 Ladies and gentlemen, it is my pleasure as a head of the ICRC law and policy firm to welcome you at the Humanitarium Whether you are sitting here in the room with us or listening and watching this panel online The discussion of tonight is part of a cycle of events on Principles guiding you may turn action This is actually our fourth event in this series and we are already planning several upcoming events The next one in September after the summer break on the history of the principles So midway through this cycle of events We have heard that these humane principles are about accessing populations in need cutting through complex decision-making and Building a legacy of trust at the local or global levels We have also seen that the main challenges facing the humane principles today are their distortion their politicization and that there is a great need to reiterate their meaning and to demonstrate their relevance through concrete fields examples so this event tonight is different is Special in that it goes beyond exploring the challenges to the principles as It marked the launch of new ethical guidelines for healthcare personnel in times of armed conflicts and other emergencies So in that sense these guidelines will directly contribute to translate humanitarian principles into the practice of millions of health care workers and medical staff You can find more information on these events on this launch of this code of ethics and more information on our panelists and moderator on the leaflets on your seats and And before before leaving the floor to the ICC president Peter Maurer I need to give you a few practical information because as you can see we are using here A tool to gather questions and stimulate the discussion After the presentations of the panel But first let me say that you are all welcome at the end of this event to a cocktail reception which will take place On the floor above nearly I CC cafeteria our staff will guide you after the event to reach this terrace above us and Second I would like to take you through This session using pigeonhole live, which is a software which will make our Q&A session more lively and interactive So from this software you can ask questions to the panelists through your smartphone You may also vote for your favorite questions and Those with the highest number of votes Will stand a better chance to be picked by our moderator So for all of you following this event live stream You are very welcome to participate as well and you can access pigeonhole live with any device connected to the internet For those in this room you need to connect to the ICRC visitors Wi-Fi network Once connected you will be redirected to a login page and if it does not happen automatically you you can use your web browser and In the login page click on the voucher login tab and type the user ID and Password you can find on this slide But we have also put it on your seat so you don't need to learn this code by heart now Once connected you go to www.pigeonhole.at and you enter the event passcode, which is health care in danger H C I D The questions you submit will appear on this screen and Your votes will affect the order in which they appear So of course those who are not Connected tonight will also have the possibility to just raise their hands in a lesser Let's say technological fashion And we'll of course pick your questions as well So thank you very much for your attention. I'm sure it will be okay. I'm sure it's not so complex as it seems And to begin the evening I would like to welcome Peter Morin president of the ACRC. Thank you. You're welcome colleagues and friends the nature of armed conflict has me always deliver speeches of caution warning gloom Description of particularly distressing situations of civilian populations in conflict and I'm very glad that tonight. I'm deviating a little bit from the tonality of my average speech in I'm glad to be here at the launch of the ethical principles of health care in times of armed conflict and other emergencies Agreeing on these Principles is indeed a substantive achievement and I would like to thank the World Medical Association the International Committee of Military Medicine the International Council of Nurses and the International Pharmaceutical Federation For their participation and commitment to this process which we had the honor to navigate at ICRC Thanks a lot to the representatives whom you will see afterwards and here in particular on the podium The ethical principles we are launching today are a ground-breaking document because now for the first time Our global associations have a common and concise set of shared principles They will apply to more than 30 million professionals civilian and military who may face ethical dilemmas in times of armed conflict and other emergencies as we all know modern international humanitarian law originated from the idea that Enhancing the protection of the medical mission personnel transports and units alike was an essential step To better assist and protect victims of armed conflict The idea was at the core of the international consensus which led the to the first Geneva Conventions of 1864 today this consensus seems to be becoming more elusive by the day Armed conflicts and emergencies are too often characterized by scores of people in urgent need of Medical care as well as widespread destruction of health infrastructure and massive displacements of health personnel in Consequence the pressure on the few remaining in the midst of combat and the emergencies becoming all the more important During armed conflict and other emergencies assaults on health facilities health workers and the patients they serve are all too common Aside from the immediate toll they take such attacks results in obstruction of access to health services They compromise the ability to deliver care to populations in great need They weaken the presence of skilled health workers They affect health systems overall and hamper efforts to reconstruct a system and health infrastructure after conflict and war In 2011 the ICRC together with other partners of the Red Cross and Recrecent movement began the health care in danger project The latest report on violent incidents against health care Released in April 2015. So a couple of months ago and not analyzed 2398 incidents collected in 11 countries from January 2012 to December 2014 The report concluded that over 50 percent of the attacks took place against Insight or nearby health facilities and that at least 598 health care personnel lost their lives or were wounded during the attack and this is only on the sample I just presented in addition over 700 medical transfers were directly and indirectly affected in most incidents local health care workers were affected most seriously as a consequence of such violence Health care facilities were forced to suspend operations fully or completely and health care personnel and victims in need of medical treatment Avoided going back to health care facilities fearing arrest intimidation harassment assault or death Every day more and more detailed information is coming to light Confirming such findings according to the organization physicians for human rights in Syria in 2014 alone an Average one medical worker was killed every other day and the hospital was attacked every four days Indeed delivering health services to victims of conflict without distinction or discrimination is an increasingly complex challenge in contemporary conflicts This is why the ethical principles of health care in times of armed conflict and other emergencies We are launching together today is so uniquely important be it in Yemen Mali or Syria Doctors and nurses are exposed to threats and violence aimed at thwarting their medical duties every day And within the constraints of armed conflict they too often find themselves Confronted with acute ethical dilemmas and until now without much guidance Existing norms are no longer sufficient and the general consensus that the medical mission has to be respected in all circumstances Has slipped into the background while abuses have increased from sporadic to systemic That is why we call on governments to help improve the situation and put an end to those violations of international humanitarian law The ICRC is raising the issue in multilateral for a both regional or global Not only to increase awareness, but to get states to take concrete action Now that all major professional organizations have come together We expect states and international organizations to offer political support to our efforts and to use all means available to facilitate their implementation as Co-authors are we will not stop our efforts now that the principles have been agreed upon Beyond reaching out to states and authorities We will remain committed to engaging Professionals and experts in their fields to use the principles in real dilemmas. They face each and every day in the field Traditionally everybody knows the ICRC addresses humanitarian challenges through assisting and protecting affected population as Directly as possible and as closely as possible to their needs, but this is not sufficient Given the complexities of the challenges we face We have a collective responsibility to prevent the real recurrence of abuses by developing normative instruments and promoting the compliance with norms and standards Beyond relief work and beyond engagement with states the practical cooperation with professional networks is a critical importance by By pooling experience knowledge and expertise of professionals we create standards that hold up to the challenges of practice In the past this approach has proven productive when we devised the manual on war surgery Which is now used across the world by surgeons operating on victims of conflict Similarly the creation of professional standards for protection work launched by the ICRC in 2009 After substantial consultations with humanitarian and human rights organizations Paved the way to a more coherent more comprehensive humanitarian protection work In turn the set of principles we launch today will help to demonstrate that the fifth century BC Hypocrates oath Remains as important and valid as ever today Whether friend or foe or human beings have the right to medical care and the medical professionals have the right to provide it The set of principles is a great achievement and demonstrates the capacity of a single sector to produce far-reaching ethical standards The processes through which we have achieved this result is a perfect example of what I like to describe as principled pragmatism Where professional experience meets normative frameworks Practical solutions will have to come from those confronted with real-life challenges While we will need stronger political support and commitment to reinforce these solutions and to create conditions in Which the principles can be concretized The endorsement of ethical of the ethical principles also Demonstrates the outstanding commitment of health care professionals to preserve the integrity of health care staff and their resolve To lead without waiting for a government process While it is critically relevant it may take some more years to materialize indeed Professional ethics transcend borders and political interest the principles can therefore be seen as an articulation by individuals and civil society of what is acceptable and what is not acceptable behavior Our common purpose today is to discuss how we are going to disseminate these rules and give them More leverage with different stakeholders We hope that you will use your own power Influence and your different networks to encourage the establishment of robust national legislations and accountability mechanisms dear colleagues More than 100 years ago Florence Nightingale wrote that I quote suffering lifts its victims above normal values While suffering endures, there is neither good nor bad valuable or Invaluable enemy or friend the victim has passed to a region beyond human classification Or more or moral judgment and his suffering is sufficient a sufficient claim Although we observe the sobering picture of a general deterioration of the protection of the medical mission There is no reason to be fatalistic the principles should rather become a source of hope a Survey of 600 US military physicians engaged in Operation Desert Storm has shown That two-thirds of the respondents said that medical needs should be the only criterion for triage and a mere 22% stated that wounded enemy soldiers no matter how severe their wounds should be treated only After all forces of after all allied forces have been treated The ICRC study our world views from the field is enlightening in this respect as well about 4200 persons living in eight countries affected by armed conflict were interviewed in 2009 Notably about their views regarding healthcare for the victims of conflict 96% agreed that I quote everyone wounded or sick during an armed conflict should have the right to health care 89% replied that I quote health workers should treat wounded and sick civilians from all sides of the conflict and 89% again that health workers must be protected when they are treating wounded or sick enemy combatants especially when treating enemy civilians After a long evolution in practice and principles of military medicine international humanitarian law over the past 50 years has imposed an unequivocal duty on all parties to arm conflict right provide impartial care for wounded and sick combatants as Shown by the history of military medicine the humanitarian principles set out by the international humanitarian law were shaped by humanitarian need and by medical practice and the battlefield The shock and horror experience by those witnessing the fate of severely wounded and dying men Abundant abandoned to their fate were at the origin of the indignation of people like Francesco de Gaia and Henri du Nord It is not human to abandon them. It is our human duty to provide them with relief and care In conclusion, I would like to stress that the respect for health care and health personnel Who carry out their mission in difficult circumstances is at the core of the principles of humanity Health systems are usually the first line of defense in many armed conflicts and other emergencies undermining their response capacity means jeopardizing the survival of entire populations Likewise weak or vulnerable health systems are usually unable to absorb the shocks of major pandemics like Ebola or polio or other The impartial access to health care and the protection of medical personnel in times of conflict is at the origin of International humanitarian law and represents the essence of the laws of war It may remind us of the prophetic tutti fratelli clamor uttering by the women of Castileone de la civiere Where they were treating the wounded on all sides in the aftermath of the battle of solferino The set of principles we are presenting today may help health personnel in Challenging situations to solve the numerous dilemmas they face in addition to the responsibility of caring for patients This is why the ICRC is putting its full Institutional weight behind this initiative today and I look very much forward to the comments and discussions That is starting now. Thank you very much So, thank you President Moyer now, I'd like to invite the panelists to Join me here and sit at the at the table so you have information about their biographies on the leaflet on your seat and The panel will be more rated by Pascal Mej with deputy director of operations here at the ICRC So Pascal the floor is yours. Thank you. Thank you Vincent Welcome everybody and welcome to our four distinguished panelists It is actually very noticeable that we have here both civilian and military as well as different health care organizations Represented it is in fact very much what makes the lounge of this ethical principles of health care In times of armed conflict and other emergencies so unique as Stated by President Mauret this is the first time that there is one common document on ethics Shared between civilian and military as well as different health care organization, and I think we cannot Insist enough on this on this element President Mauret also illustrated vividly Why those ethical principles of health care are so important in times of armed conflict and other emergencies and just to state as Well that this document is very much in line with the general spirit of the health care in danger project Which is a global project gathering around the same cause a large variety of experts partners and and stakeholders All four organizations that are represented here today are the authors of the documents So we are very lucky to have all four of you and they have Adopted this common document within the organization and since this adoption the International Federation of Medical Students The IFM SA has also Adopted it it's the first organization beyond the authors to endorse the principles, and we hope many more might join So we will now hear from our four panelists one after the other I will not repeat what stays in the biographies, but just to say that we have Ask our panelists to give a brief description of the organization to speak about the process They went through to adopt the document launch today and how these ethical principles will be promoted and implemented Within their networks just to say as well the seniority of our panelists is in itself indicative of their organization's Commitment to the ethical principles that we are presenting Today, so I will give the floor now in in this order to dr. Otmar Kloiber secretary general of the World Medical Association Dr. David Benton I'm trying to see who is sitting where chief executive officer of the International Council of Nurses then major general Roger van Hoff secretary general of the International Committee of Military Medicine and last but not least to Mr. Luke Besançon general secretary of chief executive officer of the International Pharmaceutical Federation So we start dr. Otmar Kloiber the floor is yours Thank you very much Pascal. Thank you very much to the ICRC to bring us together here And thank you to the audience to be with us this evening the World Medical Association is currently a Brella organization of 111 National Medical Association from all parts of this world and we are a Rather young organization at least by the standard of the organization which are cooperating here in 1947 the World Medical Association has been founded after a predecessor organization was given up during World War two and It has been founded on the background of what was then common knowledge or got copy-to-be common knowledge about the abuse of medicine during the time of the Nazi regime in Germany my own country and the violations of human rights during that time which were connected to medicine Since 1947 this organization the World Medical Association, which was then a fresh start for the international cooperation of physicians on that level has focused on forming building consenting The medical Deontology or the roots of the profession the medical ethics so to say and we have been quite successful with that over the past decades Coming up with the first international code of medical ethics and the Geneva Declaration in 1948 in 1949 which has now been referred to as the modern Hippocratic oath and is being more or less the blueprint for many of the ethical codes in many countries of this world The organization did focus not only on medical questions But also extended its reach to the question of social medical affairs related to medicine and Also to the questions of medical education Which we later did since the 70s together with the World Federation for medical education Which now also is a part of the process in the healthcare in danger project Since it's very early times the question of the protection of medical personnel and the work in war zones under in armed conflicts But also in disaster areas was one of the issues that the World Medical Association dealt with and our work actually on this topic started pretty much 60 years ago Leading to a first paper together with the International Committee of Military Medicine, which we will hear just in a moment the International Committee of the Red Cross and the World Health Organization in 1956 in a declaration that was taken in Havana on Regulations in times of armed conflict and other situation of violence at that time it was not encompassing all the health professionals as we do it now and As have been brought together by the healthcare in danger project just during the past years Nevertheless since then the World Medical Association was focusing on the question on how we relate to medical ethics in times of War or disasters and if I have to bring it to just one bottom line It is that we have to observe the same ethical rules during wartime and Disasters as in peace and normal situations However, that is easily sad but much more difficult than to achieve when you come to those situations Therefore, it was necessary to work this in policies over the past years we have found that Many of those regulations which some people including me thought were common standard and a Totally common understanding in this world were not what we found that increasingly health personnel physicians and other health personas was attacked medical Institutions were abused or were under fire and that the rules that we thought were taken for granted by everybody Were actually not observed anymore or at least observed than before This tendency Unfortunately has been raising over the past years and we found it more and more necessary to raise our voice in both directions As well to the perpetrators of conflict which didn't observe the science and the regulations that have been made and brought forward by the different conventions as well to our own Colleagues which we had to toll had to tell that medical neutrality is essential for the work of The health workforce especially in times of conflict and violence So the World Medical Association over the past years and especially the past decade has Increasingly dealt with those issues and we were very happy To see that the International Committee of the Red Cross started the health care in danger project Which we immediately joined and on this platform We are most grateful to the ICRC to bring together the idea us to the idea To come up with a common code for the health care ethics And that in this indeed is absolutely new and it is the first of this kind that we have to present today To you how are we going to proceed from here? We are very much Helping our national medical associations and associations which are not yet. Hopefully not yet members and will become members in the future to deal with the situation of Conflict to deal with the situation of armed violence and at that point we try to intervene and try to talk to parties involved In order to explain them how the medical ethics has to be applied in situations of wartime This is something which we do In most cases and have done in the past together with the ICRC and together with other NGOs That are working in the field and it is a work that we will continue to do But it is also necessary for us to raise this point with those parties In the international conventions which are not involved in situations of conflict directly Because they are usually providers of help and assistance and their voice is likewise necessary And has to be raised in order to get the attention Now I know we have very Many informal partners and very many partners who don't listen and don't Acknowledge the conventions or don't obey to the conventions But I think if we are not raising our voice and if you are not coming back And if we are not asking them to do so I think the value of health care will go down and They have to understand that the health care provided in the field is at very many places The only light at the end of the tunnel So we will continue to approach all parties involved really to obey or allow the physicians and the health professionals to obey The rules the ethical rules of the profession in order to be able to help the wounded the sick and those who are in danger for Medical reasons in those situations Thank you once again, especially to the International Committee of the Red Cross for bringing this together Thank you very much for this wonderful initiative of health care in danger, which we are continuing to work with you We think this really comes to the heart of our work and the heart of your work it is the common interface of what we are doing in this world and We would like to continue with you in this endeavor. Thank you very much, David Dr. Benton Thank you Like Otmar, I'm going to start with a little bit of information on our organization the International Council of Nurses was founded in 1899 and From its outset. We've really focused on three issues the conditions within which nurses work the practice that they deliver and the principles that guide them and To this day we continue to focus on those three pillars of activity. We now call them socioeconomic welfare professional practice and regulation We have 135 member associations In membership and another 40 associations that are in different stages of membership all across the world And that comes together to add up to about 19 million nurses worldwide So in terms of reach Nursing is an important part in terms of delivery of services whether you be in rural communities in remote Areas or whether you be in the heart of cities. It's about how we deliver services for us it was a very easy option to throw our weight behind this because nurses and doctors and other health professionals are often the subject of Terrible abuse and violence and therefore when this issue this opportunity arose It was very clear our Council of National Representatives, which is our highest body said we really must get involved and with this because the feeling was that if you attack or Frustrate the activities of one nurse You actually frustrate and attack all of us and therefore it was a feeling that we needed to stand together Not just as nurses, but with other disciplines to really tackle this major issue we Have been very clear that over the years we have looked at the issues of ethics and we have our own ethical code and we've been very successful in getting nursing associations and regulators in a range of countries whether they come from a common law tradition a civil law Condition tradition or an Islamic law tradition to adopt those principles So the opportunity to work with our colleagues to bring together a common set of principles was something that we felt very strongly about because if we Recognize that to deliver health care. We actually need to work in teams then we actually need to share those common principles and therefore the Opportunity to work together to distill from our different approaches a language that we could all share So that we could have a common understanding was very important So when we talk about this set of principles We need to think about it in terms of how it affects the individual nurse or practitioner How it affects their practice? How it affects the team that they work within but importantly The role that as health professionals we also have in terms of influence influencing our society as well So in terms of moving this agenda forward, it's not just about the individual Practitioners practice. It's about the wider network of influence that they can bring to bear so part of the work that we've been doing as we've moved along this journey is to Keep our membership involved in the work that has been developing sensitizing our membership through publications through various meetings to engage them in the process So that they are ready to grasp the set of principles and to have those discussions as Otmar said Through their national associations in the country to bring weight to it It's important that we do not neglect Our education colleagues as part of this process Because laying a strong foundation is very important. So from the very outset We were very encouraged in some of the developmental work We've done as part of the healthcare in danger project to produce educational resources that can then be readily used in Both the student setting and in continuing education to refresh people's memories We do have a student network We have students in 115 different countries around the world that use all the modern technologies and Part of our dissemination strategy will be to capitalize on those modern technologies to draw attention to the document and how it can be used because I think also the interpretation of how it can be used is important on an annual basis I write to ministers of health Highlighting the issues that are of relevance to nursing and Encouraging them to include nurses as part of the World Health Organization Delegations and I've been delighted to be able to work with colleagues from WHO to help promote some of these issues as we move forward and I think in the year coming where the human resources for health Features so strongly it will be important that we take that opportunity to promote these principles as well because if we do not create the Environment where individuals are safe to practice Where their rights of to make clinical judgments are respected? Then we will have a much bigger problem in terms of both recruiting and retaining health professions as well as delivering services So leveraging the policy opportunities is an important strategy we have just completed our Congress in Korea and in that Congress we featured the work that we were doing together to Amplify our voice in terms of the fact that if we as health professionals if the national societies work collaboratively together The opportunity for a voice to be heard not only by the state actors, but by armed groups as well is much stronger So standing side by side Working on this issue in a very practical way is important for us and certainly the tactics that we are moving forward on We have done some work in the past on something called positive practice environments And we see this as one of the core threads that run through a positive practice environment If we cannot protect the environment within which care is delivered If we cannot respect the clinical judgment that clinicians make in terms of the priority of need of the patient Then actually we cannot have a positive practice environment So this sits very much with our core principles It is something that like Otmar I'd like to thank ICRC in its leadership of this but also in the collaborative way that we've moved forward So when ICRC colleagues are visiting countries They reach out and make those connections between national societies and our national Organisations to build and strengthen relationship together So I think those are some of the key points that I would want to make In terms of the work that we've been doing together and the work that we now need to do to promote these principles To embed them firmly in all of the education and all of the care delivery systems that we all work with. Thank you Major Senor? Thank you. Good evening everybody The International Committee of Military Medicine started in 1921 after the first World War To give the opportunity to the different military medical services worldwide To know each other and to change practical experiences And especially scientific knowledge It is obvious that the ICMM, the International Committee of Military Medicine Felt it necessary to participate to this project As an intergovernmental organisation gathering more than 100 chiefs of military health services all over the world As ICMM represented this of their member states The ICMM is very concerned about the security problems encountered by military health personnel And about the ethical principles that govern the activities of this personnel during conflict situation The ICMM for example has each year a course on low on armed conflict here in Switzerland And also a workshop on ethical principles in conflict situations These problems and ethical principles in military health Environment are similar to those encountered by the civilian health community The ICMM therefore was very pleased to be able to participate in the setup of this ethical document And to highlight the specific situation of military health personnel This document then was approved by the ICMM national representatives at the ICMM General Assembly last month And now it is of the utmost importance to give this document the most wide distribution as possible And I see three levels for this First this document has to be distributed and the information about this document has to be given to the all the military and civilian health personnel to the lowest level Secondly the document has to be given to the military and civilian authorities of these people So that they can accept that their people act along the principles of this document And third point is that this document has to go to all political authorities Political authorities who have the power to persuade people about the necessity to protect health workers who are doing their regular job And there is a fourth level but that is the most difficult level This document should be distributed also to non-state actors because there are big problems for the security of the health personnel So thank you very much to be here and thank you to the ICSC that they give the possibility and the opportunity to the ICMM to a military medical organization to participate Thank you very much Thank you very much Thank you very much. The FIP is the World Pharmacist Organizations. We gather 132 national associations of pharmacists representing in total 3 million pharmacists there But also we count among our members 138 schools of pharmacy universities and over 3,000 individual members that are usually gathered into different structures One of which is dedicated to military and emergency pharmacy And that also was the starting point I think of our interest in that particular work Our functions usually is to gather evidence to inform policy at local and national level as well as international level And to develop professional norms and standards that would eventually be of relevance for all our members And also to support tools that help to improve practice to our different groups And we have three major fields of activities. One is around the education Developing and transforming education so then there is sufficient pharmacists with competencies required to meet local needs The second one is around the practice development to improve practice so then the practice definitely respond to the needs Whatever the needs are and the third element would be on the science So when we were approached by RCRC we were very pleased about this because it was a perfect timing At the same time we were revisiting our statements on code of ethics for pharmacists And also we were developing a model also for pharmacists Thanks to the dialogue I think we have engaged, we've been able to include and further improve our own work And I think that's also one of the strong value we had with this project Is that dialogue also enrich each organizations to further improve its own policies But also this work around the code of ethics for pharmacists and ultimately the adoptions of the model also last year For the pharmacist was really a facelidator internally to understand why this important core ethical principle when needed by a profession And so surprisingly the adoption was very quickly because everybody's agree with that No lengthy discussions, it was just normal, it was the obvious element for all our profession So that was quite a good element I thought But then also the other element is we have now a great document How can we make sure that it's really making some relevance on the ground So with some efforts we try to also promote it amongst our different events So we have an international congress gathering 3,000 participants where we have a session dedicated last year And again this year on this particular ethical principles The other element for us is of course our general assembly where we gathered leaders, 132 leaders from 132 different national associations And also promotions towards our stakeholders and towards our member organizations But also we realize that these ethical principles are quite interesting But sometimes it's about how do you implement this in practice So we have also decided to establish a permanent committee on ethics within our organization So then they will be able to respond and to facilitate each responses to issues Identify both from a code of ethics of the pharmacist but also eventually also to deal with some ethical question that can be raised In implementing these ethical principles there I think overall this ethical principle has also a key value It's to provide confidence to the different healthcare professionals in their positions, in their fact that they shall not be a target And therefore in many cases one can see that health can be considered as a power Whereas in fact it should be more considered as a right and a collective responsibility And so when you shoot at healthcare professionals or healthcare facilities That is when you try to only look at the power side and other collective responsibilities And that is also denying the fact that if you really want to put patients first The only ways you can do this is to also ensure that there is healthcare professionals Because ultimately you cannot achieve any health without healthcare professionals there And so overall speaking I think it's about these ethical principles Ensure or improve the resilience of health systems by providing them the ground that we can help We can based on lobbying activities advocacy activities around the different stakeholders to effectively improve the situation Thank you Thank you very much, very very rich indeed what is coming Maybe can I just try to extract some of the things that came very strikingly from all interventions I mean this notion of same ethical rules in peace and conflict obviously is very strong None of you went into the details of what exactly is in the document which is accessible for all But maybe just to recall that it means healthcare personnel shall provide care with humanity, respect for dignity and no discrimination Healthcare personnel must never be involved in acts of torture or any form of cruel inhuman or degrading treatment The primary obligation of healthcare personnel is to their patients which entails inter alia respecting the patient's right to confidentiality and their privacy Healthcare personnel are afforded special protection while performing their duties which must be respected by all And they shall never be punished for executing their duties in compliance with legal and ethical norms And this seems very logical I mean from what we hear from you those rules are extremely basic and should be taken for granted But you were saying they are actually no longer taken for granted and there is a feeling of urgency that seems to be coming from all of you on recalling these rules What I found very interesting is that you all said it was a very easy process You all have your own of course your own work on ethics related to healthcare in your own organizations But interestingly it comes as a notion of common language of dialogue which is enriching your own practice and your own thinking around the issue And by mobilizing this white community I mean not to forget that you represent 30 million people the four of you around this table which is quite amazing I find this gives an amplifying notion to the voice on these ethical principles And maybe to end with what you were saying Luke on providing the confidence to healthcare professionals regarding their own responsibilities So this there is a wide range of issues that we can address now in the question and answer session I will just try and see what comes on the screen and in the meantime if anybody wants to raise the hand for a live question you're welcome We will take three four questions at a time and then throw them to our panelists who will answer to what they feel is addressed to them most specifically There is one question which is having 18 votes already how concretely will these ethical guidelines make medical personnel safer during armed conflict and other emergencies I'll take the second highest vote which is why society become more violent against healthcare professionals nowadays And can I see if there is someone in the room who wants to ask a question at this stage so that we can have also the Geneva public live Yes, we have one here I'm also concerned that healthcare is in danger in much less high key circumstances We know that doctors in China are suffering an unprecedented increase in violence directed towards medical personnel in practice there In many western countries doctors and nurses and pharmacists going about their work are also at risk of assault So I think does the panel agree that we need to consider how to educate our students and our practitioners in how to deal with violence And in particular I've actually said in this room before I think it would be very interesting for health professionals Most of whom who are not used to violence except apart from the good general there But healthcare professionals are not used to violence and maybe we should learn from people who are professionals in dealing with violence From the police, from the military. Is there something to be learned from them? Thank you Very much. Do we have one more question from the floor? Now we start having too many. The gentleman here in front and then we will just take the four questions that we have for the two from the pigeonhole Is there a microphone maybe? Yes Thank you Thank you very much. My name is Syed Bares My question is when there are groups of people, violent people who do not abide by any international standards and laws They are the major challenge because we are facing particularly with the rise of the ISIS in those places and also with the Taliban and all that They don't go by any rules, any regulations How really you think that the people could be safe whether the possible measures could be taken to deal with them? This is actually linked with one question that I saw which has moved since so I can't find it anymore But on the notion of non-state armed groups as well I guess in terms of how we can reach out to non-state armed groups So can we maybe start Monsieur Besançon, you were last to speak if you want to address some of these elements that were raised with a question I may raise two points and then to leave others also possibilities for expressing this The easiest one, how to deal with violence, how we can learn from people with some experience with that We have a few of our national associations who have been dealing with violent management Like in Ireland for example or in France where the national authorities, the national pharmacist regulators Have reporting systems and sometimes even advice on how to manage violence However the best way is to instead of dealing with only the symptoms to try to also prevent the violence from occurring Or at least from eating there, so we do have some element there Of course the violence that is regular is not more acceptable but it's sometimes a bit more predictable to some extent So it's a bit easier to manage With regards to concretely these guidelines can really make personnel safer I think one of the biggest challenges we have to look at is that it will take sometimes and a lot of efforts to come back to a situation where effectively the ethical principle are applied And so FIP is dedicated towards putting its efforts in doing this I think it's also a lot around discussion with the different leaders, whether you call them political leaders, religious leaders Any kind of leaders that can help to support through their mobile authorities and reinforce this element there Very much, Dr van Hof Well as to the first question shouldn't we instruct and give some information about how to deal with violence I should say that's not a priority When you have somebody who is violent against a health worker The problem is not the health worker who doesn't know how to handle this violence The problem is this guy who is violent So that's in the civilian world and that's the same in the military world If you have during a conflict some violent group You don't have to learn your other military group how to handle this violence They know it but you don't have to That's not a priority, priority is to instruct and to inform and to persuade the first group not to be violent That's my question about that What about the non-state actors The best that can answer that is the ICRC I know that they did some studies about that Can you say something about that perhaps That's very interesting to hear that Hello my name is Ali, I'm heading the health care intervention project As it was just mentioned We just launched a publication last Friday On how armed groups can contribute to safeguarding health care By protecting health care personnel, facilities and patients This publication is the result of a large consultation Which was held throughout the world Consulting with 30 armed groups Consultation which was undertaken by the ICRC delegates And we came out, came up through this consultation process With a set of, I wouldn't call them recommendations But at least very basic practical measures That can maybe contribute to improving the situation Or at least be the foundation for a dialogue With specific armed groups in a specific context So this publication is now available It can be downloaded online The way the ICRC is going to use this publication Is by making its delegates know of the substance of that study So that it can then be embedded in the dialogue In the interaction with specific armed groups at field level Obviously we have to be very realistic concerning our ambitions There are clear limitations to that dialogue Some armed groups are not even ready to consider having that dialogue as a very basic level But we feel that it has to be pursued as a priority in the longer term And we really hope for vivid and concrete improvements throughout these initiatives Thank you for giving the floor to my colleagues in the room Just maybe Dr Benton, do you have anything to comment on the first question? How concretely will these ethical guidelines make medical personnel safer? And then there was also, sorry, now it's gone Another one which was on why society is becoming more wise That's something you have something to say about So I think the first thing is that we've got to, irrespective of who the perpetrators are We've actually got to speak up about this So whether, and I'm just going to use some work that we've been involved in over the last two years There was a nurse who refused to force feed someone in Guantanamo Bay And we took a position in relation to that, in relation to the US government and the military And that was alongside work that we were doing in relation to Bahrain and Syria So irrespective of who the state is, if you have a set of principles you must apply them vigorously and loudly And not pick and choose, and I think that's an important point Violence in society, if you actually ask, well what are some of the social determinants of health? Poverty, the excluded, and we've seen as a result of the economic crisis An elevation of many of those groups and therefore I do think that we are seeing much higher levels of violence Where people do not see any hope for themselves And I think that's the broader range of issues that need to be addressed It's taking us slightly off where we were but the question from our colleague in medical education I think does beg the question how do we prepare, and this is where I think I and Roger differ a little bit I do think that communication skills is a core part of the curriculum that is designed to de-escalate situations Before they happen and to spot some of the behaviours ahead of time In certainly the domestic environments is something that can be done I mean it's 35 years since I trained as a psychiatric nurse and those basic principles were being taught then And I think we should be thinking about that because it's something that can prevent rather than deal with the consequences If you think about many of the environments where these attacks are taking place in general society They're often cramped, people are being ignored, there's long waiting lists etc as well So it's about that parallel agenda, there's the extreme end but there's also that societal end as well And I think you've got to deal with both and as I said have a set of principles which you rigorously apply irrespective of who the perpetrators are Very much, Dr. Kloiber anything on education to deal with violence, making a difference concretely, societies more violence, non-state armed groups Thank you very much, I think the first question which got the most votes I think is indeed a very interesting one No house vanished but it's still quite too particular It's very nice to play with the system but indeed it would be better if we just see the questions Instead of having this up and down there This question has a very practical meaning how does it work and can it work But it also has a logical background this question We are discussing and we are saying that there is more attacks on house facilities That house facilities are more under fire, that there is violence against house professionals And here we sit and come up with rules how to behave for house professionals And of course one would say well why don't you first turn to the perpetrators of the violence Those are the ones you have to address because they are the ones who are killing the people, they are doing the violence And not those ones who are sitting in the field last night or in the clinic and in the hospital who are doing the work there So there seems to be a logical break but that indeed is not one Because what we need is we need a very clear environment of rules for those who are working in this environment Because they themselves feel unsafe, they don't know what to do They have to know how to treat the different people coming in friend or foe Can they really treat them the same way? This is a question for many of those working there And yes we say you have to give them equal treatment, no difference And then there is a commander behind them or a chief who says no no no my people first My soldiers have to go back into the field or our people are more worth than others And here comes in place what these rules mean These rules say no there is equal treatment that is necessary And it entitles you to say no to your commander To say here is that what is accepted by the international community To say this is the way we go, does it help? Well let me give you my own experience with that which I had to learn a couple of years ago Actually now probably two decades ago when I started in this international field We were working on guidelines for triage, very much connected to this And I was part of the German delegation and I was told to get it in one specific way And in the international discussion it was a little bit different from that So I was arguing very hard, prolonging the process Some would say I was filibustering the process in order not to get it that way And during the coffee break the representative of the ICRC came to me and said Stop it, we need this rule now And I said what do you mean? I mean we are just finding here a solution for that And really I was thinking we were talking an academic process here And I said no, my colleagues are out in this field, they have to justify every day what they are doing Why they are doing a triage in one way and not another way And why they are taking one decision over the other decision We need this paper So I had to go back to my delegation and say we have to stop here, we have to come to a conclusion with that And to bring up the paper, it is necessary And we have a lot of examples especially which were brought back from the colleagues in the field And telling us we have used this policy in order to explain why we are doing A and not B And why we are preferring C over D So this can have a work, is it a perfect solution? No it is not Is there a guarantee? No there is not But if there is not hope that we can convince people to change their behavior and to become better All this what we are doing here will be worthless We are up for a second round, so I saw some more hands in the room if we can take two from the rooms Yes? Microphone please Hello, my question is similar to one that is up there, but I wonder if the panel could explain Why we need special ethical principles for healthcare workers separate from other humanitarian workers and emergencies I just wanted, well Dr. Cloyber was starting to focus specifically on a particular problem about treatment of different combatants But until then I was a little confused as to why we need special principles just for healthcare workers And whether it is a difference in healthcare workers and other people delivering life saving assistance and emergencies And wars such as someone delivering food or water or some other form of life saving assistance Isn't a special healthcare worker professional, thanks Thank you that connects actually to one that we have here on the connection with principles with a sphere and other humanitarian standards So it is very much a question around the articulation between this set of principles with other principles applying in such situations And we can also take the one which is linked to IHL, there was a reference to the 1864 Convention on the Wounded and Sick But more generally probably what is the relation that there is between IHL and the obligations in international humanitarian law Versus those ethical principles, we actually have our legal advisor in the room Our specialist on the IHL issues for that, so that is a very good point if we need to answer that Can I take one more from the floor, on the back over there Thank you very much and thank you for indulging me because I was asking the question about sphere So my question is also a very much a follow on from that And it is based on the discussion now about what practitioners are facing in the field I am thinking has there been a discussion of also a responsibility to report So thinking about intersections with also the humanitarian accountability project What would happen in case a healthcare provider or professional experienced or saw something That they felt needed to be reported, how would they do that Is there guidance that you provide on that in terms of the intersections there, thank you Thank you, I think we can actually also link that even if remotely to the notion of what are the expectations towards political leaders Nationally and internationally in terms of promotion of these principles There is notion of accountability, of reporting of how we see political circles committing to that So we have linked with other standards with international humanitarian law Why ethical principles for healthcare workers only and not more generally other humanitarian or emergency workers And a notion of reporting by those who witness problems in the field if I understand your question well And I will probably give the floor to Dr. Van Hoof, major general as well First A lot of questions too You choose what you want to take I think yes we made together and together with the ICRC This document on ethical principles for healthcare workers Because it will help organizations of healthcare workers who were around the table And I have the impression that part of most of the ethical principles that are in this document are also valid For humanitarian workers but part of them are not valid for them And there must be specific, I think specific principles for humanitarian workers I don't have experiences as military physician about humanitarian, just strictly humanitarian work So I think there are other regulations that must be added to that document for these kind of humanitarian workers That's my feeling Dr. Klobber your microphone is on so you can take it Yes there are actually and I refer to the question why only for the health professionals here and not for others There are several answers to that Number one is we as a group or as four groups representing here have a mandate to speak for our groups and not for anybody else So that is the very simple one Yes what we think and what we are actually discussing is what about bringing other professions also in the boat And that is what we are inviting to do Some have responded and have positively responded and I think this group will grow Some have been not that much interested maybe that will come later on When it then comes to other humanitarian assistance like for instance the provision of water and food and so on I wholeheartedly would agree with you but that is a privilege that quite obviously under the current state of warfare in this world Is not necessarily being agreed on by all the parties I would wholeheartedly wish that this would go And maybe answering a second question in the same line is we had in our discussion to learn that there is a different in our approaches Because here this certainly is the world workshop for the humanitarian law the ICRC We are coming from a human rights approach and that at some times is a little bit different And we for instance would like to extend all those privileges that we are asking for this freedom not to be attacked This freedom to be out of a conflict also for other conflicts for which humanitarian laws do not apply We have heard about that from David there is a general tendency of violence in our societies against health professionals against healthcare facilities We very much would like that we can take the approach that has been crafted here into that sphere as well But it doesn't apply because simply there humanitarian law does not apply to those situations which is a problem for us It has been a problem in understanding is a problem in execution with that And I can assure you yes we are working on those other areas as well And I think that's true for all of our organizations as far as I know us So this indeed has to be a little broader The other question was about the reporting Now this is one policy which we have We have a whole policy apparatus at least as physicians And we also have reporting requirements for instance when it comes to acts of torture Those are very clear guidelines which we have what we request from physicians to report Or degrading treatment which would be for instance giving preference to own people over other people And by the way that is something that really works it happens in this world Very often people report under danger for their own person and for their own life even But those things are happening and going on And we also have a stronger requirement to physicians but against this is our guideline to physicians And not a common one which is asking for advocacy Advocacy for exactly those questions you mentioned for instance access to food Access to water just to be able to have somewhat healthy living under those situations Thank you Thank you very much Mr Benton, Dr Benton I'm going to pick up the point that Ottmars just been addressing in terms of speaking up mechanisms It is I think no one has got it right Even in my country the UK where abuse is taking place particularly with elders and vulnerable communities We don't have systems that are sufficiently robust to enable people to report when things are going on And to avoid the repercussions The difference of course in conflict zone is that repercussion can often mean death Whereas in the UK it is being victimized as part of the process And I think that's an area that we all need to work together on to find mechanisms to enable that to happen We know from other conflicts like one that I'm familiar with is when we had problems in Northern Ireland The mechanisms to enable people to raise their concerns about the behaviors of forces etc Were far from ideal and I think this is something that we need to work on together in terms of making it possible For people to raise concerns without suffering the repercussions of that Like Ottmar we also have a series of positions on use of torture and various other elements of it But that in itself is not enough unless you've got the practical means to actually draw attention to this One of the things that we tend not to do of course is to identify good practice and to promote it And that's the other side of the coin so when we have groups that are respecting some of these values How do we actually draw attention to that as part of the process so that we actually promote what is good As well as condemning what is bad and getting that balance can help in terms of at least having a debate raised Rather than just simply going after the negative side all the time When we talk about ethical it's if you look at the economic theory which might be challenging here Just to say it's because we have an agent an agent that is here to help making choice To perform something that the individual the patients is not able to fully understand And I think the value of the ethical guideline is to remind that we have a delegation of power to do act in the best interest of the patient there If you look at the ethical principle I think one of the value of the existence is that it is there So then people are aware when they need to speak up when there is a break of them If they don't have any ethics you cannot say it's wrong Once you get a reference that you can compare it to your own practice or what you see around you And say it's wrong then you can able to speak up Of course what you see that in often conflict zone you get weak regulations system Or if there is an assist the regulations the systems is not in place so that one of the challenge you can see there However I think as indicated about the promotion of good practice I think is a key element there And I think the last points that we haven't really touched upon yet on the full question was around What expectation do we have towards our leaders our political leaders I think overall is first to support very vocally these ethical principles If needed to take appropriate measures against groups that precisely do not support these ethical principles And if needed even go willingly against them on purpose Second element I think is about informing their different communities And using their authorities in different ways whether it's not only military authorities But also moral authorities religious authorities in putting some pressure on those who perform actions that are against these ethical principles So I think overall that's I think is the value of this is also to remind the people where the good practice are And helping others to recognize these good practices to push for better practices eventually Thank you very much. We are actually five minutes to the end And I was just wondering whether anyone from my CRC wanted to speak about the complementarity with international humanitarian law I mean that can be a pretty simple one but Mr. President would you like to take the floor again to close Hello In a sense I think we are very much aware that there is a bigger issue than the one we are discussing tonight And there is a specific vulnerability in armed conflict which these principles address in particular an emergency And there is a wider world of violence and I think our exchanges in particular with the World Health Organization Has shown us that there is no country which is spared from the particular vulnerabilities Just the legal frameworks to which we refer may be different from one to the other But I think just to put it also very blunt, I mean we know where our areas are and our specialties are And where our focus is and we appreciate that the four partners here on the panel have also joined us in our effort To address a particular situation of vulnerability which is armed conflict and emergency But this does not mean that outside this area we don't have big problems and we are increasingly led to deal with those problems as well Also as a humanitarian organization committed to humanitarian principles So we are increasingly led to reference to human rights law because we are increasingly operating in situations Which are less than clear on which legal framework we refer and therefore I just wanted to acknowledge the importance of having a broader perspective And also being active beyond the realm of international humanitarian law And I think what all of you in one way or the other set during the discussion is also and it's in the principle that in times of war and in times of peace These principles are equally valid If I just may add one sentence also to highlight what the strategic importance is of professionals and 30 million professionals coming together I mean there is the power of politics and the power of politics in the dynamic of conflicts we have seen has led to an instrumentalization of the health sector in present day conflicts And has led to enormous pressures on health operators during conflict So what I would expect is that this is a symbol of the power of professionals which basically try to defend themselves through devising those ethical principles But also reminding political actors that there is an area here to protect politically if I just may also respond to the question of expectations towards political leaders Very much President Maurer. I think this leads us to the conclusion and I just want to give you 30 seconds each to say what would you see as your dream What should happen with this document in your best possible wishes. Can we start with you Dr. Klobber maybe? Yes I certainly would like to see that it penetrates also into those informal conflict groups That we finally get an approach to those groups in talking to them and convincing them that those rules are valid But also of value for all conflict partners be they formal or informal I think this would be a reach out which really would be helping many many peoples around the world What I said in my short speech are these three levels and the first level is that we have to instruct our own people, our own health workers And we have to show them what their rights are and what they have to do in their work But in the second level it's very important that the military authorities are informed because without the support of the authorities And especially military but also civilian authorities All this information of your workers will be of no value because there will be always obstruction And then these military authorities and civilian authorities will not act if they have no push of the political leaders And so that's what the dream that I have Thank you very much for your dream Mr. Besanson I think for me there would be two elements there to further promote this key element Whether it's a high level discussion at the United Nations or at any regional groups I think that's an important element for us The second element is around the education Education of officers at the army, often those army officers may turn into non-state actors at some states We also have education of healthcare professionals of civilians as well So then they know what to expect but also I would say maybe of those who study political sciences in their respective countries Because by definitions it's difficult to predict in advance which country will be turning into an armed places So I think these also are elements to consider not only from the healthcare sector but I would say a broader perspective as well Thank you very much Dr. Benton I'm going to be much more practical There's something called chaos theory which says that if there's a butterfly beating its wings in a jungle somewhere It can cause a tornado on the other side of the planet I just want to challenge all of you You've came here tonight, you're clearly interested in the topic And if each of you go away from tonight and contact 20 people and talk about this Then maybe we can actually cause that tornado across the planet Because unless we all speak about it, nothing will happen Silence is not an option, that is the challenge I give you Thank you very much, I think it's exactly all the points I wanted to conclude with So it's absolutely perfect, this notion of feeling of urgency I think we hear it extremely strongly from all of you as well as your strong commitment But this we knew I believe however your notion of amplifying the voice in all the different sectors within your organizations And the healthcare profession in general But way beyond also you know up to the UN for a debate And the call for 20 persons to be contacted by each of you It was actually also for us as ICRC and as having a very strong commitment to the healthcare and danger project To ask all of you to help us amplify the voice in that regard And I think beyond talking to people there are social media and all the tools that we have today To really create a feeling of urgency that is shared beyond those 30 million health workers That are concerned and humanitarian organizations that have contributed to this process So thank you extremely, really thank you very much for your presence, for your interventions For the public here and for those online who might be still following us from far away places And as time is now ripe we have to move upstairs for the cocktail Unfortunately not for those who are online but we can still Thank you very much for having joined us and wishing you all the best for the rest Thank you to help us create the buzz