Security Council Distr.: General 29 March 2019
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United Nations S/2019/278 Security Council Distr.: General 29 March 2019 Original: English Letter dated 14 March 2019 from the Permanent Representative of Sweden to the United Nations addressed to the President of the Security Council On 21 December 2018, Sweden and France partnered with Belgium, Côte d’Ivoire, Germany and Peru to host an Arria formula meeting on the protection of health care in armed conflict (see the concept note for the meeting, annex I). The purpose of the meeting was to take the important debate on the protection of health care in armed conflict – and the implementation of Security Council resolution 2286 (2016) – from policy to practice, to the country contexts where its implementation matters the most. Another objective was to identify key actions and support measures needed to strengthen the protection of medical care. Please find attached to the present letter – as a contribution to the further work in New York and beyond – a report that summarizes the discussions and main findings of the meeting (see annex II). I would be grateful if, in your capacity as President of the Security Council for the month of March 2019, you could have the present report and its annexes circulated as a document of the Security Council. (Signed) Olof Skoog On behalf of the six co-hosts Ambassador Extraordinary and Plenipotentiary Permanent Representative 19-05327 (E) 030419 *1905327* S/2019/278 Annex I to the letter dated 14 March 2019 from the Permanent Representative of Sweden to the United Nations addressed to the President of the Security Council Concept note for the Arria formula meeting on “Protecting medical care in armed conflict – from policy to practice”, hosted by the Permanent Mission of Sweden to the United Nations, in partnership with the Permanent Missions of Belgium, Côte d’Ivoire, France, Germany and Peru on 21 December 2018 in New York Objective 1. Reiterate the need to protect medical care in armed conflict and implement Security Council resolution 2286 (2016). 2. Take discussion from policy to practice by looking at country-level challenges and implications with field-level practitioners. 3. Identify key actions and support measures needed to strengthen the protection of medical care in the field. Background International humanitarian law is clear – parties to conflict must search for, collect, evacuate and provide medical treatment to the wounded and sick, regardless of whether they are combatants or not, regardless of which side they belong to. This is the very foundation of contemporary international humanitarian law. Attacks against medical care in situations of armed conflict are prohibited. Medical personnel, transport and facilities exclusively assigned to medical duties must be respected and protected in all circumstances. Punishing a person for performing medical duties compatible with medical ethics or compelling a person engaged in medical activities to perform acts contrary to medical ethics is prohibited. Attacks directed against medical personnel and objects displaying the distinctive emblems of the Geneva Conventions in conformity with international law are war crimes. The landmark Security Council resolution 2286 (2016), adopted in May 2016, reiterates the legal framework that protects the wounded and sick and those endeavouring to assist them in situations of armed conflict. Resolution 2286 (2016) reaffirms applicable law by clearly stating that States have an obligation to ensure the protection of all the wounded and sick, medical personnel and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment, as well as hospitals and other medical facilities, in situations of armed conflict. The Council has confirmed these obligations in a number of resolutions. Only in 2018 the Council has condemned attacks on health care and called for respect for obligations under international law, inter alia, in resolutions 2401 (2018) on Syria, 2405 (2018) on Afghanistan, 2406 (2018) on South Sudan, 2409 (2018) on the Democratic Republic of the Congo, as well as in thematic resolutions 2417 (2018) on conflict and hunger, 2427 (2018) on children and armed conflict and 2439 (2018) on Ebola. However, there is a steady and often daily flow of horrendous reports from conflict situations around the world of attacks against medical facilities, transport and personnel: and this is just the tip of the iceberg. Access to medical care is often impeded by parties to conflict in more insidious, less visible ways: doctors and nurses are threatened or attacked for performing their duties; medical equipment is looted; and ambulances are prevented from reaching those in need. 2/6 19-05327 S/2019/278 The World Health Organization has reported 583 attacks on health care to date in 2018, resulting in 132 deaths and 742 injuries, each of them equally unacceptable. In recent years, the United Nations and Member States have strengthened their response, notably following the adoption in May 2016 of resolution 2286 (2016) and – later the same year – the presentation of a set of concrete recommendations by the Secretary-General to enhance the protection of medical care in armed conflict. Additional efforts have been made to maintain and reinforce multilateral momentum for the protection of medical care in armed conflict, including through the organization of successive high-level side events and seminars in New York and the signing of a political declaration on the protection of humanitarian and health workers on 31 October 2017. Progress has been made in a number of areas, including monitoring within the United Nations system; however, the situation as regards the protection – or lack thereof – of medical care in armed conflict remains unacceptable and the current trends worrisome. Most importantly, there is still often a clear gap between the principles and priorities set out in Security Council and General Assembly documents and the real-life behaviour of parties to armed conflict – a gap between norms and practice that unfortunately is not uncommon under the protection of civilians agenda. In view of this, the purpose of the Arria meeting – open to the whole United Nations membership, as well as stakeholders in civil society – will be to take the debate on the protection of health care in armed conflict and the implementation of United Nations Security Council resolution 2286 (2016) from policy to practice, to the field level and to the country contexts where its implementation really matters the most. The meeting will focus on two country situations, Afghanistan and South Sudan, hear from practitioners dealing with health-care issues in those two countries and with the aim of identifying a set of key measures that could be taken by national Governments, international partners and/or the United Nations system to improve the situation and reverse current trends. Programme Introductory remarks Olof Skoog, Permanent Representative, Sweden Legal framework and the main challenges for protecting medical care in conflicts Alice Debarre, Policy Analyst, Humanitarian Affairs, International Peace Institute Experiences from medical practitioners in the field Farhad Javid, Country Director, Marie Stopes International, Afghanistan Dr. Evan Atar Adaha, Medical Director, Maban Hospital, South Sudan Statements by co-hosts, other Council Members and – time permitting – other participants Concluding remarks 19-05327 3/6 S/2019/278 Annex II to the letter dated 14 March 2019 from the Permanent Representative of Sweden to the United Nations addressed to the President of the Security Council Summary report of the Arria formula meeting on “Protecting medical care in armed conflict – from policy to practice”, held in New York on 21 December 2018 On 21 December 2018, Sweden – in partnership with Belgium, Côte d’Ivoire, France, Germany and Peru – hosted an Arria formula meeting on the protection of health care in armed conflict. The purpose of the meeting was to take the important debate on the protection of health care in armed conflict – and the implementation of Security Council resolution 2286 (May 2016) – from policy to practice, to the field level and to the country contexts where its implementation matters the most, as well as to identify key actions and relevant support measures needed to strengthen the protection of medical care. The present report summarizes the discussions and main findings of the meeting. The meeting was opened by Olof Skoog, Permanent Representative of Sweden to the United Nations, who recalled that, despite some progress on the policy side (notably the adoption of Security Council resolution 2286 (2016) in May 2016), there was still a steady and almost daily flow of horrendous reports from conflict situations around the world of attacks against medical facilities, transports and personnel – “there is a wide and unacceptable gulf between what is said and what is done”. Following that introduction, Alice Debarre of the International Peace Institute then set out the legal framework for the subject matter and pointed to the robust and longstanding rules and principles of international humanitarian law in relation to medical care in armed conflict. Ms. Debarre underlined the importance of resolution 2286 (2016), which reaffirms international humanitarian law and calls for respect for and implementation of those rules. Ms. Debarre then pointed to three main challenges to its implementation: first, lack of accountability; second, inadequate or burdensome national legislation