Measurement of attacks and interferences with health care in conflict: validation of an incident reporting tool for attacks on and interferences with health care in eastern Burma

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• 作者：Rohini J Haar (6)
  Katherine HA Footer (7)
  Sonal Singh (8)
  Susan G Sherman (9)
  Casey Branchini (10)
  Joshua Sclar (11)
  Emily Clouse (8)
  Leonard S Rubenstein (12)
  
  6. Department of Emergency Medicine ; St. Luke鈥檚-Roosevelt Hospital ; 1111 Amsterdam Avenue ; New York ; NY ; 10026 ; USA
  7. Johns Hopkins Bloomberg School of Public Health ; 615 N. Wolfe St. E7141 ; Baltimore ; MD ; 21205 ; USA
  8. Department of Epidemiology ; Johns Hopkins Bloomberg School of Public Health ; 615 N. Wolfe St. E7141 ; Baltimore ; MD ; 21205 ; USA
  9. Johns Hopkins Bloomberg School of Public Health ; 615 N. Wolfe Street ; E6543 ; Baltimore ; MD ; 21205 ; USA
  10. Department of International Health ; Johns Hopkins Bloomberg School of Public Health ; 615 North Wolfe Street ; Baltimore ; MD ; 21205 ; USA
  11. Johns Hopkins Bloomberg School of Public Health ; 615 N. Wolfe St. WB 602 ; Baltimore ; MD ; 21205 ; USA
  12. Johns Hopkins Bloomberg School of Public Health ; Center for Public Health and Human Rights ; 615 N Wolfe Street ; E7148 ; Baltimore ; MD ; 21205 ; USA
  
• 关键词：Conflict ; War ; Attacks on healthcare ; Health workers ; Violence ; Medicine ; Safeguarding health ; Health protection ; Health and human rights ; Humanitarian law
• 刊名：Conflict and Health
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：8
• 期：1
• 全文大小：523 KB
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• 刊物主题：Medicine/Public Health, general; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1752-1505

文摘

Background Attacks on health care in armed conflict and other civil disturbances, including those on health workers, health facilities, patients and health transports, represent a critical yet often overlooked violation of human rights and international humanitarian law. Reporting has been limited yet local health workers working on the frontline in conflict are often the victims of chronic abuse and interferences with their care-giving. This paper reports on the validation and revision of an instrument designed to capture incidents via a qualitative and quantitative evaluation method. Methods Based on previous research and interviews with experts, investigators developed a 33-question instrument to report on attacks on healthcare. These items would provide information about who, what, where, when, and the impact of each incident of attack on or interference with health. The questions are grouped into 4 domains: health facilities, health workers, patients, and health transports. 38 health workers who work in eastern Burma participated in detailed discussion groups in August 2013 to review the face and content validity of the instrument and then tested the instrument based on two simulated scenarios. Completed forms were graded to test the inter-rater reliability of the instrument. Results Face and content validity were confirmed with participants expressing that the instrument would assist in better reporting of attacks on health in the setting of eastern Burma where they work. Participants were able to give an accurate account of relevant incidents (86% and 82% on Scenarios 1 and 2 respectively). Item-by-item review of the instrument revealed that greater than 95% of participants completed the correct sections. Errors primarily occurred in quantifying the impact of the incident on patient care. Revisions to the translated instrument based on the results consisted primarily of design improvements and simplification of some numerical fields. Conclusion This instrument was validated for use in eastern Burma and could be used as a model for reporting violence towards health care in other conflict settings.