A/68/297 detrimental to mental health patients, some of whom may require continuous treatment. 25 D. Attacks on health facilities and health-care workers 26. Destruction of health infrastructure by States, or failure to protect against such destruction by third parties, impairs the availability and accessibility of quality health facilities, goods and services. Intentional targeting of health facilities also constitutes a violation of the principle of distinction under international humanitarian law, which obliges parties to the conflict to refrain from attacking medical personnel, units, material and transports unless they are used to commit hostile acts outside their medical and humanitarian functions. Acts that do not involve specific targeting of health facilities may also violate the right to health where the acts increase the risk of damage to the facility or decrease patient access to it, such as by locating military outposts or weapons in the vicinity of a clinic. 27. Health-care workers are essential for ensuring availability of health-care services. States therefore have an immediate and continuous obligation to provide health-care workers and humanitarian organizations with adequate protection during periods of conflict. 28. Attacks on health workers including assaults, intimidation, threats, kidnapping, and killings, as well as arrests and prosecutions, are increasingly used as a strategy in conflict situations. 26 Conflict-affected areas have recorded disruption in supply chains, looting of health facilities, demanding of confidential information about patients, intentional and recurrent shelling and bombardment of clinics and hospitals, and shooting at ambulances carrying patients to target civilians and health-care workers as a military strategy. 27 In countries with poor health infrastructure, as may be the case with most conflict-affected regions, destruction of even a single hospital or attacks on already scarce health-care workers can have a devastating impact on the availability and accessibility of health services and therefore on public health. 28 Furthermore, health-care workers may condemn the actions of security forces or may not cooperate in providing information about patients where laws may violate fundamental human rights. Such health-care workers may frequently be harassed, relocated, tortured, arrested and sentenced. 29 __________________ 25 26 27 28 29 13-42297 Bayard Roberts and others, “Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan”, BMC Psychiatry, vol. 9, No. 7 (2009), pp. 7-8. Available from www.biomedcentral.com/content/pdf/1471-244X-9-7.pdf. Saúl Franco and others, “The effects of armed conflict on the life and health in Colombia”, Ciência & Saúde Coletiva, vol. 11, No. 2 (June 2006), p. 357; John M. Quinn and others, “Iraqi physician brain drain in prolonged conflict”, The New Iraqi Journal of Medicine, vol. 7, No. 1 (April 2011) pp. 91-92; Leonard S. Rubenstein and Melanie D. Bittle, “Responsibility for protection of medical workers and facilities in armed conflict”, Lancet, vol. 375, No. 9711 (23 January 2010), p. 332. Human Rights Watch, “Sri Lanka: repeated shelling of hospitals evidence of war crimes”, 8 May 2009. Available from www.hrw.org/news/2009/05/08/sri-lanka-repeated-shelling-hospitalsevidence-war-crimes. ICRC, “Health care in danger: a sixteen-country study” (Geneva, July 2011), p. 3. Available online in English only from www.icrc.org. PHR, “Under the gun”, p. 6; Médecins Sans Frontières (MSF), “Syria two years on: the failure of international aid”, special report (New York, 6 March 2013). Available from www.doctorswithoutborders.org/publications/article.cfm?id=6669. 9/24