What works and who knows? The importance of community and health worker perspectives in defining solutions to attacks on healthcare1,2,3,4

Abstract

Attacks against healthcare are increasingly a strategy of modern warfare, with devastating short and long-term impacts on health staff, patients, and the health system as a whole. What is the solution? Communities play a significant role in protecting healthcare in war zones, as do health workers and civil society networks. We argue existing methods can help identify operationally-relevant solutions in a timely way, facilitating response strategies co-designed with those most affected and in support of existing capacities. This commentary draws on three studies in Nigeria, South Sudan, and Democratic Republic of Congo (2022-2024) that examined health worker and community perspectives on attacks on healthcare and about response priorities in order to inform strategies to prevent attacks and reduce their impact. Here we identify two additional contributions of this research approach. First, these studies document contextually-relevant responses of community- and health worker-defined actions and priorities. Second, they provide new insights on how health worker and community perspectives can be gathered in a timely way, considering the many competing priorities of health workers and people exposed to conflict. They elicited what affected people prioritise, when asked. As such, the approaches are relevant for operational actors working in all areas where people face systematic violence against healthcare.

Keywords: Attacks on healthcare; Community perspectives; Conflict; DRC; Healthcare workers; Impact; Nigeria; Participatory approaches; South Sudan.