No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Medical Neutrality and Political Engagement
Abstract
A claim is often made that medical neutrality requires that health workers practicing in conflict settings or in situations of political violence refrain from taking a position on controversies of a political, racial, religious, or ideological nature. The admonition is also applied to human rights documentation and reporting and advocating for political change. That position, however, is highly problematic, in part because the phase is “medical neutrality” is not contained in international law and because has at least three different meanings: immunity from attack, impartiality, and political neutrality. More importantly, refraining from political engagement is inconsistent with contemporary medical ethics, including obligations to prevent abuses, report those that take place, and advance health equity. Moreover, the humanitarian principle of humanity, on which the purported obligation is predicated, is not morally grounded and lacks the status of the companion principles of humanity and impartiality. These principles both justify and encourage health professionals to engage in political matters that can protect the rights and health of patients and the larger populations. In taking such stances, health professionals can employ decision-making processes that account for possibly conflicting values and obligations and assessing the benefits, burdens, and risks of alternative courses of action.
ResearchGate has not been able to resolve any citations for this publication.
Background
Medical neutrality is a normative arrangement that differentiates a zone of medical treatment disconnected from the field of politics. While medical neutrality aims to ensure impartial healthcare for all and to shield the healthcare personnel from political demands, it can also divert attention away from conflicts and their effects on health inequity. This article analyzes how healthcare professionals understand and negotiate the depoliticized space of the emergency department (ED) through their views on neutrality. It also examines how medical staff use depoliticized concepts of culture to account for differences in the health status of patients from disadvantaged groups. These questions are examined in the context of the Israeli-Palestinian conflict.
Methods
Twenty-four in-depth, semi-structured interviews were conducted with healthcare personnel in a Jerusalem hospital’s ED. All but one of the participants were Jewish. The interviews were analyzed using qualitative content analysis and Grounded Theory.
Results
The ED staff endorsed the perspective of medical neutrality as a nondiscriminatory approach to care. At the same time, some medical staff recognized the limits of medical neutrality in the context of the Israeli-Palestinian conflict and negotiated and challenged this concept. While participants identified unique health risks for Arab patients, they usually did not associate these risks with the effects of conflict and instead explained them in depoliticized terms of cultural and behavioral differences. Culture served as a non-controversial way of acknowledging and managing problems that have their roots in politics.
Conclusions
The normative demand for neutrality works to exclude discussion of the conflict from clinical spaces. The normative exclusion of politics is a vital but under-appreciated aspect of how political conflict operates as a structural determinant of health. Healthcare personnel, especially in the ED, should be trained in structural competency. This training may challenge the neglect of issues that need to be solved at the political level and enhance health equity, social justice, and solidarity.
Applying the humanitarian principles of humanity, impartiality, neutrality and independence in a relevant manner in concrete operational settings is a constant challenge for humanitarian organizations. Bound by this set of norms, the International Committee of the Red Cross (ICRC) has incrementally developed over the years a rational framework that allows its leadership and staff on the ground to act according to these principles while developing adapted solutions and pragmatic approaches. This article begins by describing the history and development of the humanitarian principles; it then explains how the strategic choices of the ICRC are informed by these principles, and what the consequences are for the organization's capacity to act in favour of victims of armed conflicts.
This paper follows the testimony of Izzeldin Abuelaish, a Palestinian physician who bears witness to his experiences working, living, and suffering under Israeli rule. He presents his story as a doctor's story, drawing on his identity as a medical professional to gain credibility and visibility and to challenge the limited legitimacy of Palestinian grievances. In this paper, I explore his testimony as a medical voice that at once recounts the suffering and loss endured by the Palestinian people and also struggles to negotiate the values associated with being a "reliable" witness. Consequently, I ethnographically examine the social life and reception of his story in Jewish-Israeli publics. In comparison with most Palestinian narratives, Abuelaish's testimony achieved an extremely rare degree of visibility and sympathy, a phenomenon that calls out for analysis. I identify the boundaries that typically render Palestinian grievances invisible to Israeli publics and suggest how medicine's self-proclaimed ethos of neutrality served as a channel for crossing them. Finally, I reflect on the political possibilities and limitations of medical witnessing to render suffering visible and arouse compassion toward those construed as a dangerous/enemy Other.
This article provides a legal analysis of the largely uncharted notion of “acts harmful to the enemy” under international humanitarian law, which reconciles the humanitarian need to grant special protection to medical services (medical personnel, units and transports) in the interests of the wounded and sick with the military necessity to remove it when acts are committed contrary to good faith and for hostile purposes or with effects which harm the adverse party. The meaning of the notion is clarified by primarily looking into the legality of an attack against land-based medical services by the aggrieved party to the conflict as a consequence of harmful acts. It concludes with specific recommendations on how to interpret the law governing such an attack, considered prima facie lawful, on a hospital.
This story is a necessary lesson against hatred and revenge, says Elie Wiesel, Nobel Peace Prize Laurate, about a Palestinian who has lived through half a century of horror and destruction in Gaza. After losing his three daughters in January 2009 during an Israeli incursion into Gaza Strip, Dr. Abuelaish said: "If I could know that my daughters were the last sacrifice on the road to peace between Palestinians and Israelis, then I would accept their loss".
Who better than Henry Dunant to shake the reader with a gripping account of the suffering of the thousands of wounded soldiers left untended after the battle of Solferino? In this work, Dunant succeeds in taking the vital step between that vision of devastation and an impassioned appeal on behalf of the victims of combat.
Globally, attacks on and interferences with health workers and healthcare delivery, including targeted violence towards providers, attacks on hospitals and delays and denial of health care, represent a serious humanitarian and human rights issue. However, gaps in research about these events persist, limiting the evidence base from which to understand and address the problem. This paper focuses on experiences of local health workers in eastern Burma's chronic conflict, including their strategies for addressing security and ensuring access to vulnerable ethnic communities in the region. Face-to-face in-depth interviews were conducted in June and August 2012 with 27 health workers from three health organizations that operate throughout eastern Burma, with their operational head quarters located in Mae Sot, Tak Province, Thailand. Qualitative analysis found that health workers in this setting experience violent and non-violent interferences with their work, and that the Burmese government's military activities in the region have severely impacted access to care, which remains restricted. Data show that innovative security strategies have emerged, including the important role of the community in ensuring securer access to health care. This study underscores health workers' concern for improved data collection to support the rights of health workers to provide health care, and the rights of community members to receive health care in conflict-affected settings. Findings will inform the development of an incident reporting form to improve systematic data collection and documentation of attacks on health in this setting.
International humanitarian law and violation of medical neutrality
- Frits Kalshoven
Rudolf Carl Virchow: Medical scientist, social reformer, role model
- Theodore Brown
- Elizabeth Fee
- T Brown
The principles of the red cross
- Max Huber
The responsibilities of health-care personnel working in armed conflicts and other emergencies
- Icrc
Emmerich de Vattel, The Law of Nations (1758)
- Carolina Kenny
The fundamental principles of the Red Cross. Geneva: International Federation of Red Cross and Red Crescent Societies
- Jean Pictet
Humanitarian resistance: Its ethical and operational importance
- Hugo Slim
Humanitarians at war: The red cross in the shadow of the holocaust
- Gerald Steinacher
Report of the special rapporteur on the highest attainable standard of physical and mental health
- U N Assembly