WHO’s surveillance system for attacks on health care is failing Ethiopia

First Published: March 26, 2022

An increased disregard for international law in armed conflicts and humanitarian crises endangers health-care facilities and the health workers prompted global institutions to develop systematic monitoring mechanisms. In response, the World Health Assembly adopted WHA65.20,


 a resolution calling on WHO’s director-general to “Provide leadership at the global level in developing methods for systematic collection and dissemination of data on attacks on health facilities, health workers, health transports, and patients in complex humanitarian emergencies, in coordination with other relevant UN bodies, other relevant actors, and intergovernmental and non-governmental organizations.”


Following the WHA65.20 resolution in 2015, WHO established the Attacks on Health Care initiative as a priority of WHO’s Health Emergencies Programme. Provision of essential, lifesaving health services to emergency-affected populations unhindered by any form of violence or obstruction is the vision of the initiative. The Surveillance System for Attacks on Health Care (SSA) is one of the primary outputs of this initiative. Advocacy against attacks on health care, and providing evidence on the effectiveness of practices to minimise attacks and mitigate the consequences of attacks are the two initiatives of the surveillance system. The SSA is supposed to systematically collect data on attacks on health care, and produce and release the report online immediately after the event. This surveillance system would facilitate accountability through global health governance, improve the visibility of the SSA within WHO and throughout the UN, analyse data to support engagement with perpetrators, and strengthen the SSA as an effective mechanism to safeguard health and human rights. However, the incompetence of WHO in fulfilling its mandate on the issue potentially undermines efforts to engage with those who attack health-care facilities, and weakens efforts to prevent future attacks.


A war has been going on in northern Ethiopia since the Tigray People Liberation Front attacked the Ethiopian federal army bases in the Tigray region on Nov 4, 2021. The war led to the damage and looting of more than 40 hospitals, 453 health centres, 1850 health posts, four blood banks, one oxygen bank, and the displacement of more than 10 000 health workers in Amhara regional state, serving over 30 million people.




 In Afar regional state, one hospital, 17 health centres, and 42 health posts were attacked—their infrastructure, medical equipment, and supplies were destroyed, looted, and wrecked. The destruction left the regional state health system on the brink of collapse, and left millions of people without access to basic health-care services. Despite the destruction and lootings of health facilities, pharmaceutical stores, and ambulatory care services in the conflict regions, the WHO SSA published zero reports. As a result of inaction by WHO, millions of people are exposed to health-care crises, which leaves us wondering why there has been no action by WHO


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