NEW DELHI (Thomson Reuters Foundation) - Syria, Somalia, Afghanistan, Myanmar and the Democratic Republic of Congo are the toughest places for aid workers, who not only struggle to reach vulnerable people due to conflict, but are also killed for being seen to help opposing groups, the head of medical charity Medecins Sans Frontieres (MSF) said.
The Geneva-headquartered agency has more than 30,000 staff working mainly as doctors, nurses, surgeons and psychiatrists in around 70 countries where the impact of conflict, natural disasters, epidemics or poor healthcare has left a dire need for assistance.
Unni Karunakara, MSF's international president, told the Thomson Reuters Foundation he believed the challenges faced by humanitarians, particularly health workers, were on the rise.
"The perception we have is that the challenges for aid workers are increasing. A lot of incidents happen in health facilities and centres and are targeted against vehicles such as ambulances," Karunakara said in an interview.
"I don't want to rank countries, but you can say today that Syria and Somalia are two of the most dangerous countries," he said, adding that insecurity in Afghanistan, the Democratic Republic of Congo, Myanmar and Mali had also often left humanitarians in a precarious position.
According to The Aid Worker Security Database (AWSD) – a project of research consultancy Humanitarian Outcomes - 308 aid workers were killed, kidnapped or wounded in 2011 -- the highest-ever recorded since it started tracking attacks on aid workers in 1997.
While AWSD says the number of aid worker victims decreased to 187 last year, some experts say the 2012 data is unverified and is likely to be an under-estimate.
"MEDICAL CARE UNDER FIRE"
Karunakara cited numerous examples of how MSF staff have become victims or face hurdles in doing their job.
"On 13th October 2011, two of our Spanish colleagues were kidnapped in Dadaab in northern Kenya, near the Somali border, where they were providing services to Somali refugees. Today is 576th day and we are still trying to get them free," he said.
"While in Myanmar today, we are facing a situation where our doctors and nurses personal details are being put on websites, and they are being characterized as favouring one group over another in a conflict."
In Syria, MSF did not have access to communities in government-controlled areas, with staff only able to work in rebel-held regions where there have been horrific stories of villages and hospitals being bombed, he added.
As a result, 57 per cent of public hospitals are damaged and more than one third are estimated to no longer be functioning. Some communities are refusing to set-up medical centres, fearing that they will attract air raids.
In the east of the Democratic Republic of Congo, MSF teams suffer dozens of security incidents every year. In March, shelling hit a hospital and killed two people. The previous month, two MSF health centres were looted.
There were several incidents in countries such as Afghanistan, he added, where soldiers or militias had barged into hospitals, threatened doctors and dragged away patients.
"All of this goes towards undermining the ability of humanitarians to reach the people most in need because confidence in them is undermined," said Karunakara. "If you sow a seed of doubt in communities, then the ability to keep our teams safe and provide assistance is undermined."
The MSF president said while all humanitarian actors faced serious risks in many countries, the attacks on health workers appeared more pronounced.
As a result, MSF is now launching a new research project called "Medical care under fire" which will collect data on violent incidents, analyse it and work out a response.
This is not the first time that aid groups have voiced concern over the risks to health workers. In late 2011, the International Committee of the Red Cross launched a campaign called "Health care in danger" to draw attention to what they called "violence against health care".
"The space for humanitarian medical action is not fixed, and acceptance of our work is not a given. It must be created. It must be negotiated. We can only work with the acceptance of all parties," said Karunakara.