 Thank you so much Julia and thank you all for joining and a good day to you whatever you are dialing in from. From Ukraine to Afghanistan to Yemen and Sudan and most recently in Gaza, civilians continue to pay the highest price when healthcare is under attack. For anyone who has watched the news over the past few weeks, it is clear that attacks against healthcare are a grave threat to everyone living in areas affected by conflict. The impacts of the attacks on healthcare workers and facilities are simply devastating. Protection and health teams in over the past few years have implemented protection centered health interventions to reduce the impacts of attacks against healthcare. In this session today, we will look at different operational level best practice interventions to reduce this type of violence, as well as the impact of the violence on the people affected. Practitioners from Syria, Yemen, South Sudan and Colombia will share their experiences with interventions that have supported the reduction in violence or have supported communities to cope with the impacts of such attacks. They will speak to the collaboration between health and protection teams and what it takes to prevent and mitigate impacts of attacks on healthcare. I'm pleased to introduce our first speaker, Samira Tikka from IRC, whole of Syria. She is the protection cluster co-lead. She will share with us about protection of civilians and healthcare facilities in armed conflict, its scope and definition and the impact of attacks on healthcare. Over to you, Samira. Thank you so much Jane and hello everyone. So as we all know the protection of civilians and healthcare in armed conflict is a critical aspect of international humanitarian law and human rights law. International humanitarian law, especially the Geneva Conventions and their additional protocols provide clear protection for medical personnel, medical vehicles, facilities and patients during armed conflict. And this protection also includes a principle of distinction which requires partners of the conflict distinguish between civilians and combatants and between civilian objects and civilian and military targets. Even the combatants if they are not engaged in hostilities anymore are still protected under international law. Also international humanitarian law under IHL, any attack that deliberately targets healthcare facilities or does not take appropriate measures to avoid destruction of healthcare facilities is illegal. Therefore, we see the principle of proportionality and distinction here are applicable. IHL also get the primary responsibility for protection of civilians and of health care to the states and the parties that are controlling the geographic area where the civilian population are located. That also includes the non-state actors armed groups that are controlling those areas. So the responsibility is on the states and whoever is controlling the areas where civilian populations are located at. We also have in addition to this the UN Security Council Resolution 2286. The resolution was adopted in 2016 and is strongly condemned attack against medical personnel facilities, transport during the armed conflict and emphasis the need to respect and protect all of this. It also urges the state and parties to the conflict to develop effective measures to prevent, address and investigate these attacks. However, as Jane mentioned, as we have seen unfortunately despite having all of this legal framework and international norms, we see that in reality these laws are often ignored. We see the increase of attack on civilian infrastructure population. Like very recently in the past month we've seen hospitals are being attacked, targeted schools and civilian infrastructure unfortunately and that has led to countless of civilians and medical personnel's losing lives. We already in this year we've seen so far safeguarding health and conflict coalition has reported over 1500 attacks on healthcare and killing over 300 healthcare workers and I mean I'm sure this number is increasing even as we speak. So, generally these attacks include obviously direct violence in the form of bombing rates, withholding medical supplies, but also nonviolent interferences which is threatening, intimidating, arresting the healthcare workers and interferences with the healthcare. We also seeing the misuse of health facilities and ambulances for military purposes that occurs frequently and these are all against the violations of IHL. World Health Organization basically defines attack as any act of verbal or physical violence that obstructs or threatens to interfere with the availability and delivery of healthcare services during emergency and or with patients access to healthcare. So we see that access to healthcare is also an issue and attack on healthcare what we mean is attack on healthcare also include patients access to healthcare preventing access to healthcare. So some of the impacts of conflict on healthcare of course there are numerous dimension of the impacts that includes personal impact on health worker that includes death, injury, emotional distress that also applies to the patients. Patient could die, more injury, intimidation from seeking health and so on. We also have a destruction of healthcare facilities that seriously impact the health system where the population are affected by the conflict by reducing the availability, accessibility and functionality of the healthcare system. In a context where I work in Syria we have seen this attacks again healthcare facilities are system happening over the years. In some areas we have seen that it's basically has really weakened the healthcare system in some areas in the country. Many doctors have fled and basically leaving the system coping with health needs. We've seen many healthcare facilities are being built or relocated to geographic areas that are far away from the front lines and that's especially true in terms of with the protracted conflict situation that limits access to health services for community that are in conflict zones and that we have seen in the north-west Syria. I recently published a report in the north-west Syria where pregnant women for example reported that they have to travel a long distance to seek medical care. In some instances people are avoiding going to the healthcare or hospitals, fearing that those places become a target because it happened time and time again. In pregnant women for example the report actually was one of the findings that they opt for C-section instead of natural birth because they don't want to spend as much time in the hospital. In general there are reports of harmful coping practices people who need treatment or especially the patients who need regular treatments suffering from chronic diseases for example like treatment for the cancer or I don't know dialysis that they need regular visits or avoiding those visits which could negatively affect them in many cases has led to increased number of deaths that could have been easily preventable otherwise. So we discussed we've seen I mean there are legal frameworks and which most of the time are not being respected and the impact on healthcare. So it's today we're here to see what are some of the best practices that health and protection actors could do to support to prevent or reduction of the civilian harm from the attacks on healthcare and how to basically improve the health outcomes as well as the protection outcomes in terms in the cases where the attacks on healthcare is happening and impacted the population. As we know protection is fundamental to quality of health response and the quality health response contributes to the achievement of protection outcome. So I'm just going to give you some examples of operational level, operational level interventions and then in the following sessions we will look at some of them more closely. So advocacy and awareness raising it's very important. This has been done in various operation by jointly by protection and health actors or separately but it's to raise awareness about the importance of protecting healthcare facilities during the conflict at international and local levels. Also advocacy can put pressure on the partners to the conflict to adhere to the legal obligations to protect civilian and civilian infrastructure and to promote greater accountability for violations of IHL. Also establishing or strengthening the existing mechanisms for documenting attack and monitoring attack on healthcare facilities and personnel. These reports are also very important and are being used to develop protection, health and legal intervention response and also to generate support for protection efforts and are being used as advocacy tools basically. Example is a WHO surveillance system for attacks on healthcare in conflict. We also have seen training healthcare workers and security personnel from IHL could be useful in basically training on the IHL and the rules of protecting healthcare facilities. This can help to prevent accidental violations and ensure compliance. Humanitarian negotiations this also I think is very has so far proven to be effective. Of course that depends on the context that we are operating in but engaging in negotiation with parties to the conflict to basically secure the commitment to protect healthcare facilities for example and allow safe access to medical personnel and humanitarian aid. It's really important we have seen that's not just for protecting health facility but also schools and other civilian infrastructure especially health and schools and therefore is applicable to other sectors as well. Immediate response and emergency response intervention jointly done by protection and health to reduce barriers that people face in access and healthcare during the armed conflict. This could be I don't know include cash based intervention and to reduce like maybe there are additional costs for transport as mentioned earlier and providing the you know the provision of information for alternative services. So, in short, these are some of the examples that we have seen, you know, in different contexts and operations around the world. Of course, these are, we're talking about very different contexts depending on who is in control of those territories whether they're states where we're dealing with non-state actors. You know the capacity in terms of access and, you know, having the actors on the ground and so on. So, as I mentioned, we're going to in the next presentation see some of the protection center. Health intervention and some of the promising practices from Yemen, South Sudan and Colombia's and we're hoping that this example could provide us, could provide the protection and health workers with useful tools, useful ideas to be able to mitigate or to reduce the impact of attacks on healthcare and on the population which were affected by it. With that, I give to Jane and thank you so much for your time. Thank you so much Samira for setting the stage for this discussion and sharing those insightful thoughts and examples of your own experiences in Syria on how protection and healthcare workers can work together to address these issues. I'm now pleased to introduce our next six speakers who will present their operational perspectives of best practices currently being implemented by protection and health clusters in South Sudan, Colombia and Yemen. From South Sudan, we have Dr. Mukesh, health cluster coordinator. We have Shehu from IRC South Sudan and we have James Key from UNIDO. We also have from Colombia Dr. Jose from ICRC and from Yemen we have Dr. Usan. Starting with the team in South Sudan, Dr. Mukesh, James and Shehu, could you help us understand the context in South Sudan and what you have learned from the response strategy? Thank you so much, Jane and colleagues greetings from South Sudan. As previous speaker has said, the centrality of protection is very important in what we are doing and how we are doing together health and protection cluster actors. Today I have a together with Shehu and James. Shehu represent international NGO and James represent national NGO and I represent cluster. So we will go through with how together we do the protection and health interventions together. So just to give you a background, next slide. South Sudan is facing worsening humanitarian crisis and many factors are responsible for current complex crisis. So conflicts going on, subnational violence is going on, food insecurity in many areas are under food insecurity, climate crisis and outbreaks. This is outbreaks currently is also going on, hepatitis E is there. So it's a complex humanitarian crisis and we are running and on so many fronts. In 2023, we are targeting 76% these are people in need and that's coming to 9.4 million. In here 2023 humanitarian response plan, we are targeting 55, so half of population and 72% of the people in need. Next slide please. For health, what we do is a three prong approach. We provide essential life saving health services. We address outbreak prone diseases, so manage disease outbreaks and we ensure that we are connected with other clusters or sectors which are very important in a various way. One of way is to referring pathways for MHPSS, GBB survivors and maternal and child health emergencies. We have a broad community. We use a community health system as a base to provide services in addition to mobile clinics and other static health services. Next slide. So let me hand over with these backgrounds how we work together. Sheu can give some practical experience and recommendations followed by James that how we take forward. So over to Sheu. Thank you so much Makesh and thank you Samira for giving a quick background on the situations around attacks on healthcare. Ideally not any healthcare provider need to die as a result of or need to be attacked as a result of his service to humanity. It is quite unfortunate but of course I would want to say that there have been a lot of research which has been conducted and of recently there was a safeguarding health in conflict reported that about 24 incidences of violence against and all obstructions on healthcare have been reported from South Sudan so far and within this year. And also we've seen that in every seven cases of attacks on healthcare workers, one of that is coming from one of those reports comes from South Sudan. That's to tell you how complex South Sudan is and of recent we have a cases where 10 healthcare workers were killed and also 20 healthcare workers were kidnapped. So that that really really have great impact on both not just only the health service providers but also to the services and to the beneficiaries we are serving. Some key scenarios where we have some key scenarios of incidences include a healthcare worker that was severely injured among other other key staffs and in that same year we had an incident where one of healthcare healthcare worker was killed. And also similarly we had a medical doctor as well who was equally killed within South Sudan and we had several cases of attacks both on the individuals staff and also on health facilities and also we have issues of vandalization where health facilities are being vandalized. And as well as the direct attack on the community where we serve and as well as on the beneficiaries. Next slide. Yeah so when we look at what we talk about attack on healthcare it also carries a lot of consequences which which could be on the direct health service providers itself and also on the on the community where we serve and also the general response. So one of the the the consequences on such kind of attacks would not will be on the humanitarian action. Definitely whenever there is an attack it on on healthcare mean that access becomes a big issue. So which will lead to suspension and as well as a closure of health health facilities which would also impact greatly on the humanitarian action in those communities. And also we've seen cases we've seen where such kind of attacks also impact on the health facilities where where the health facilities that are quite limited have been destroyed and also we've seen a lot of staff who have been injured had some a lot of physical injuries and also which they have to be evacuated out of the field. And in that case also it's it's it's it's it's have a great impact on service provision meaning that with the service service providers who are meant to be there to provide services will no longer be there. And we've seen also cases of some of the the staff who have been directly attacked also coming up with a lot of psychological torture which also requires a lot of psychological support for them. So we have to also evacuate those staff out of the field, which also impact greatly on the services and also significant reduction on health services. Health services also because as you all as you rightly know South Sudan have high rate of of maternal mortality and also one of the key issues around South Sudan as well is is that it is it's it's South Sudan have high rate of health and limited health facilities functioning. So with this with this kind of frequent attacks it's also go a long way to limit the the the access for women to access here. So that also increase the level of home deliveries which which trigger the high rate of maternal mortality and and then we have a lot of cases of disruption in supply chain for medical supplies, which is what really also impact the services. of humanitarian response in South Sudan. Next slide. So, when we look at this what is our recommendation we we look at it from trade from three dimension one as organizations or implementing partners within South Sudan. So we were looking at we need to also go along with improve on physical infrastructure of our, our, our service points, for example, creating parameter fencing, and also ensure that we reinforce put in more security just to provide some data in case there's any form of attack that may come. And also, we should be able to make use of early warning mechanisms but at the community level at government and also at interagency level to be able to get generate the right get the right information to be able to take action as as as as as possible. And then also creating of great feedback mechanism, good feedback mechanism for both the patients we serve and also their relatives will also go a long way to help us to get the right information about the services we are providing, and as well as to see if there are any issues that are needed to be addressed we'll be able to address them in a timely manner, and also existing use of existing monitoring and reporting mechanism, for example, the, the WHO surveillance system on on attacks, and also other reporting mechanisms, all those are reporting channels that could also be well utilized to be able to monitor the trends of attacks. And also, from the, as from the angle of the donors, we also need the donor to provide sufficient funding to meet identified health need, according to the humanitarian response framework. And also, we need a lot on advocacy, because most of these attacks that go on reported are not been advocated for so we are raising out our voice from South Sudan to say there's a high rate of attack in South Sudan, and we need a lot of advocacy on that regard. And in terms of government, we call advocacy and legal framework should be in place to be able to protect healthcare workers, to be able to protect assets, and as well to be able to protect the system, because healthcare workers were there to support the system where he did is to provide healthcare, and we were there to ensure that no any patient dies, or not in any patients is inflicted as a result of disease. But we are not, we should not be the targets. And also, stakeholders, consultants and sensitization, so there's consultations and sensitization on responsibilities and accountability. So we should be able to hold, hold, people should be hold accountable for their actions. And it should be done in the right manner. And I think that is what we are, we from the humanitarian platform in South Sudan are speaking out on a large force. So I'm going to give this opportunity for my colleague James to be able to take us through into some of the key areas that that just to throw people light on. John, over to you, please. Thank you. Thank you, Dr. Marquette and Cahoot and thank the colleague from the global. And yes, indeed, my name is James Care. I'm the executive director for UNIDO and UNIDO is a national end user in South Sudan. I'm happy to see Eva online. This is a good opportunity to see a long colleagues and a big thanks to the organizers of these meetings. So as my colleague presented, I'm going to also build on some of the recommendations that Cahoot have just recommended. And some of the lessons learned are on the positive for lesson learned on the process, but all of us will have to understand South Sudan fall into the project state. And I believe all of us on this platform are presenting the fragile in states at the UN definition of country with conflicts. So some of the lesson learned from the process of all these conflicts and the potential concern is that the government of South Sudan have shown the leadership and the ownership. And this is very important because whatever happens on the atrocity, whatever happened on the abduction of the advocates is the government that take the leadership, the government that take the ownership and that is very practical. So we have seen that and we do appreciate that. And the second thing that we also took out a good lesson learned is there has been a lot of, you know, like partnership between the international, the national, the UN agency and other actors like MSF, ICRC, South Sudan, So the humanitarian family has been moving together and work together and hear all the pain and hear all the challenges. The third thing that we have also taken as a lesson learned is actually on the engagement. Take an example of communication. In South Sudan, the clusters are doing an amazing job and I must admit as a local partner that a lot of services, a lot of fries that we are discussing today come from the clusters and that is a big thing to the UN family who are managing these clusters. So communication has been very much on top of everything and people are getting information and all that. Then the fourth thing is the integration and the mainstreaming of the both internal and external and cross cutting existing of practice. And this is something that is also going back to the clusters because clusters are the ones who are very much close to the implementing partners and the implementing partners are the ones that are actually working with the community. And the fifth thing that I just wanted to mention is the fact that the services delivery has been ongoing even if there is an insecurity because of the partnership between the national and the international and the UN agencies. So whenever there is an insecurity that will result into an evacuation, services are not in stock. So the local organization will remain on ground and will continue providing the services and report to the respective cluster and also to the lead of consortium. So those are some of the lessons learned and of course there are many, it's just because of time we only pick those few lessons learned and I'm so thankful to our class later. Thanks. Thank you so much. Dr. Mukesh Sheu and James from South Sudan for those examples that you have provided. We'll now move on to Latin American where we have Dr. Jose from ICRC in Colombia. Dr. Jose, could you explain to us how ICRC is implementing integrated health and protection interventions to reduce the impact of violence on healthcare? Over to you. Thank you very much. I will do my best in 10 minutes. It's a big challenge. Good afternoon, morning and evening to all of you from different parts of the world. It's a honor and I really have to thank the organizers to have invited ICRC and to have invited us to represent Latin America. Can we move to the next slide please? Colombia is the country of diversity, is the second biodiversity in the world and is the seventh in Guinea inequalities. It's a country, apparently a functional state with patches of a failed state under the control of armed groups that coexist with a functional state. This results in a humanitarian crisis that is less visible. It's according to Ocho Lazier, it's approximately 10 million people in need in Colombia. And this is for the figures there. Colombia has been the second country in the world among victims between 2009 and 2019. And in 2021 was the third country in internally displaced people due to the conflict. And this half of functional state that exists in Colombia has given rise to paradoxical situations like an extremely highly developed normative and protection of health care. About the situation of, can you click once more please, just to allow the animations to work okay. Violence against health care has been constantly reported. Colombia has also a very complex conflict with a non-international armed conflict with formally identified non-state armed groups. Leftist guerrilla, FARC, ELN and in a range now that coexist with organized crime. You will remember Pablo Escobar and a gang, urban violence groups. It's a very compounded and complex dynamics that hits health care repeatedly and brutally. As you can see that in the statistics, Ministry of Health among these fantastic developments, it has a system to report and keep track of violence against health care. As you can see from 2018 to 2022, we have quadrupled the number of attacks. And if we look at the homicides reported within the system, it has grown from 111, 133 in 2021 and 7 in 2023. We are really heading for a difficult situation. And as the ICRC has a confidential contact with health care staff personnel in the conflict affected areas, we know that like every reporting system has underreporting. But in this case, it has a qualitative underreporting. The ones that are not reported are the most severe events. We have regular verbal aggression by frustrated parents in the emergency department, common in the whole world. We have physical aggression. We have armed communities threatening and attacking health care. We have organized crime, extorting and theft of material. And we have security forces disrupting the service by heavy presence in the facilities or mostly non-state armed groups. We have regularly taken health care staff and taken it far away to take care of health staff, death threats, killings, etc. As I said, it's very complex. For all of these, the ICRC has, first since 1996, the ICRC hand-in-hand with the Ministry of Health and the Colombian Red Cross, identified this problematic and worked little by little step-by-step in developing a normative. A normative that includes a manual for implementation includes an inter-ministerial and institutional platform that conveys police, army, Ministry of Health, Ministry of Labor, and a few other institutions, civil institutions. To regularly, used to be monthly after COVID, we are having it try monthly or bi-yearly, to convey to discuss on the report, I think it's quite unique. Then the reporting system that I said in the epidemiological way to identify what the problem is and tailor the interventions to that. That is why the qualitative and the reporting is hiding the most severe events, and we are not tailoring the response to these most severe events. The ICRC has a comprehensive, inside the ICRC, completely multi-departmental and multi-approach health protection and legal advice IHL work really hand-in-hand with our FAST, which are the ones that our colleagues that work with the state forces. And we do a wide range of interventions that focus first on the armed actors, how to interact and engage with them to decrease their actions against healthcare. Second, with the authorities, this commitment of working with the Ministry of Health keeps alive today. The ICRC has been advised sort of to the Ministry of Health where normative exists, it needs to be adapted to the new context, and the ICRC is very active on that. Third, we work in supporting healthcare staff in the conflict affected areas with first of all, identification, follow-up and support to specific incidents, but also we have a mental health program on the line of caring for helping the helpers, those of you who may know, which aims not only at providing psychological first aid, but at developing sustainable healthcare mental health resilience for these healthcare teams. Second, we have a security management training for healthcare staff. We are handing over to them our NGO and Human Internal Organization's skills on security management, so they are a bit more resilient to that. Thirdly, we have some interventions as we saw in South Sudan on the physical infrastructure, and we have an intervention at community level which aims partly at dissemination and awareness, and secondly, in some cases, at decreasing the aggressions of the community towards the healthcare facility. I think it's a bit of a political incorrect, but communities sometimes are perpetrators of violence also. We have put them together with the healthcare staff and have developed a model of interaction, Friends of Healthcare is the program that has yielded excellent results in turning around completely by mediating and approaching the two of them. But, and I hope I have time to get into this, the real thing is the engagement with the arms bearers, and here I have, I want to go a little bit more in detail. First of all, the ICRC does, by its own nature, mandate a confidential dialogue with both the state security forces and the non-state and groups. In Colombia today, healthcare, violence against healthcare is clarified and it's inserted in any dialogue with any of them in the ongoing dialogues. The specific violations of normative or event against healthcare, they are individually and confidentially discussed with the perpetrators, be whoever he or she or it is, and promoted the improvement of the situation. Besides that, we have, the ICRC is invited to formal training on IHL to state security forces, mostly police, and for the last two years, the Health Unit of ICRC is invited to participate to provide a non-legal point of view by the public health and I would say a human point of view on the violence against healthcare to make sure that scores and scores of, we are doing a one hour and a half presentation on protection of healthcare from a health point of view to all the police runs that are being promoted to captain and mayor and colonel. So I think we are having a cumulative impact. And this is for formal training. We have a module on protection of healthcare for all the first state training the ICRC does, mostly with the non-state armed groups, but exceptionally with the police also. But probably this is all still within the conventional view of what should be done. I wanted to bring something, a different angle is that considering how the access to healthcare of the war wounded arms bearers, the state security forces and the non-state armed groups as in Colombia, an enormous negative impact on healthcare because they both seek the civilian healthcare system for the war wounded in ways that interfere and damage the civilian healthcare system. We are working on one hand on improving the access to healthcare or war wounded army soldiers, policemen and guerrilla fighters. Remember that they are all human beings that deserve attention in healthcare. And according to IHL, they are no longer combatants and they are fully protected, hoping and working on the assumption that this will happen. It's working in some places an impact on decreasing the pressure on the civilian healthcare system. But also we have started organizing at national level in a very formal way, aiming at normative and at local level in a pretty pragmatic way, mediating by sitting down military authorities and healthcare authorities or managers of hospitals to prepare contingency plans for the repeated events of them bringing a war wounded to a hospital and interfering enormously with their functioning or bringing a wounded policeman to an area under control of the non-state armed groups. And this raises enormous fears among the health staff and then the wounded person is not treated. We are trying to change that into a prearranged contingency planning that is supported by normative and agreement between Ministry of Health, Ministry of Defense that improves and avoids these situations. And I think I have to apologize to you but I handed over my presentation too late and all the rest of the slides that should have been now explained but I have told you the last part is not included. So no, this is a likely one. This was explained in a bit. This was a draft because I also sent the wrong one. I think I hope I'm in time because I wanted to share with you the recommendation. Colombia is a highly strange situation. I told you it's a functional state co-existent with patches of completely failed state and so the very broad lesson learned from me from these specificities of Colombia and sharing with you in Yemen, Somalia and many other parts of the world is that it's a bit common sense that it's worth to restate. The programs and interventions need to be adapted and tailored to each environment and context. Even within Colombia with different in context we can import the way we work in Chocó which is a lot like Haiti to the way we work in Catatumbo which is a bit more structured with a different degree of development. So first recommendation imperative to adapt interventions. I think the idea of sharing best practice should never be considered as a blueprint. It's inspirational. Secondly looking at the case of Colombia and all the debates about state's responsibilities wherever the states are not collapsed or failed states they are responsible to take initiative and that should be supporting the protection of health. There is IHL, they all have signed Geneva Conventions. There is the UN resolution that you mentioned and in many cases there is also a range of national normative. We are investigating here and we are advocating very strongly in Colombia. You have a problem with the context where there is a conflict and the IHL applies and the IHL when there is no conflict and then human rights law applies. Well, human rights law strongly defends health care. There is no need to resort to IHL to claim the protection of health care. And that's a very important thing that also and then where states start being involved they should be supported, they should be advocated for, supported and then coordinated with strongly. Third lesson of Colombia. We have a beauty obligation. If you can wrap up in 30 seconds, 30 seconds please, thank you. Yes, there is just one more, two more recommendations. The third one that goes on my list. The beauty and the thoroughness of the involvement of the state with the normative, the coordination I didn't have time to explain to you, between Colombia and the IHLC, and Bajo and the Ministry of Health, we are the core group. This has taken two decades to be developed. The length of the time that it takes to build it should not discourage anyone to start. Why not starting now? Even if we see the results in 10 years, it is worth to start state engagement whenever, so you will see the results later. The last one, arms bearer, arms bearers are clearly a major actor and responsible in violence and health care, not the only ones. It is necessary to engage with them and conventional preaching IHL is not the only way. And as health care providers, we have the very interesting approach of considering arms bearers, the IHLC, actually the euphemism for state forces and non-state groups, they are both aggressors and perpetrators and beneficiaries of the health care system. And we can play with that to improve protection of health care. I finish here. Thank you very much. Thank you, that's all right. That was very, very, very interesting. Thank you so much. Our final speaker is from Yemen, Dr. Ossan from WHO. Dr. Ossan, could you explain what the WHO is doing in Yemen to reduce attacks and any recommendations that you may have from those interventions? Over to you. Thank you. Thank you so much. And good afternoon, everybody. I will present to you an experience from Yemen on contingency planning. Next slide, please. So most of us know that Yemen is witnessing a civil war since 2015 involving three major actors who have control on different parts of the country. And mass casualty incidents, communicable disease outbreaks, displacement of population in addition to disturbances of health services are the main health consequences of this conflict. This slide that you can see the level of functionality of health facilities in addition to population in need and number of IDPs. Next slide, please. Yeah, so the WHO work against attacks on health care are based on a request from the member states in the world health assembly, resolution number 65 article 20, and that was in 2012 to collect and disseminate data on attacks against health resources in complex humanitarian emergencies. And the military surveillance system for attacks on health care is one of the mechanisms to collect data in 19 countries. And I'd like to stress here that the SSA is not used for accountability purposes. It's only a monitoring mechanism. Next slide, please. In Yemen attacks on health care have a dramatic impact on the population we serve the majority of this. As you can see in the slide involved the use of heavy weapons and the impact on healthcare facilities. And beyond the direct deaths and injuries that it causes. They also deprived the entire communities of essential health services in the long run. Next slide please. Here, I'm going directly to the practice itself which is the contingency planning. So the mitigation measure implemented in Yemen to reduce harm to affected population aims to protect access to health care services during hostilities. And contingency plan that we activated during an escalation of the conflict in the western part of Yemen. The plan consists of a transfer of service provision from the frontline hospitals to the second line hospitals after an attack to maintain access to healthcare for those in need. Next slide please. As you did, the military started by coordination with health partners followed by providing these hospitals with life saving medicines and supplies and skilled human resources. In addition to support referral system. What I would like to say here is this is not a prevention measure but it's mainly a mitigation measure that is activated when the frontline hospitals are exposed to security threats. Next slide please. So the result of this plan was that the three second line hospitals are ready and continue to be on standby in case frontline hospitals become exposed to any type of attack or security threats. And also the delivery of health services has been maintained in Hajj and the data governor is despite the armed conflict and the last result. After that the health contingency planning has become widespread practice in Yemen. So the main challenges in implementing this practice, it included finding qualified health workers that are willing to work in the frontline health facilities as well as the shortage of funding. In addition to that availability of life saving supplies materials. It can be also difficult to be find in the local market. What I want to go now is for the lesson learned. And from this experience that we should always prepare our contingency plans based on the close understanding of local conflict dynamics, and also the importance of coordination with health partners ahead from before we start the planning itself. The last slide please. Just our next step that we would like just to to to improve and to call for further collaboration between the protection and health clusters at the national level. And that will definitely lead to improve efforts to mitigate the impacts of attacks and uphold the practice of health care amidst the conflict. That's all from my side colleagues. Thank you so much. Thank you so much, Dr San from Yemen and a big thanks to all the panelists for sharing your practices and some of the innovative ways you're practically addressing this. It's really incredible to see such strong collaborations, but still a demonstration that we need to do more and we need to do more together as health and protection actors. We now want to hear from you the audience on what else can we do, or should we be doing. We have a participant mentor where we ask for your ideas, are there other examples of how protection centered health interventions have prevented and reduced civilian harm. If so, what, when, who, and secondly, how can the international community further support health and protection actors in crisis to protect health assets. We'll take a few minutes and gather your feedback, and then we will get back to the panelists to respond to some of the questions. Just a reminder, if you have any questions for the speakers, please stick them in the chat. We are looking at it and we will share this back with the panelists in a few minutes. So five minutes to complete the questions and we will be coming right back up. Thank you. Thank you. Thank you so much. Thank you so much for that. After that, as we try and collect your responses, I would like to invite back our panelists to kind of deliberate on some of the responses that we have from the Mentimeter. I'm pleased to welcome back Dr. Mukesh, Shehu, James, Dr. Hossan, and Dr. Hossan. I think first question that I have to you is to the South Sudan team. In what ways might we enhance health interventions in context of crisis? How best can we prepare ourselves as protection service providers in situations of violence? If you could try and keep it down to two minutes, quick response so that every presenter is able to get an opportunity. Thank you. Dr. Mukesh, if you could start. Maybe, you know, community is in center and then in case of South Sudan attacks are coming from communities. It is very important that we make aware of challenges as well as what we are providing our limitations to the communities. That will help us to prepare communities on accepting our limitations, accepting our challenges. Second one, health care service provider, which is very much like majority are from that community itself. And that health service care provider, which is a part of us as well as part of community will be a perfect link between community and health service provision. That will help to bring the community's confidence in healthcare as well as identifying early warning. No matter whatever attack is there, you get some early signals and that early signals are recognizing that and responding and making sure your contingency plan is there is very important in mitigating impact of the health care. Let me stop here. Thank you. Yeah, let me just quickly add on to what Dr. Mukesh just mentioned. I would really say awareness raising it's it's quite effective, which I think we need to keep raising awareness and also peace building should be one of the component that should be mainstream into our programming, because we understand how delicate South Sudan has been how the long history of war, and also a lot of cultural belief, which it is quite disintegrated from the, it is quite disintegrated from the, the legal system, which is something that we need to keep on raising awareness at community level, and keep engaging, and also take every little rumor. We think we have to take it seriously and dissect it and to hear what understand what are the, what are the reasons or what are the, the, the rumors all about and see how that can be best address. And, and I think it will go a long way to prevent some of those cases of attack, and as well also ownership, ensure that the community takes ownership of the services being provided to them. Let them see the services that we are providing as their own services, we are just there to support them, we are not just there to provide, we are just there to support to be just like an uncle for them to be sure that services reach out to them. Thank you. I think to me, just to add on what Dr. Makeda and Chehua say, I think one thing that is also very important in South Sudan in the context that we are living in is to have an engagement with the youth, because you see the youth are the majority and the other one that have been used by politicians who do a lot of destruction. So I think if we can have a mechanism of working with the, with the next slide, the, the, the, the peace partners that will be able to sanitize the youth that will really be very good. And again to have also a special focus on women, because you see women are the majority of the civilian and especially in South Sudan where a lot of men died during the war. So if there is any escalation of a conflict, they would be able to advise those few husband that they have that don't, don't go to destroy or don't go to kill. I think those will help and that thing is also to involve them in the planning and I think as the humanitarian workers, we need to involve the community at the planning stage so that they take the ownership. And even when conflict erupted, they are able to program the facility. Thank you. Thank you so much for that. For the Syria team, Samira, and perhaps Dr. Ossan from Yemen. In your context, what is needed for health and protection actors to work together more effectively. Yes, so yeah, you know, so Syria is a very complex situation we have different context in different areas of the country. But overall, I think to invest more on integrated approach with protection and health and that specifically for example to invest more in mobile clinic and mobile health protection services. Because as mentioned, given the limited functionality of the health system. And so that's one way to invest more on that. Also, to, again, we have also primarily health centers where these are the safe spaces where, you know, different services are being provided including health services but we could also strengthen that. And invest more on those centers and the primary health services provide GBB and mental health psychosocial support and awareness raising capacity building and also illegal interventions because this is also very important and takes me to the next And points that is to work with the protection health and protection can work better together for example to secure access facility access for some of the IDPs and first of all in negotiating the access we have IDPs in camps for example that are not allowed to leave or you know suffering or need of health assistance but because they don't have, for example, civil documentation legal identity they're unable to reach those facilities. Here protection actors can work together with health to facilitate access to civil documentation legal identity but also to negotiate and facilitate that transport and access. And also, you know, it was mentioned in terms of negotiations and humanitarian negotiation I think this is also important again to invest on it to strengthen and already existing interventions. And also a protection of civilian program means that some organizations are doing to, again, try to support those type of interventions more in this context. Thank you very much Samira. Anything to add. Yeah, thank you. I may take this point from the, what we call it the strategic level. So, I think if both protection and health can start by doing joint risk analysis for humanitarian needs overview, especially for those countries in emergencies. And also to do the integrated planning and programming in multi sectoral strategies, including the to develop joint strategic indicators. Again, sharing information during the production of health situational analysis and protection analysis update. These are some of the areas that we can enhance the coordination collaboration between the two sectors. Another thing is also, it will be good if both sectors developed an integrating or integrated proposals for fund opportunities. And the truth. This last thing happened recently here in Yemen when both health and protection sectors developed one proposal in the area of land mine risk reduction. I think those are just some ideas that if we started to to to implement at the strategic level between two sectors or any actors between health and protection. It will it will help a lot on this. Thank you. Dr. Jose, we have a question here from the chat for you. What are some of the biggest challenges in engaging with non state actors and groups. And what arguments are useful in encouraging compliance with international humanitarian law. You're on mute. Sorry for this engaging with non state and groups is like engaging with any other interlocutor but a bit more difficult in the very peculiar. We are not engaging with prime ministers with ministers of health with regional governors, when you have to do your best to convince them some of them are really tough some of them are more reasonable. The same with with with a non state and groups in Colombia we have an enormous range of non state and groups from highly leftist militant with the world structure doctrine, which is very easy to argument on the doctrine and bear a huge respect to it to complete criminal groups were were were legal argument to not work. We always combine legal arguments and human or humanitarian impact arguments. We, we don't think that the law is a is a dry issue I've seen in these fashions before or around, whether we should be advocating against attacks of health care because it is a violation of it. It's an abhorrent in human way to increase exponentially human suffering. And because of this is legal, but not the other way around. The main thing, and if we can transmit to on groups on the on the neutral stance of the ICC it is important to remark to them that that very often any attack against health care has no military advantage for them at all, and rather is a big discredit with the communities. But it's extremely in a case by case, and I don't claim that we have the magic wants to make it work always we have also a wide range of response to our dialogue and we have, we have groups that are a bit more difficult with with the staff on the on the field, in this case in Colombia, mostly the Colombian staff that everyone's that stay here long enough. And and with a diplomatic persistent attitude, we get to first start dialogue and then to start introducing arguments. Well, in Colombia, we have a, we have a privileged situation also in the dialogue with both state security forces and the, and the non state and groups, which, which we do not enjoy everybody in the world, I have to, I have to admit, but it's a, it's an art of dialogue and I have to insist we use both legal and human arguments. That's why me as the health coordinator and the health unit in Colombia has got to be nearly a satellite or an adjuvant to the protection unit to support them with convincing human arguments and public health arguments to support the importance of protection of healthcare. About the previous question about coordination of a health cluster and protection cluster, I would have to share the, the, the ICRC experience and my personal experience I work with with MSF for nearly 10 years and I change purely medical action very I think it's changing a lot now to ICRC, which is completely protection driven and there is a big a click to be to be made. I don't know when you are in the field. Do you feel like a human oriented institution who has to increase the vaccination coverage of children, or do you feel like a human like a, I don't know, like, like a human rights activist which is able to detect with your medical skills, a human rights violations to support with them, it's different approaches. When I work in the ICRC, I am here to put my medical skills at the service of protection, and it takes, it takes a bit, it's a question of priorities. There are other areas where the pure medical public health priorities may be overwhelming and then it is difficult to use your your health knowledge and skills to support protection argument, but, but there are two different paths. They're complementary but two different paths and approaches. It's, it's the, it's the, the health activists and the public health technician, the technical approach. And they, they are similar but not the same. And I think we need, we need for supporting a protection with a lot of health activists who are ready to be humble enough to put down their health and medical, holy skills and knowledge and put it at the service of protection. Thank you. Thank you. And just as a follow on to that question, we have another question here on your negotiations for, for populations to access. And I think we need for supporting a protection with a lot of health activists who are ready to be humble enough to put down their health and medical, holy skills and knowledge and put it at the service. Sorry, what is the question? I cannot read it on the, do you want me to reply to the questions on the text directly or? It was the question on, on negotiations and a colleague was asking if your negotiations are for populations to access healthcare or if they are negotiations for armed actors to respect healthcare and its protections under IHL. That is, that is a really good question because we had, we, we have had this discussion inside the IHLC. When you look, when you look at the spectrum of, of balancing in healthcare, you have some of them who are IHL violations, and many of them who are public health disruptions with an impact on no access to healthcare. The legal, I was going to say dogmatic, but the legal strict part of the IHLC has been wanting to focus on the violations of IHL and discussing with the armed groups so they don't violate IHL. The protection of civilian population part of the IHLC is much more concerned about the access to healthcare of populations affected by conflict, regardless of which, which institutions, which instances is perpetrating this violent disruption of healthcare. The predominant view and the doctrine today in the IHLC is any disruption of healthcare, any violent disruption of healthcare that makes population in conflict areas not being able to access healthcare, we work on it. We take it serious. We work on disruptions of healthcare perpetrated by criminal groups. We work on disruptions of healthcare perpetrated by the violent communities, and we work on violations of healthcare perpetrated by armed groups and hence IHL violations. We work on the whole spectrum, and the reason is that the focus of IHLC is to ensure one of the areas of conflict IHLC is the access to healthcare of populations in conflict affected areas. We have a bad reputation because we are a bit strict about conflict affected areas and we do not take care of whole countries, whole regions, or whole problematics. We focus on conflict affected areas in these populations. We do our best to ensure they have access to healthcare. IHL is an enormous, strong tool to work on it, but it's not the only one. As I said, the range of actions we do is a lot of the resilience of healthcare staff that we have of the community, the broader messages, human messages and not only IHL messages. Thank you so much for that. Thank you for that response. I think we're coming up to time, and I would just want to thank you very much for your participation for joining us for this very, very important session to thank all the panelists as well for such a rich and insightful discussions. I think the session today and the recent attacks on healthcare in Gaza and Ukraine, they really do bring home what happens when healthcare is under attack. Health personnel are risking their lives daily to provide these services at a very high cost to their mental health. Patients often injured and killed during such attacks and cannot access life-saving healthcare. When services are suspended, communities cannot access them and they are deprived of healthcare. They can no longer trust, they can safely go to the hospital that they can safely give birth or they can safely bring their children for vaccinations. This is a matter of global importance. Most of those attacks against healthcare actually happen outside the headlines. We don't hear a lot about them. Last year, at least 35 health workers were kidnapped in Cameroon. In DRC, more than 20 hospitals were burned down in just 12 months. In Myanmar, many direct attacks as in Ukraine were recorded between February 2021. But whose responsibility is this? It is the responsibility of governments to provide safe and prompt access to healthcare and to ensure the protection of that healthcare. Non-state actors are also responsible to provide safe access to healthcare for the communities under their control. All parties to the conflict must ensure protection of safe access to healthcare. Almost all countries in the world have endorsed the right to health. That means that governments are responsible for bringing healthcare in safe reach for all sections of the population, including persons with disabilities and for vulnerable groups. More than seven years ago, the UN Security Council unanimously adopted Resolution 2286, which calls for greater protection for healthcare in armed conflict. It is time for states to reaffirm these commitments with practical action. It is time for them to reaffirm these commitments. Even in armed conflict, all parties are to uphold international humanitarian law and international human rights laws, which dictate health personnel, patients, medical vehicles and health facilities are protected. So what is our role as humanitarian actors? It is clear that not all governments and armed actors are able or willing to comply with international humanitarian law and international human rights law. In several situations, the communities have played a significant role to ensure the protection of healthcare. As do civil society networks and local actors, where their gaps, humanitarian and development actors have stepped up in support of local and national capacities. The World Health Organization, through its WHO attacks on healthcare initiative, has set up a system to monitor and respond to attacks, as Dr Osan in Yemen has shown us. The Health Cluster coordinates local level response and advocacy with frontline and human rights actors, as illustrated by the Health Cluster team in South Sudan. The Safeguarding Health Care in Conflict Coalition brings together civil society actors to share data, provide analysis and advocate for change. Health humanitarian organizations such as IRC negotiate on a daily basis with communities and non-state actors to grant safe access to communities and healthcare, but it is not always sufficient. This collaboration cannot be addressed by just one actor alone. It requires a strong collaboration between health and protection teams. The joint operational framework established by Health and Protection Cluster is an example of an initiative that can be used for such collaboration. Today, we've had some good examples from South Sudan, Yemen and Colombia. However, the different speakers also clearly highlighted the challenges and what needs to be urgently done to address these issues. That is, joint analysis by health and protection actors to understand the issues, exchanges between health and protection actors to increase awareness of common objectives, collaboration between health and protection for joint action and response to help reduce violence and the impact of violence, and increased resources to end violence and implement interventions to reduce such violence. Attacks on healthcare is a protection concern that requires action at all levels, from local to global and across all sector. I really hope this session has brought us one step closer to working together to protect civilians. Thank you all for taking the time and looking forward for continued conversations on this issue of attacks on healthcare. Thank you for joining us today.