Revisiting the Colombo Declaration

The Colombo Declaration in support of the Stop Bombing Hospitals campaign

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The issue of attacks on medical facilities in conflict zones was brought to the fore by several presentations during the DevelopingEM 2016 Sri Lanka conference.

The moving presentation by Kass Thomas describes the 2015 attack on the MSF run Kunduz Trauma Centre in Afghanistan. It contains distressing content and graphic images and it stirred emotions in everyone present at the conference.

In response to these presentations a petition of conference faculty and delegates recorded unanimous condemnation of past and ongoing attacks on health care facilities.

At the suggestion of our friends and colleagues within the Sri Lankan Society of Critical Care and Emergency Medicine (SSCCEM) an attempt to crystallise the feelings of the faculty and delegates into a formal declaration was undertaken.

The resultant Colombo Declaration was presented formally during the plenary session of the SLEMCON 2017 conference.

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Final Logo-03The Colombo Declaration

Attacks on health care facilities in conflict zones have, unfortunately, been documented in many wars throughout history. In the aftermath of World War II, in an attempt to limit the suffering caused by armed conflict, the international community drafted and ratified the 1949 Geneva Conventions, establishing rules to protect people who were not participating in the hostilities – civilians, medical personnel, injured soldiers etc. Violations of these rules of war, such as bombing a hospital, constituted a war crime punishable under International Humanitarian Law.

Despite the global acceptance of the Geneva Conventions, recent years have seen an escalation of the pattern, frequency and nature of attacks on hospitals in conflict . Recently termed the “weaponisation” of health care, these hospital attacks have become part of a multi-dimensional war strategy, which uses large scale violence to deprive people of access to health care. While Syria and Yemen have recently suffered the largest volume of attacks on health care facilities, a recent report documented attacks in 23 countries in 2016 alone.

The majority often using highly advanced precision aerial bombardment. These attacks are not simply collateral damage.

Under mounting pressure from all major international health related organisations, the UN Security Council passed Resolution 2286 in May 2016 condemning attacks on health care and demanding that all warring parties fully comply with the Geneva Conventions. Unfortunately, the resolution has not been implemented or enforced, attacks continue with impunity.

At the 2016 DevelopingEM conference in Sri Lanka an eye witness description of the bombing of the Medecins Sans Frontieres run Kunduz Trauma Centre in Northern Afghanistan was emotional provided by Dr Kathleen Thomas. Forty two staff and patients were killed in the US attack and the Trauma Centre was utterly destroyed. Other presenters and conference delegates later described similar attacks on health facilities in other conflict settings that they too had witnessed.

As a group, evidenced by a signed petition, the faculty and delegates (approximately 300 clinicians) of the conference agreed to cement the overwhelming abhorrence at the ongoing situation globally in the Colombo Declaration.

The Sri Lankan Society of Critical Care and Emergency Medicine (SSCCEM) and DevelopingEM in behalf of the faculty and delegates of the 2016 Conference present the Declaration as follows.

We, the directors and organizing committee of DevelopingEM and the SSCCEM, are concerned about the serious worldwide attacks on healthcare facilities, personnel and their patients. We have assembled at the 2017 Sri Lankan Emergency Medicine Conference (SLEMCON), to consider enhanced action to tackle this problem in a spirit of trust and cooperation. We:

  1. Condemn the attacks on health care facilities, health care workers and vehicles in conflict zones.
  2. Reaffirm our belief that all people regardless of gender, sexuality, race, ethnicity, political affiliation, or religious beliefs should have the right to access health care, and all medical professionals should be able to deliver this care in facilities without threat of
  3. Call upon the UN Security Council to take immediate action to fully implement and enforce Resolution 2286
  4. Call upon all Member States to uphold and comply with the Geneva Conventions; to commit to making attacks against healthcare in conflict zones an absolute redline; to support the enforcement of UNSC Resolution 2286; and to call for an immediate cessation to any further attacks on health care facilities
  5. Call upon national medical societies, specialist colleges and clinicians to individually and collectively condemn attacks on healthcare facilities in conflict zones, and to promote respect and awareness of the Geneva Conventions and enforcement of UNSC Resolution 2286.

These are serious promises which will be difficult to achieve, but we are resolved that such commitments will be met by practical action and the resources needed to ensure real and measurable results;

Together we can raise the profile of this issue and advocate for the correct and proper enforcement of the Geneva Conventions and UNSC Resolution 2286.

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Since the formal declaration DevelopingEM has used social media and other platforms to spread the word about the Colombo Declaration to clinicians around the globe.

Kass Thomas followed up her presentation in Sri Lanka with an article describing the Kunduz attack and outlining her thoughts on the way forward.

As individuals, we have begun approaching local health districts, academic colleges and professional organisations.

As a result of these approaches the Australasian College for Emergency Medicine (ACEM), the College of Emergency Nursing Australasia (CENA) and the Australian and New Zealand Intensive Care Society (ANZICS) have all formally come out in support of the Colombo Declaration.

We have also begun the process of appealing to our political representatives.

Unfortunately as time passes the problem of the weaponisation of healthcare has not halted with ongoing attacks on facilities around the globe and a total disregard for the Geneva conventions and the UN security council resolution on bombing medical facilities. In 2017, 701 facilities were attacked in 23 countries, more than ever before, according to the Safeguarding Health in Conflict Report.

As such we feel there is very much still work to do and as we progress we plan as an organisation to:

  • Vastly increase global medical community support for this declaration by gaining signatory support from as many clinicians and professional organisations as possible.
  • Report on Dr Thomas’ website whenever we become aware of a new hospital attack so that these atrocities do not go unnoticed.
  • Seek media interest in reporting the declaration and the concern across the medical community for our colleagues under attack.
  • Utilise this media interest to have a voice with individuals and organisations of potential influence on this complex issue.

 

This issue is a daunting one to confront but there are things that you can do to help raise awareness and contribute to the groundswell of medical opposition to this tool of modern warfare.

As individuals you can

  • Update your understanding of the issue by checking out Safeguarding Health, the Report on Attacks on Healthcare facilities in 2017, and the Stop Bombing Hospitals website
  • Visit the Stop Bombing Hospitals booth at #DevEM2018 to find out more
  • Sign the Colombo Declaration here
  • Become a local champion and encourage your colleagues and local representative organisations, wherever you hail from, to sign the online declaration. Every signature counts.
  • Spread the word about news of ongoing attacks and also strategies to address the issue such as the Declaration, through your own social media platforms
  • Write to your Member of Parliament or other political representatives in your country about this issue and feel free to forward the Declaration.

At DevelopingEM 2018 Fiji we will be restating the Declaration and there will be an information desk where you can learn more about how to contribute.

As delegates of DevelopingEM you are part of our organisation and we invite you to be part of this movement.

We thank you for your support and look forward to working with you to progress this Declaration.

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