and may again maybe context driven, but but we actually have been looking at data from within this.

Although we haven't specified them as probably specific attack on healthcare.

Thank you, Nick.

Nick Cummings Cruz from New York Times.

I have just sent the the the remarks and the link to the to, to all Palais Palais accredited journalists.

If you have not received for any reason, please let me know when I will.

I will forward.

Nick.

Yeah, thank you.

I wonder if we could just clarify a little bit the extent to which when you talk about incidents, whether these are incidents where hospitals and healthcare workers and facilities are the specific target of an attack or where there is also, you know, you're including incidents where they are sort of collateral damage.

And you talk about 588 incident attacks in 2021.

Can we be a bit more specific on how many of these specifically targeted healthcare facilities or healthcare workers?

Thank you.

Thank you, Nick, who would like to take this one.

Again, I'd like to draw everyone's attention to the the analysis that is now publicly available.

The the data collection is actually granular by country.

By country.

We do focus on the system at large and it does address both indirect and direct attacks on the system.

And again, it's very important to point out that we stressed the most impacted part of the system were the healthcare workers.

But that does not discount the fact that the system at large, whether it's the medical assets, the IE ambulances, whether it is medical equipment, essential medicines or the structural facility itself is something that we do record.

And that granular information country by country or attack by attack to a certain degree is available in the analysis.

So you can see what is being attacked within the system.

But obviously just stressing on the importance of the healthcare workers as a critical component of the overall system.

Thank you.

Peter, do you have a follow up?

Yeah.

I'm just wondering, are these incidents increasing and are they increasing in so-called peacetime situations where you don't really have an ongoing war being waged, but you do have conflicts in the societies?

Thank you.

Yeah, Thank you, Peter.

Again, as both myself and you Zhang, have pointed out, this is active in 17 countries.

These 17 countries are those countries that Rep or territories that represent fragility, conflict or insecurity.

And the data is certainly showing that contextual changes are driving the increased nature of these attacks.

And again, remember that we've said that one attack is is too many, and so there's no baseline because it should be 0.

The space needed for healthcare workers and the system to do its work in a humanitarian environment, particularly imposed with COVID-19 is vital that healthcare workers and all its assets are given the necessary space.

And so this is one of the reasons today we have brought your attention to the fact that this analysis is pointing out that there is way too much damage, way too much direct and indirect impact on the healthcare system at large.

And we must continue to collect the data, address the vulnerability of the system and protected, and then look to where best practises may be and advocate against any violations.

And continue to address not only violations against the system, but making sure that people in these extreme environments have access to unfettered, safe, neutral space so that they can seek healthcare.

Thank you.

Altaf.

There is a another question from from again I said this time, this time it's Robin.

Robin.

Yes, thank you.

I wonder what we can say about why these attacks are happening.

Is there anything that we know or anything that's emerging from the data about, about what's what's behind this?

Yeah, that's, that's my question.

You know why is?

What do we know?

About why this is happening.

Thank you.

So the the analysis is ongoing and and I'm going to hand over to Hugh John who's obviously the principal lead and looking at some of the operational research.

And I think it's an ongoing question that we continue to look through and and understand contextually.

As I mentioned, every situation is very different in terms of its context.

The parties to the conflict must be held accountable and must ensure safe access.

But again, it is a lot of the contextual changes which are highly specific to those events that continue to drive up these events.

And again, not just to say the healthcare system, we know that the education system is equally under attack.

But let me hand it over to to huge young that might have additional specificity from the operational research side.

Thank you.

I think I think you said it well.

It is very, it is so context specific that it's very difficult for us to say this is the main driver behind all these attacks.

It could be, as I mentioned, it could be very much conflict driven or it could be due to collateral damage.

It could be driven from misunderstanding of the situation from certain communities.

And these are all very mixed variables that we are seeing across the board.

So one thing we have realised as we were doing this analysis is, is not to start from what is driving the attacks on healthcare, but just to start from understanding what is the context in which we are operating.

And that contextual understanding is extremely important for us to see how we can try to prevent or protect our healthcare better from potential attacks in the future.

But it is still a very much a learning progress because it is so new relatively and we we're still learning from from the data that we are collecting.

But it is one thing is clear, it is very content specific.

So we need a whole of society approach needing to to try to address this problem.

Thank you very much.

Thank you, Alta.

OK, last last follow up for for Peter as we have to finish by 10 O clock.

Peter.

OK, thank you.

I'm just interested to know if the specific attacks on healthcare in terms of the places that you're analysing are increasing because I'll give you an example, a counter example of say, like attacks on journalists.

Attacks on journalists have increased increment hugely since I first became a journalist and it was very rare for journalists to be attacked.

So are attacks directly on healthcare workers increasing?

Thank you.

Thank you, Peter.

And again, if we look at specific examples, as I pointed out the highest number of events recorded in two thousand 2021 happens to be Myanmar.

So the data is very clear that within its contextual period of insecurity fragility within that time frame we've had a significant uptake and reported incidents.

Now that is within the context in Myanmar.

Similarly, when we look at a very different context, the OPT, here again we we see continued violation of the healthcare system being able to do what it needs to do within that environment.

So let me draw your attention to the report where you start to see each context.

I want to be very careful that we don't compare any suffering to suffering because that each emergency situation is very different and our important message today is 1 attack is too many of attack.

Parties to the conflict must uphold the Geneva Conventions, the international humanitarian law, medical ethics and provide patient and provider fair and safe access to healthcare.

They need it most in these in these settings.

But again, the report that is or the analysis that is online will give you that granularity to show what we are deeply concerned about, which talks about a number of countries that are we are reporting through a systematic process of attacks on healthcare.

But I don't know if he's wrong if you want to add anything.

Again though, thank you.

I think you just it will also just just say, I think just on the trend analysis aspect we have our data is to to ***** as of now to give up the trend of whether anything is increasing or decreasing.

So we are also very careful about how we phrase our our analysis around that topic.

However, as I've mentioned, when you look at the context, when contextual aspects change, the number of attacks change.

So it's very much correlated to the situation rather than them there being an overall trend of increasing or decreasing number of attacks.

So I think we do need to be slightly careful how we've phrased that language.

However, as I've been mentioned, one attack is an attack to many.

And although even immediate impact of one incident may seem very small, the reverberating impact is very, very big on the health system.

So we need to be very careful that we don't have what we.

I guess our message is please stop attacking after.

Thank you.

Thank you both.

I see no, no further question and we are just at the time so we can let colleagues in units prepare for the press briefing at 10:30.

Many thanks, Altaf, Many thanks Yojong.

So the you normally should have in your inbox opening remarks of of Mr Moussani.

You also should have a link to the to the to the web page where the data has been posted.

If there are any further questions on this topic, don't hesitate to to contact me and the media team and we will make sure that our guests today answer answer your questions.

With this, I wish everyone a lovely day.

WHO press conference - New data on attacks on health