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Table 2 Potential Future Steps in Studying Attacks on Health in Conflict

From: Violence against healthcare in conflict: a systematic review of the literature and agenda for future research

Agenda on Improving Data Collection and Utilization • Explicit definitions and descriptions of key terms, such as conflict and attacks would aid in better understanding of the topic and allow for more comparisons across professions and conflicts.
• The ‘misuse of health facilities and ambulances for military purposes’ category will be critical to include on ongoing data collection mechanisms, as it allows for documenting significant attacks that are not well-classified into the other discrete categories.
• Given the redundancy in data collection, with multiple actors collecting and collating data in the same areas, there must be more availability of and accessibility to disaggregated data (with all the security precautions) to make this work more efficient.
• Continued research on attacks on health and on civilian protection in conflict must become a bigger funding priority.
Agenda on Deepening Research • Exploration of gender dynamics in attacks on health, both in terms of the gendered nature of forms of attack and the broader gendered impacts that attacks may generate, will be a critical next step.
• Disentangling the experiences and perceptions of expatriate, national and local health workers, their interactions with each other and with the community, especially in settings of insecurity and where they may work together closely but have different experiences and responses. It is especially important to consider the overlapping and intersectional nature of these identities and to distinguish the specific vulnerabilities they raise (e.g., the differences, between a local health worker working in their national health service and a local health worker working for an international NGO).
• Legal analysis of the weaknesses of IHL, such as data on the number of prosecutions and their outcomes, potentially linked to a better understanding of other IHL protections if they exist. Legal analysis could also continue to explore other accountability mechanisms, such as the United Nations Security Council, the ICC, ICJ and local, national or regional courts.
• There must be more in-depth analysis and discussion of chronic and/or small-scale attacks as there is early evidence that these can be insidious and have reverberating impacts on the community and health workers.
• The geographic focus of research needs to continue to be expanded, as attacks are known to be global and pervasive.
• Studies looking at the cumulative impacts of attacks, including behavioral changes, population movements, or health outcomes would expand our knowledge of the effects of attacks.
• More research is needed on perpetrators and intentionality, especially on the dynamics in specific contexts and conflicts. With better understanding of why specific attacks happen in specific conflicts it will be possible to design more effective protection strategies and interventions designed to elicit behavior change in perpetrators.
• Research which analyses the processes of collecting data on attacks on health and how it may be used operationally among humanitarian organizations to protect from future attacks would provide valuable insights.
Agenda on achieving meaningful change: • Utilizing ICC, ICJ and national frameworks for legal accountability in addition to traditional IHL frameworks.
• It goes without saying that perpetrators need to curb their attacks on health. More research into perpetrator motives and the operationalization of insights from research into what influences the behavior of armed groups is necessary for this [93, 94].
• Allocating resources to disseminate research to local and national actors.
• Involving and engaging survivors and local actors in all levels of the research and dissemination.