When impartiality is compromised, doctors and aid workers become targets
The discovery last week of the beheaded body of Khalil Dale, a British humanitarian aid worker in Afghanistan, marks yet another tragic fatality in a rapidly accelerating line of murdered neutral and impartial health professionals. The immediate and obvious response to Dale’s death has been to ask whether more could have been done to negotiate the ransom demanded by his captors. But a far deeper level of disquiet has also emerged.
David Wright, the Save the Children spokesman, powerfully and poignantly suggested that Dale may have been kidnapped and killed precisely because he was a humanitarian aid worker. The impartial and neutral status accorded to all international aid workers was not only ignored, but actually seen to highlight him as a prime target. An emergency healthcare worker was considered just as much if not more an enemy as those actually fighting.
Why has this situation arisen? First of all, the US Anti-Terror Law judges the provision of medical aid to ‘terrorists’, or negotiation with ‘terrorists’ to gain access to wounded, starving or destitute civilians, to constitute a major criminal offence. This has actively removed any identifiable ‘neutral’ status for doctors, nurses or allied health professionals in battlefield, conflict or famines zone. You are either for the ‘terrorists’ or against them.
In any case, who cares for any wounded, traumatized or displaced civilians in such zones becomes deeply problematic. One outcome seems certain: once humanitarian aid workers become front-line targets, INGOs like the Red Cross, Red Crescent and MSF have no choice but to withdraw their aid teams and close down their activities in the area. Who will then care for the innocent civilians is unclear and uncertain.
Even more troubling is the de facto withdrawal of the impartial and neutral status traditionally accorded to doctors and allied healthcare workers. This is not only written into everyday basic medical ethics, but also forms a central part of the Geneva Declaration (2006). It is alarming indeed to contemplate that troops might open fire on ambulances and hospitals, but it is truly terrifying to observe the covert removal of the basic human right of everyone to receive healthcare, irrespective of their social, religious, financial or political status.
It is absolutely vital in this respect that this impartial and neutral role of doctors and allied humanitarian aid workers is defended in public. If their ‘neutrality’ is flouted, and their power to provide basic healthcare is removed to accommodate one political agenda or another, then all humanitarian medical aid must inevitably lose its fundamental ethical framework.
Doctors who accept any forfeit of their impartial role – including the upcoming forfeit proposed by the prioritisation of treatment programme arguably legitimised by Clause 12 of the Health and Social Care Act – will inevitably violate their own professional ethics, and inadvertently collude with a current worldwide attack on humanitarian aid. In this tragic context, outspoken and uncompromising support for the fundamental impartiality and neutrality of all healthcare provides the only fitting tribute to the memory of Khalil Dale.
Dr Martin Stanton is a Visiting Professor at Roehampton University, and co-organiser of an international conference on ‘Impartiality and Neutrality in Healthcare’ at Hammersmith Hospital on 12 October 2012. Visit www.w12conferences.co.uk for more information.
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