Working safely when health care is under attack
In many conflicts, clinics, ambulances, health workers and patients are threatened, obstructed or attacked. Each attack harms the people hurt in it and also everyone who can no longer reach care. Health teams cannot stop attacks, but they can reduce risk, protect patients and their information, and make sure attacks are recorded.
- For clinicians, clinic leads and health coordinators in conflict-affected settings
- Reviewed October 2026
What counts as an attack on health care
WHO defines an attack on health care as any act of verbal or physical violence, obstruction or threat of violence that interferes with the availability, access and delivery of curative or preventive health services during emergencies.
Attacks range from heavy weapons to threats and intimidation. WHO's Surveillance System for Attacks on Health Care (SSA), running since December 2019, records attacks that affect:
- health facilities
- transport, including ambulances
- health personnel
- patients
- medical supplies
- warehouses
Examples of types of attack include violence with individual or heavy weapons, psychological violence and intimidation, armed or violent searches, removal of health care assets, setting fire to health resources, militarisation of facilities, and abduction, arrest or detention of health workers or patients.
Source: WHO Surveillance System for Attacks on Health Care (SSA)
Neutrality, impartiality and acceptance
- Treat on need alone: care for the wounded and sick without distinction, including people from all sides.
- Be seen to be neutral: parties to a conflict, the community and patients may not understand this, so explain it often.
- No weapons inside the facility or ambulance. Weapons are left outside. This keeps the space neutral, reduces tension and can stop the facility becoming a target.
- Location matters: a facility next to a military camp may be seen as taking sides.
- Acceptance by the community, officials and parties to the conflict is one of the strongest protections. Good-quality, fair care builds it.
- Physical security measures protect staff and patients, but think about how they look to the public: a clinic that looks like a fortress may lose trust.
Source: Sphere Handbook 2018, health chapter: special considerations to protect health care
Keeping staff and patients safe
- Know your organisation's security plan: who decides, how you communicate, and when to stop work, stay put or move.
- Agree with the team what to do if armed people enter the clinic: stay calm, do not resist, protect patients, and report afterwards.
- Keep a list of staff on site each day and a way to account for everyone.
- Plan how to keep the most essential care going if the clinic must close: medicines handed out in advance, community health workers, mobile or remote follow-up.
- Keep patients' medicines and records portable where possible (a patient-held card).
- Plan emergency referral routes that avoid known danger, and agree what to do when roads are closed.
These are general good-practice points: follow your organisation's security rules and the advice of your security focal point.
Protecting patients and their information
- Confidentiality of medical information and personal data is part of neutrality: never hand records to armed actors or authorities without the patient's consent unless the law clearly requires it and your organisation agrees.
- Collect only what you need for care. In conflict, a diagnosis, a place of origin or an injury pattern can put a patient in danger.
- Store paper records securely, and know which records you would take or protect if you had to leave quickly.
- Share only aggregate data in reports, unless there is a clear clinical reason.
- Survivors of sexual violence, detainees and people with conflict injuries need particular care with records.
Source: Sphere Handbook 2018 (protecting health care; health information standard 1.5)
Documenting and reporting an attack
Reliable records help to show what is happening, and support advocacy for the protection of health care. WHO collects reports through its SSA, usually through WHO country offices and health partners.
| Record | Examples |
|---|---|
| When and where | Date, time, place, name of the facility or route |
| What happened | The type of attack, in plain words, without speculation |
| What was affected | Facility, transport, staff, patients, supplies, warehouse |
| The impact | Number of people killed or injured (staff and patients separately); damage; services stopped and for how long |
| Source | Who reported it, and whether you saw it or heard it from others |
- Report through your organisation and the health cluster, following the agreed procedure.
- WHO grades each report as rumour, possible, probable or confirmed; rumours are not published. Say clearly what you are sure of and what you are not.
- WHO's system does not collect or verify information on who carried out an attack. Do not put yourself or others at risk to find out.
- Protect the identity of staff and patients in any report.
Source: WHO Surveillance System for Attacks on Health Care (SSA)
After an incident
- Care for the injured and make the site safe.
- Account for all staff and patients.
- Report to your organisation's security focal point and through the agreed route.
- Decide with your organisation whether and how to keep services going.
- Tell the community what services are available and where.
- Offer psychological first aid and follow-up support to staff and patients.
Looking after the team
- Working under threat is exhausting. Staff can develop stress-related problems such as burnout and vicarious trauma.
- Offer psychological first aid after frightening events, and access to mental health care for staff who need it.
- Protect rest, rotate difficult duties and keep in touch with families.
- Supervision and team meetings help people talk about what they have seen.
We treat everyone who is sick or injured, whoever they are. Please leave weapons outside, so that this clinic stays safe for all patients.
Source: WHO, UNFPA, UNHCR 2020 (provider well-being); mhGAP-HIG 2015
Sources
- World Health Organization. Surveillance System for Attacks on Health Care (SSA): definition, data dashboard and methodology. 2019. Launched December 2019; pages accessed October 2026.
- Sphere Association. The Sphere Handbook, fourth edition (health chapter: special considerations to protect health care). 2018.
- World Health Organization, UNFPA and UNHCR. Clinical management of rape and intimate partner violence survivors: developing protocols for use in humanitarian settings. 2020.
- World Health Organization and UNHCR. mhGAP Humanitarian Intervention Guide (mhGAP-HIG). 2015.