The messaging service Whatsapp is being used in Syria to help monitor and collect data on attacks on health care workers and facilities, providing robust data in support of advocacy and accountability efforts.
The system, which enables teams to share data about attacks within 24 hours, identified 402 attacks against health care in Syria between November 2015 and December 2016, according to a new study in The Lancet. The study shows that during this year of the study, nearly half of hospitals in non-government controlled areas were attacked and a third of services were hit more than once.
Attacks on health care have reached unprecedented levels in Syria, now in its 7th year of conflict. Collecting robust and reliable data is important to convince the international community to enforce legal protections, and to achieve accountability for widespread breaches of international law.
While reporting of attacks has improved, until now there has been no standardized method of collecting robust data. Collecting first-hand accounts from people on the ground can result in limited coverage, and using second-hand data such as media reports, satellite images, and retrospective accounts can result in incomplete data, and collection is hampered by access constraints, security fears, and concerns about confidentiality.
Following the 2010 UN General Assembly Resolution that threats to health care should be addressed, the WHO was tasked to develop a method of collecting more reliable data on attacks on health care.
The new tool was piloted by the Health Cluster in Gaziantep (Turkey), which coordinates humanitarian activities in Syria, including the UN and around 50 NGOs. The Health Cluster supports 352 health facilities in Syria, serving a population of approximately 5.5 million people.
The monitoring tool uses a 293-member WhatsApp group. When an incident occurs, a short message is posted to the group (see Whatsapp message, figure 1). All members with physically-verified information (ie, who have visited the site or were present – not hearsay) are then asked to complete an anonymous and confidential online form to detail location, attack type (eg. aerial bombardment, gunfire, arson), facility type, extent of damage, who was affected, injuries and deaths.
Within 24 hours, the team in Turkey issues a flash update to key partners, the WHO, UN, and donors. Every month, data is verified by checking health cluster alerts against external reports. Reports that remain unverified because of insufficient information are also recorded.
From November 2015 to December 2016, 402 individual attacks were identified, of which 158 were verified. A total of 938 people were harmed, a quarter of whom were health workers. Nearly half (44%) of hospitals in non-government controlled areas were attacked and a third of services were hit more than once. Services providing trauma care were attacked more than other services. Aerial bombardment was the main weapon, and land operations to take over a specific location were associated with increased attacks.