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Reality makes our decisions: ethical challenges in humanitarian health in situations of extreme violence

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This project explored the ethical challenges humanitarian health organisations face in situations of extreme violence against civilians, particularly when healthcare facilities and personnel become targets in the conflict. Its objective was to provide processes and mechanisms as well as practical tools to guide humanitarian health organisations through complex ethical challenges facing them in these settings.

The project originated as a result of the challenges international and local non-governmental organisations (NGOs) and front-line health workers face as a result of violence inflicted on hospitals and health workers in Syria. At times, individuals in these settings must forgo compliance with core ethical commitments, choose to comply with one ethical obligation at the expense of another, or to take an action where no obviously right action exists. For example, when a hospital is attacked and cannot continue operations, is it better to rebuild at the same location or move to a safer one farther away—even when doing so may hinder access to health care for some individuals and communities? How much deference should be shown to local communities that do not want a hospital nearby because they may be at risk of further shelling or bombing from targeted campaigns?

Although the research focused on Syria, the recommendations that flow from the project may be useful in other violent contexts where humanitarian organisations work.

This report is a collaboration among the Center for Public Health and Human Rights, Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health; the International Rescue Committee; and the Syrian American Medical Society

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