WHO/L.Mackenzie
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新疆十一选五助手:Taking risks to provide care in a conflict zone

Charles Lwanga-Kikwaya is one of many health workers operating in a conflict zone. On New Year’s Day, his team was attacked at an Ebola vaccination point in the Democratic Republic of the Congo.

22 May 2019

新疆十一选五组选 www.luhcv.com This week on an overcast and drizzly day the 72nd World Health Assembly opened in Geneva. The weather was somewhat fitting for a sombre and sobering moment in the opening plenary when Director-General Dr Tedros led a moment of silence to remember all health workers killed or injured in the line of duty.

In the Democratic Republic of the Congo (DRC) alone, as of 21 May 2019, there have been 131 attacks on health care in Ebola-affected areas, with 40 injuries and 5 deaths of health workers and patients, including Dr Richard.

Dr Richard Mouzoko was killed by armed men while he and colleagues were working on the Ebola response.

Every attack disrupts our operations, makes it harder to reach communities and gives the virus an advantage.

Every life lost is a tragedy but every life saved is a triumph. This is the story of a life saved following an attack. This is the story of a small triumph.


WHO/A. Tardy
Minister Manaouda Malachie, Ministry of Public Health, Cameroon and Madame Mouzoko (Friquette Nadege Ulrich) and her eldest daughter Margaret Danielle Lydie Ketna receive honour for Dr Mouzoko

A New Year's Day attack

Rewind to the beginning to New Year’s Day 2019, when this year’s horrifying statistics began. Most of the world was on holiday. Not Charles Lwanga-Kikwaya, a DRC Ministry of Health Ebola responder and his colleagues. They were working. They were vaccinating patients against Ebola in Bunia, a city in Ituri province of the Democratic Republic of Congo.

Mr Lwanga-Kikwaya had just finished screening patient No. 23 when he and his team were attacked.

“We were in the middle of vaccination when a group of about 30 young men and women started throwing stones at us. Blood started gushing out of my head,” says Mr Lwanga-Kikwaya. “I was hit in my leg and I fell to the ground. Soon after, I lost consciousness.”

Charles was taken to a nearby hospital.

At the same time, WHO’s Director-General Dr Tedros was on a visit to Bunia to pay his respects to Ebola health workers far from their families and friends during the holidays. Accompanying Dr Tedros was a small group of doctors, including Dr Michael Ryan, the Executive Director of WHO Health Emergencies Programme and Jeremy Farrar, Director of the UK-based Wellcome Trust. They came to Mr Lwanga-Kikwaya’s aid.

“Charles had spent a night, unconscious, without treatment in a hospital with very limited facilities, medicines or supplies,” says Dr Farrar. “We were able to stabilise his condition in the morning, but that was not an environment in which he could have recovered. We urgently needed to evacuate him if he was going to have a chance to survive.”

“Charles was very badly injured, and he needed to be airlifted,” says Dr Ryan. “There was only one helicopter and that was the helicopter that was transporting the Director-General.”

Mr Lwanga-Kikwaya was airlifted to Goma for treatment.

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WHO/G. Gomina
Frontline responders in affected zones have been mobilized for community outreach. Populations living in hard-to-reach zones are being reached via community radio, social mobilizers and community networks.

Building trust

For the visitors from afar, and for the individuals who came under attack, the episode was a confronting reminder of the daily dangers faced by health workers in conflict zones. It also underscored how difficult it can be to deter people who choose to attack those working to save lives.

“It’s a tragedy that mistrust, fear and the constant threat of violence, fuelled by decades of conflict and instability, leads to people like Charles being attacked while trying to help their neighbours survive this outbreak of Ebola,” says Dr Farrar. “I am humbled by the bravery of every one of those health workers putting their lives on the line day after day in DRC and around the world. We must honour their selfless dedication by offering them all the support we can to end the outbreak as soon as possible.”

WHO recognizes the need to work together with communities to build trust between them and health workers. “We understand the sense of vulnerability that communities face when it comes to disease outbreaks,” says Hyo-Jeong Kim, who leads a WHO initiative called Attacks on Healthcare that aims to collect evidence and document best practices to prevent attacks on health care.

A global problem

In December 2017, WHO launched the Surveillance System for Attacks on Healthcare (SSA), which collects detailed primary data. The electronic surveillance system allows WHO and partners on the ground to report on attacks in a consistent and systematic manner. The aim is to capture evidence in different countries, activate measures to further document their impact, and advocate at all levels for preventive and protective actions.

From 1 January to 21 May 2019, 344 attacks on healthcare were recorded in the SSA, leading to 53 deaths and 262 injuries of health workers and patients. This data shows an average 17.2 attacks per week, or more than 2.4 attacks per day. Among all 7 countries that have reported attacks in 2019, Ebola-affected areas in DRC have recorded the highest number of attacks, showing the magnitude of the problem faced by health workers in this area.

Collecting data is crucial to understanding patterns. “WHO is a scientific organization. Our job is to understand the problem: how big it is, where it is occurring. So, the world can see the problem and then use that information, together with other United Nations agencies, governments and NGOs, to advocate to stop the attacks,” says Dr Ryan. He knows first-hand what it means to survive an attack. In 1990, as a young doctor, he was held hostage in Iraq.

For Dr Ryan, health systems and health workers are among the bedrocks of society. “Intentional attacks on healthcare are not only intolerable and illegal, but they also strikes at the heart of the community's capacity to survive. Directly targeting people takes away their means to be cured or helped if they become sick or injured,” he says.

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WHO/D. Lourenco
Charles Lwanga-Kikwaya shortly after returning to work

Unwavering commitment

After six days at the hospital - part of it in intensive care - doctors told Mr Lwanga-Kikwaya that he was well enough to go home.

After his release, he experienced headaches along with psychological trauma that included flashbacks at night. However, he wanted to get back to work. This was difficult for his family to accept. On medical clearance, he returned to his work with the DRC Ministry of Health in the Ebola response.

"The truth is I could get sick and so could my whole community. I must keep fighting until the epidemic is over,” says Mr Lwanga-Kikwaya. "Ebola is a dangerous disease so we have to get involved. I cannot let my friends, my brothers and sisters, die from the illness when I have expertise in stopping it."

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