Measurement of attacks and interferences with health care in conflict: validation of an incident reporting tool for attacks on and interferences with health care in eastern Burma.
BACKGROUND
Attacks on health care in armed conflict and other civil disturbances, including those on health workers, health facilities, patients and health transports, represent a critical yet often overlooked violation of human rights and international humanitarian law. Reporting has been limited yet local health workers working on the frontline in conflict are often the victims of chronic abuse and interferences with their care-giving. This paper reports on the validation and revision of an instrument designed to capture incidents via a qualitative and quantitative evaluation method.


METHODS
Based on previous research and interviews with experts, investigators developed a 33-question instrument to report on attacks on healthcare. These items would provide information about who, what, where, when, and the impact of each incident of attack on or interference with health. The questions are grouped into 4 domains: health facilities, health workers, patients, and health transports. 38 health workers who work in eastern Burma participated in detailed discussion groups in August 2013 to review the face and content validity of the instrument and then tested the instrument based on two simulated scenarios. Completed forms were graded to test the inter-rater reliability of the instrument.


RESULTS
Face and content validity were confirmed with participants expressing that the instrument would assist in better reporting of attacks on health in the setting of eastern Burma where they work. Participants were able to give an accurate account of relevant incidents (86% and 82% on Scenarios 1 and 2 respectively). Item-by-item review of the instrument revealed that greater than 95% of participants completed the correct sections. Errors primarily occurred in quantifying the impact of the incident on patient care. Revisions to the translated instrument based on the results consisted primarily of design improvements and simplification of some numerical fields.


CONCLUSIONS
This instrument was validated for use in eastern Burma and could be used as a model for reporting violence towards health care in other conflict settings.
Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, 1111 Amsterdam Avenue, New York, NY 10026 USA.
Rohini J
RJ
Haar
Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. E7141, Baltimore, MD 21205 USA.
Katherine Ha
KH
Footer
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. E7141, Baltimore, MD 21205 USA.
Sonal
S
Singh
Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6543, Baltimore, MD 21205 USA.
Susan G
SG
Sherman
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA.
Casey
C
Branchini
Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. WB 602, Baltimore, MD 21205 USA.
Joshua
J
Sclar
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. E7141, Baltimore, MD 21205 USA.
Emily
E
Clouse
Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, 615 N Wolfe Street, E7148, Baltimore, MD 21205 USA.
Leonard S
LS
Rubenstein
Attacks on healthcare; Conflict; Health and human rights; Health protection; Health workers; Humanitarian law; Medicine; Safeguarding health; Violence; War