Health Care Providers in War and Armed Conflict: Operational and Educational Challenges in International Humanitarian Law and the Geneva Conventions, Part II. Educational and Training Initiatives

Abstract

No discipline has been impacted more by war and armed conflict than health care has. Health systems and health care providers are often the first victims, suffering increasingly heinous acts that cripple the essential health delivery and public health infrastructure necessary for the protection of civilian and military victims of the state at war. This commentary argues that current instructional opportunities to prepare health care providers fall short in both content and preparation, especially in those operational skill sets necessary to manage multiple challenges, threats, and violations under international humanitarian law and to perform triage management in a resource-poor medical setting. Utilizing a historical framework, the commentary addresses the transformation of the education and training of humanitarian health professionals from the Cold War to today followed by recommendations for the future. (Disaster Med Public Health Preparedness. 2018;page 1 of 14).

Differences in Ethical Viewpoints among Civilian–Military Populations: A Survey among Practitioners in Two European Countries, Based on a Systematic Literature Review

“…Healthcare professionals must deliver care and services consistent with ethical standards in all routine scenarios [30,37,55,56,[58][59][60][61][62][63]. However, during a disaster or war, ethical dilemmas can intensify further under crisis standards of care when complex decisions must be executed to use and allocate resources and to "do best for the most" [56,60,64].…”

“…Such consensus is probably not feasible in armed conflicts unless better anticipation and improved prevention are in place to reduce the risk of deliberate or unintentional breaches of the human rights to directly and indirectly affect disaster and war victims. Human rights violations may simply be associated with forced participation, triage by 'gross' criteria, assumed consent, assumed contamination, forced decontamination, undermining dignity, competing for ambition, and full disclosure [36,37,68,69] Although, in contrast to wars, disasters might be unexpected, the chaos and disorganization caused by both in the society result in a grave violation of the entire range of human rights and, during the event, have the potential to influence all beings. In such a situation, the diversity in ethical viewpoints among healthcare providers may cause a considerably vaster issue [30,37,55,[68][69][70].…”

“…The use of new technology, such as drones, with both civilian and military implications [32], also adds a new perspective to the four existing bioethics principles (beneficence, non-maleficence, autonomy, and justice), namely, artificial intelligence ethics, and highlights the way military and civilian ethics overlap through medicine. This calls for evaluation of the crisis standards of care within the concept of CMC, which should focus on ethical justification in triage, preparation, responsibilities, resources, and social utilities, and may encompass ethical issues, such as forced participation, triage by 'gross' criteria, assumed consent, assumed contamination, forced decontamination, undermining dignity, competing for ambition, and full disclosure [36,37].…”

“…However, although there are publications dealing with ethical viewpoints of both populations, there is a lack of direct comparison between military and civilian healthcare providers. Hypothetically, recent armed conflicts using new technologies (e.g., drones), public health emergencies, and the way affected populations may behave both in nature, medically and politically, can influence the significance of civilian military collaboration and any multiagency assistance, particularly within the healthcare systems [14,[32][33][34][35][36][37].…”

The Development of Swedish Military Healthcare System: Part II—Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners

“…Possessing clinical skills needed to manage sudden-onset disasters, public health emergencies, complex humanitarian emergencies, and training in International Humanitarian Law and Geneva Convention, along with advanced training in competency-based skill sets, should all be included in such a curriculum for the benefit of humanity. 17 , 56 , 57…”