By Dr Hassaan Afzal, HCRI Research Fellow.

In August 2017 I joined HCRI as a research fellow to work on the impact of attacks on healthcare. HCRI is a World Health Organisation Collaborating Centre for Emergency Medical Teams and Emergency Capacity Building, and through this link with WHO we learned that they too have a file on attacks on healthcare and an interest in research in this area. It was through this partnership between HCRI and WHO that I was given the opportunity to work a secondment at the WHO headquarters in Geneva to assist with their attacks on healthcare file.

Violence against health workers is becoming more pervasive. This is especially problematic in conflict regions and areas of insecurity. Up until the end of 2017, there was no systematic process to report and collect data on attacks on health workers, their facilities and patients. Efforts to report attacks were limited to specific regions and by the resources of those collecting the data and therefore the number of reported attacks was likely a gross underestimate. The WHO had been given the mandate to develop a system in order to fully understand the extent of the issue.

My role was to help with the development of a surveillance system and to roll this out to the WHO country offices. It is easy to underestimate the complexity of such a surveillance system. It had to be accessible to over 27 country offices, their partners and to the public; have a process of verification for reported attacks and to assign a level of confidence that the attack occurred; encrypt data and be able to maintain the confidentiality of reporters and details of victims; account for all types of attacks; assign user privileges levels to ensure operators could only access what they were authorised to do so; be user friendly and comprehensible in multiple languages; present data in easy to understand formats and to make this data exportable. Its creation was a gruelling trial and error, back and forth, planning and re-planning with the WHO team and IT staff to ensure it had all the requisites stated above. At the end of 2017, we introduced the first phase to the WHO country offices and began training them to use the system. In January 2018, the surveillance system will be officially launched and WHO teams will start entering data.

Data collected from WHO’s surveillance system will, amongst other things, help to inform further research on this topic, which in turn will produce an evidence base to advocate for these attacks to end. The secondment has been a good example of the collaboration between WHO and HCRI working in practice and demonstrates HCRI’s commitment to the Collaborative Centre role. I believe it will help strengthen the working relationship between HCRI and the WHO, and opens up the opportunity for further secondments for HCRI students and staff in the future.

For my own research, in which I aim to determine what data is needed to understand the wider and long-term impacts of an attack in healthcare, the secondment has connected with me with the right people to help carry out my work.  I hope that on completion of my study, we will have a clearer understanding of the data required to better describe these impacts, and ultimately help set the research priorities for a longer term project.

Documenting these attacks and their impacts is just the beginning. The ultimate goal is to put an end to the attacks and to return the sanctity of healthcare. The enormity of the task is not lost on any of the committed people in multiple organisations working to address this issue. It is clear that only through a joint effort, a pooling of skills and resources, and a collective voice will we be able to protect healthcare for those who most need it. I look forward to further collaborative opportunities with our partners at the WHO and others working in this area.

Hassaan Afzal

hassaan.afzal@manchester.ac.uk

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