International Committee of the Red Cross
International Committee of the Red Cross

Regional Delegation for the United States and Canada

In This Issue:
Respecting and Protecting Healthcare in Conflict
Middle East and North Africa: Coping with Medical Emergencies
Afghanistan: Ambulance Used in Attack on Police Training Compound
ICRC News from
Around the Globe
New ICRC Animated Documentary - Death in the Fields
Death in the Field
Renowned editorial cartoonist Patrick Chappatte has teamed up with the ICRC  to create a new animated documentary on the impact of cluster munitions in Lebanon
In 2009, Chappatte, who draws political cartoons for leading international and Swiss newspapers, traveled to Lebanon to see for himself how cluster munitions continue to threaten people's lives and livelihoods.
Almost five years after the war between Israel and Lebanon, which saw millions of bomblets dropped on Lebanese territory, the decontamination of these deadly weapons continues.  Since the 2006 war, 354 people have been injured and 49 killed, including children and teenagers, by these munitions.
New ICRC Publication - Assistance for People Affected by Armed Conflict and Other Situations of Violence

Assistance Publication 

The ICRC's assistance activities address essential needs of individuals and communities affected by armed conflict and other situations of violence. These needs vary by their social and cultural environment.. They are assessed in relation to the context and in close consultation with the affected communities and the ICRC's responses are as varied as the needs.
This booklet explains assistance work of in the ICRC: the aims; the basis for action; and the main activities carried out by assistance programmes. It also describes different areas of assistance work in 2011, and the different professions this work involves.
New ICRC Film - Reconnecting Families in Liberia and the Côte d'Ivoire

An Ivorian refugee child calls to find his mother. 

Conflict and disasters leave more than physical wounds: in the turmoil, panic and terror, family members can be separated in minutes, sometimes leading to long years of anguish and uncertainty about the fate of children, spouses or parents. Trying to locate people, and put them back into contact with their relatives, is a major challenge for the ICRC and the national Red Cross and Red Crescent societies.
Following an escalation in fighting in western Côte d'Ivoire, the Red Cross has stepped up its work to reconnect children arriving in neighboring Liberia, who have been separated from their families. The ICRC and the Liberian National Red Cross Society have registered and assisted more than 50 unaccompanied children since the latest influx of Ivorian refugees at the end of February.
New ICRC Film - Fighting Tuberculosis in Lurigancho Prison
Detainees on Lurigancho Prison
Tuberculosis kills more than 50% of its victims if left untreated. The disease thrives in crowded, stuffy, dark environments such as prisons.
The TB rate in Lima's Lurigancho Prison used to be almost 50 times as common as it was elsewhere in Peru. The ICRC is helping the management of Lurigancho Prison and other prisons across Latin America to eradicate the disease.
Upcoming Events   
May 19-20
4th Annual National Security Law Junior Faculty Workshop/IHL Training held at the Army JAG School, University of Virginia, Charlottesville
June 27 - July 7
29th Course on International Humanitarian Law organized by the ICRC and the Polish Red Cross and held in Warsaw, Poland.
May 09-27: Ouidah/Bénin
June 13-24: Geneva/Switzerland
July 11-29: Baltimore/USA
July 11-22- Hawaii/USA
Health Emergencies in Large Populations (H.E.L.P) Courses a multicultural and multidisciplinary learning experience created to enhance professionalism in humanitarian assistance programmes conducted in emergency situations

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ICRC Mission
The ICRC is an impartial, neutral, and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. 
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News and Notes
April 2011 

This month we bring your attention to one of the most pressing humanitarian issues of today: insecurity of health-care in conflict.
First, we share some information about this subject, including the ICRC's experience with it, and the campaign it is launching this August on the anniversary of the 1949 Geneva Conventions. The First Geneva Convention, established in 1864, codified protection for the sick and wounded on the battlefield.

Second, we have an interview with Dominik Stillhart, ICRC's Deputy Director of Operations. In this interview, and in view of recent events, Mr. Stillhart focuses on the need for safe access to health-care in North Africa and the Middle East.
Finally, we include an ICRC News Release condemning the use of an ambulance to attack an Afghan National Police regional training center. Attacks against health personnel and facilities are prohibited at all times. We also note with interest the public media response of the Afghan Armed Opposition immediately following the publication of our News Release. 
As always, please write us with your thoughts and feedback.
Kind regards,
The ICRC Washington Delegation
Respecting and Protecting Healthcare in Conflict
Given recent developments in the field, including in North Africa and Afghanistan, and the visit to Washington this month by Robin Coupland, who has been leading the ICRC's project on healthcare in conflict, we wanted to bring your attention to the campaign ICRC will launch on this critical issue in August. Below we note the ICRC's historical involvement, share some relevant research, and highlight the major constraint in accessing safe healthcare in conflict: insecurity. 
The foundational activity of the ICRC and the Red Cross and Red Crescent Movement is caring for the sick and wounded on the battlefield. We have nearly 150 years of experience in dealing with health in conflict. Today we directly aid victims, support health structures and train armed actors and health professionals in emergency response. 
Despite this experience, and the efforts of many aid organizations, governments, and armed actors, the problem of accessing life saving care in conflict remains one of the biggest humanitarian problems in the world.
The intersection of health and security is neither well-studied nor well-integrated in humanitarian operations. Two of most relevant articles on this subject are: "Responsibility for protection of medical workers and facilities in armed conflict" by Leonard Rubenstein of USIP and Physicians for Human Rights and "Security, insecurity and health" by ICRC's Robin Coupland. It is the opinion of the ICRC that in order to access and provide healthcare in conflict zones, a safe, secure space is necessary. Weapon bearers, policy-makers and health practitioners must work together to achieve this goal as a matter of priority.
In August, the ICRC will release a report analyzing events hindering access to healthcare; over 32 months of data from 16 contexts, including Somalia, Afghanistan, and Sudan, document this problem. One of the most striking elements is the massive implications of a single violent act targeting healthcare structures and workers. For instance, in 2009, an attack in Mogadishu killed 29 Somali medical students at their graduation ceremony. Had they lived, and based on current statistics, they would have provided health consultations to more than 300,000 people per year.
The release of this report in August will launch a four-year campaign led by the ICRC to improve safe access to healthcare in conflict. We look forward to sharing more detailed information about the campaign at that time. We hope that we will have the opportunity to interact with many of you in the coming months and years to advance this cause.  
Middle East and North Africa: Coping with Medical Emergencies
Dominik Stillhart, ICRC Deputy Director of OperationsAs unrest and violence continue to spread across the Middle East and North Africa, ICRC Deputy Director of Operations Dominik Stillhart outlines the challenges that local health workers and hospitals are facing in the region and the support that the ICRC is giving them.
What are the greatest medical challenges and priorities in the wake of the latest outbreak of unrest?
In general, violence has resulted in many deaths and vast numbers of injuries. The armed conflict in Libya has been raging for weeks now and casualty figures there continue to mount, while humanitarian access to some parts of the country remains restricted.

In other places, civil unrest has flared up against the backdrop of an existing armed conflict, as in Yemen, where a protracted - although largely unreported - armed conflict is under way in the north of the country. In Iraq, too, recent demonstrations have resulted in casualties, while hundreds of people continue to be killed or injured every month by violence linked to the ongoing armed conflict. When you add civil unrest to an already precarious humanitarian situation in a country weakened by years of armed conflict, the result can be disastrous in terms of the cost in human lives.

That's why one of our top priorities is to support local health staff in saving lives and ensuring that people in need of emergency medical care - in particular, those wounded in the violence - receive the help they're entitled to. I cannot emphasize enough the importance of giving health-care workers immediate access to the wounded and sick and allowing them to do their jobs safely. It's literally a matter of life and death.

What is the ICRC doing to address these challenges?
Caring for the wounded and the sick, relieving suffering and saving lives is really at the heart of what we, and our partners within the International Red Cross and Red Crescent Movement, do on a day-to-day basis.
In the wake of the recent civil unrest and violence in North Africa and the Middle East, we've been doing all we can to support first-aid providers. This means working hand-in-hand with the national Red Crescent or Red Cross societies in the affected countries and with health ministries, other government authorities and local organizations.

Volunteers giving medical care at Tahiri Square.In Egypt, for example, the health ministry is in charge of first aid and emergency care. The Egyptian Red Crescent helps identify needs, while a number of other organizations also play an important role, as do private individuals who spontaneously volunteer their services when violence erupts, as many did in Cairo's Tahrir Square. The ICRC maintains a good network of contacts with all concerned, which enables us to assess needs and respond effectively.

Humanitarian organizations must have safe access to those in need and everybody must respect and protect medical personnel, medical facilities and vehicles that are transporting the wounded.

What are the main risks for health-care personnel?
Whether they're navigating their way through road blocks or handling a sudden influx of patients with weapon-related injuries, local health workers face considerable risks and challenges. Some of them have paid a high price. In Libya, two volunteers were injured on 3 March when the Red Crescent ambulances they were travelling in were shot at in Misrata, west of Benghazi.

It is totally unacceptable to attack those providing medical care and to obstruct the safe passage of ambulances. All those taking part in the violence must safeguard medical personnel, medical facilities and any vehicle used as an ambulance. Health personnel and Red Crescent and Red Cross staff must also be respected and allowed to carry out their life-saving work in safety.

First-aiders are particularly exposed to serious danger and obstructions in performing their tasks, because they're often first on the scene. It's vital that they be allowed to perform their duties safely and quickly.
While minor injuries can often be treated on the spot, severely wounded people have to be taken to hospital. Emergency medical services stabilize patients and use triage to ensure that the patients with the most serious needs are treated first. The ICRC supports local medical services in their efforts to care for the injured and ensure that all the sick and wounded receive assistance, regardless of their allegiance. Our priority is to ensure that they obtain the care they need.

How does the ICRC promote compliance with the rules protecting the sick, the wounded and those who are treating them?
By raising awareness that the aim of health workers is to help people, and that everyone must respect and protect patients and health workers. One way we do this is through dialogue with everyone involved in the violence - security and police forces, but also demonstrators - and with the parties to an armed conflict. Basically, one of our roles is to keep reminding everybody of their obligations as often as necessary and for as long as it takes.

To my mind, there's a humanitarian imperative that security and police forces, and anyone else taking part in the violence, respect and protect medical personnel, facilities and ambulances at all times. It's that simple. Failure to do so is totally unacceptable.

Could you give us a few examples of how the ICRC has been supporting medical staff in countries affected by violence?
This kind of activity lies at the core of our mandate, and we've been protecting the wounded and sick for more than 150 years. So even before the civil unrest erupted, we were already supporting health activities in several of the countries where violence has occurred recently.

In Tunisia and Egypt, the ICRC has long been cooperating with the national Red Crescent Societies. During the recent events in Egypt, we provided a dozen hospitals with enough supplies to treat up to 1,000 severely wounded patients. In addition, we gave the Egyptian Red Crescent enough bandages and dressing materials to treat 5,000 patients. We also made sure we had enough additional emergency dressing kits on hand to treat 5,000 people with minor injuries.
In other countries, such as Yemen and Iraq, the ICRC has been supporting local health facilities for decades. In Yemen, the Red Crescent is currently working around the clock to provide first aid in areas where demonstrations are taking place, while the ICRC is delivering surgical and medical supplies and providing first-aid training for volunteers. In Iraq, medical staff regularly receive ICRC training to help them cope with influxes of mass casualties from the ongoing armed conflict. We stand ready to provide further assistance should the need arise.

In Bahrain, which is covered by our regional delegation in Kuwait, we carried out an assessment mission on the ground in cooperation with the Bahraini Red Crescent during the very early stages of the unrest. We have pre-positioned stocks of first-aid materials with the Bahraini Red Crescent, along with enough surgical supplies to treat up to 250 casualties.

Al Jalaa Hospital, Benghazi. Libyan doctors and nurses treat a patient.During the early stages of the fighting in Libya, we sent in two medical teams, including surgeons and nurses, to help local doctors cope with the large number of casualties arriving at hospitals in Benghazi and Ajdabiya. Together with the Libyan Red Crescent, we also replenished those facilities' emergency stocks of supplies. In addition, in coordination with the Benghazi Health Committee and the Libyan Red Crescent, the ICRC's medical teams held a surgical seminar for more than 70 Libyan doctors and nurses at Al Jalaa hospital. The latest news from Libya is that a team of ICRC delegates arrived in Tripoli on 30 March to discuss issues of humanitarian concern with Libya government officials.
To see more pictures of the ICRC's response to the crises in the Middle East and North Africa, please click here to be redirected to the complete photogalleries on ICRC's flickr account.
Afghanistan: Ambulance Used in Attack on Police Training Compound
On April 7, the ICRC issued a News Release condemning an attack that used a bomb hidden in an ambulance to attack Afghan security forces. That News Release is reprinted in full below. Soon after this statement, IRIN reported that the Taliban acknowledged this act as a violation of the laws of war and have promised investigations. To read the full article detailing the Taliban's response to the ICRC's statement, please click here
Geneva/Kabul (ICRC) - The International Committee of the Red Cross (ICRC) strongly condemns the use of an ambulance - intended for transporting wounded and sick persons - in a suicide attack that took place today at an Afghan National Police regional training centre on the outskirts of Kandahar city, southern Afghanistan.

Several members of the security forces were killed and others injured during the assault.

"Using an ambulance for the purpose of deceiving the adversary in carrying out an attack constitutes perfidy. This is strictly prohibited by international humanitarian law and is totally unacceptable," said Jacques de Maio, the ICRC's head of operations for South Asia.

By violating the neutrality of health care services, such acts of deception endanger medical personnel engaged in caring for the injured and sick in hospitals, clinics and rural health posts. "They undermine the delivery of and access to health care, already precarious for ordinary Afghans in many parts of the country as a result of the conflict," added Mr. de Maio.