背景:对医疗保健的攻击进一步削弱了中非共和国本已脆弱的卫生系统。我们调查了三个受冲突影响的县-瓦卡对医疗保健的袭击,Haute-Kotto,和Vakaga-从2016年到2020年。这项研究的目的是深入了解袭击对医护人员的直接和长期影响,设施,供应链,护理质量,以及卫生系统的其他组成部分。我们对事件进行了定性描述,评估其影响,确定缓解努力,讨论复苏面临的挑战。
方法:我们使用目的性和雪球采样来识别研究中的参与者。与行政和卫生当局进行了半结构化的关键线人访谈,一线人员,和非政府组织的工作人员。采访是在桑戈完成的,法语,或英语。对记录的访谈进行转录,并对未记录的访谈进行笔记。成绩单和笔记使用归纳编码进行分析,允许参与者的反应来指导发现。
结果:在研究期间确定的126次攻击中,36个关键线人讨论了39次攻击。袭击包括杀戮,身体和性侵犯,绑架,纵火,用手榴弹炮击,掠夺,职业,口头威胁。暴力事件导致长期关闭和医疗服务短缺,不成比例地影响弱势群体,比如五岁以下的孩子,或者是老年人,长期患病,或流离失所。由于反复的攻击和无法提供足够的护理,医护人员面临心理创伤和道德伤害。人员和社区为减轻影响做出了巨大努力,并倡导援助。它们受到失败的报告机制的限制,持续的不安全,持续缺乏资源和外部支持。
结论:存在保护医疗保健免受暴力侵害的有效策略,但对社区和卫生工作者的更好支持至关重要,包括评估需求的措施,增强安全性,并通过快速重建促进恢复,补给,和重新配置人员设施。CAR\的政府,国际组织,捐助方应作出一致努力,改善报告机制,结束肇事者有罪不罚的现象。他们对社区组织和长期卫生系统支持的投资,特别是对卫生工作者的培训,工资,和社会心理护理,是建立抵御和减轻攻击对医疗保健影响的重要步骤。
BACKGROUND: Attacks on healthcare have further weakened the already fragile health system in the Central African Republic. We investigated attacks on healthcare in three conflict-affected prefectures-Ouaka, Haute-Kotto, and Vakaga-from 2016 to 2020. The study aim was to gain an in-depth understanding of the immediate and long-term effects of attacks on healthcare workers, facilities, supply chain, quality of care, and other components of the health system. We provide a qualitative description of the incidents, assess their impacts, identify mitigation efforts, and discuss challenges to recovery.
METHODS: We used purposive and snowball sampling to identify participants in the study. Semi-structured key informant interviews were conducted with administrative and health authorities, front-line personnel, and staff of non-governmental organizations. Interviews were done in Sango, French, or English. Recorded interviews were transcribed and notes taken for non-recorded interviews. Transcripts and notes were analyzed using inductive coding, allowing participant responses to guide findings.
RESULTS: Of 126 attacks identified over the study period, 36 key informants discussed 39 attacks. Attacks included killings, physical and sexual assault, abductions, arson, shelling with grenades, pillage, occupations, and verbal threats. The violence led to extended closures and debilitating shortages in healthcare services, disproportionately affecting vulnerable populations, such as children under five, or people who are elderly, chronically ill, or displaced. Healthcare workers faced psychological trauma and moral injury from repeated attacks and the inability to provide adequate care. Personnel and communities made enormous efforts to mitigate impacts, and advocate for assistance. They were limited by failed reporting mechanisms, ongoing insecurity, persistent lack of resources and external support.
CONCLUSIONS: Effective strategies to safeguard healthcare from violence exist but better support for communities and health workers is essential, including measures to assess needs, enhance security, and facilitate recovery by quickly rebuilding, resupplying, and re-staffing facilities. CAR\'s government, international organizations, and donors should make concerted efforts to improve reporting mechanisms and end impunity for perpetrators. Their investment in community organizations and long-term health system support, especially for health worker training, salaries, and psychosocial care, are vital steps towards building resilience against and mitigating the impacts of attacks on healthcare.