Advocacy In Conflict And Catastrophe

Question 1

Learning Objectives

Answer 1

• What is advocacy?
• Why might health professionals and health information have a strong influence?
• What is the best sort of information to use for advocacy?
• Other considerations: presentation, timing, expectations
• Anticipating the reaction
• Case studies and exercises

Question 2

What is advocacy in the context of public health?

Answer 2

• ‘The pursuit of influencing outcomes – including public policy and resource allocation decisions within political, economic, and social systems and institutions – that directly affect people’s lives’
• ‘Advocacy is an important tool and includes lobbying, political organisation and activism, overcoming bureaucratic inertia, identifying a champion for the cause, enabling community leaders and mediating to manage conflict.’

Question 3

Why are health professionals used as advocates?

Answer 3

• Duty of care / clearing up the mess
• Bearing witness to the health consequences,
• Using professional knowledge to provide evidence to use for advocacy
• Research – in difficult environments
• Using professional credibility to speak out
• Working towards prevention
• Awareness raising, education, mitigation of the effects, holding to account, conflict prevention.

Question 4

What are the reactions to the health consequences of conflict and disasters?

Answer 4

• Evoke pity and should evoke empathy
• Represent a common danger ‘this could be me/you’
• Create a common understanding
• Create a sense of urgency
• May also: Raise issues of responsibility, Causes may be disputed, Lead to the extent/degree of the health consequences being contested
• Can they be clearly assessed / demonstrated / communicated?

Question 5

What data and information do we want / can we use?

Answer 5

• Ideally: Information and analysis that indicates what should be done
• But often have to use: Information that is the best available at that point in time
• What you would often like is: Information that ‘speaks for itself’ and cannot be contested

Question 6

What are some checks that are carried out before an advocacy is carried out?

Answer 6

• Good evidence / argument (provided by a trusted source)
• A strategy: will you be heard?
• A principled approach: do no harm; the ethics of advocacy
• Will it put anyone at risk?
• Legitimacy – who are you speaking for? Are they involved?
• Are you the best person to make the case?

Question 7

How would you make a strong case for more advocacy of sufficient resources?

Answer 7

• Possible concepts and strangles, which would be the best to use?
• Health as a right (universal right)
• Health as a need
• Health as a commodity
• Health as a public good

Question 8

What are the considerations you need to think about in relation to advocacy?

Answer 8

• Is your information appropriate for your target audience?
• Other considerations: presentation, timing, expectations.
• What might you be up against?
• Opportunities
• Case studies and exercises

Question 9

How has health data been used for advocacy in the case of land mines?

Answer 9

• 90% of landmine victims are civilians
• They destroy infrastructure, mean fields cannot be cultivated and prevent the return of refugees and IDPs
• They cause disability, demoralisation, unemployment, social stigmatisation and economic hardship for families and communities
• Women have a higher deathrate from landmines
• A disproportionate number of victims are children

Question 10

Describe the success of advocacy on the health consequences of landmines

Answer 10

• ‘Buried or “point-detonating” anti-personnel mines are the only weapons in widespread use which cause specific and
  severe injury resulting in specific and permanent disability.
• The treatment of the injury requires, on average, twice as many operations and four times as many blood transfusions as an injury from other weapons.
• This is a surgeon’s view.’

Question 11

What are the health consequences of explosive violence in built up areas?

Answer 11

• AOAV Explosive Violence Monitor 2023
• Explosive weapons were responsible for over 47,476 deaths and injuries globally, the highest levels recorded since 2010 (when they started recording).
• Out of the total number of casualties, over 34,791, or 73%, were civilians.
• 90% of those killed and injured by explosive weapons in towns and cities were civilians – compared to 13% in other areas.
• Global incidents of explosive weapons use surged by 70%, alongside a 67% spike in civilian casualties and a staggering 130% rise in civilian fatalities compared to 2022.

Question 12

What were the attacks on healthcare as a result?

Answer 12

• In 2023 the SHCC documented 2,562 incidents of violence against, or obstruction of, health care in conflicts across 30 countries, regions and territories.
• Incidents increased by 25% in 2023 compared to 2022.
• 487 health workers were killed, 445 arrested and 240 kidnapped
• Health facilities were damaged or destroyed in 625 incidents.

Question 13

What were the attacks on health workers in Gaza like?

Answer 13

• By January 5 2024 613 people had died within health facilities in the Occupied Palestinian Territory in the three months since 7 October 2023
• 606 in Gaza and seven in the West Bank
• And more than 770 have been injured
• According to latest data on healthcare attacks from the World Health Organization (WHO)

Question 14

What are the challenges of using health data?

Answer 14

• Exercise monitoring mortality in Iraq
• Iraq body count
• Two random cluster sample surveys
• Ministry of health mortality data
• Iraq living conditions survey

Question 15

List some other methods of using health data

Answer 15

• Gathering information from media sources in a thorough and methodical way
• Two random cluster sample surveys
• Mortality records from the national health information system D. a door-to-door interview survey using a larger random sample (mortality was one question among many).