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seen as separate, independent and neutral politically.[6] However, evidence shows that this has little impact and instead that western aid agencies are perceived as an intrinsic part of the western 'agenda' and not merely associated with it.[6] In the case of Afghanistan, with the notable exception of the International Committee of the Red Cross, it has been surmised that locals no longer make distinctions (as they once did) between organisations, e.g. those were working with the coalition force's Provincial Reconstruction Teams and those that did not.[6] In remote areas, they sometimes represent the only accessible western target.[6] Although empirical studies on aid worker insecurity have been scarce, two have been conducted in Afghanistan. Watts (2004)[7] did not find evidence indicating heightened aid worker insecurity in provinces where the US military was present. Similarly, Mitchell (2015)[8] was unable to discover a relationship between attacks against NGOs and their proximity to the US military or US-led PRTs respectively; however, his study did reveal that aid workers were more likely to encounter a greater number of security incidents in provinces with PRTs not led by the US. Trends in risks faced by humanitarian workers Wars between states became much less common in the period following the end of the Cold War. Unfortunately, these wars have been largely replaced by an increased incidence of internal conflict and resulting violence and miscommunication, increasing the risk to civilians and humanitarian workers alike. Most deaths of aid workers are due to deliberate violence. One third of deaths occur in the first three months of deployment, with 17% occurring within the first 30 days.[9] Since 2006, violence is once again on the increase and growth in the number of incidents is faster than the growth in the number of humanitarian aid workers.[6] Attacks on health care Among all attacks, those on health care are numerous. Hospitals, clinics and ambulances are attacked and health workers injured or killed. As to the Safeguarding Health in Conflict Coalition initiative there have been 973 attacks on health in 23 countries in 2018.[10] Attacks usually either target wounded and sick individuals, health personnel, facilities or medical transport; facilities or medical emblems are misused.[11] These attacks have a negative impact on the overall delivery of health care
Despite the immediate effects of deaths, injuries and the destruction of facilities, the long-term effects are often even more severe. Already weakened health systems, due to present conflicts, get targeted. That can lead to the collapse of entire health systems that are urgently needed in conflicts. Th health systems are unable to cope with the situation, people have no access to health care and long-term public health goals are almost impossible to achieve.[12] Many facilities have to close after attacks, hospitals run out of supplies and health projects, like vaccination campaigns, come to halt. Additionally, staff leave their posts, flee the region or country and international organizations withdraw their staff and/ or close projects.[13] The general access to health facilities and care is restricted for people in need. The number of people affected indirectly is therefore even higher than the actual numbers of victims. Moreover, attacks have a negative impact on the psychological well-being of staff and affect their motivation as well as the quality of care provided by them

List of major attacks on humanitarian workers A full downloadable list of major incidents, from 1997–present, of violence against aid workers can be found at Humanitarian Outcomes' Aid Worker Security Database.[15] 1993 Somalia – January 2, 1993 - A gunman killed Sean Devreaux, 28, a British worker for UNICEF in Kismayu.[16] Somalia – February 22, 1993 - Gunmen killed Valerie Place, 23, an Irish nurse with the charity Concern.[17] Bosnia – July 5, 1993 – Scottish aid worker Christine Witcutt shot and killed by a sniper in Sarajevo.[18][19] Bosnia – October 25, 1993 – Danish aid worker Bjarne Vium Nielsen killed in attack on humanitarian aid convoy.[20][21] 1996 Burundi – June 4, 1996 – Three ICRC delegates were killed in an attack on two vehicles on the road between the villages of Rugombo and Mugina in the northern province of Cibitoke, resulting in a withdrawal of ICRC from Burundi.[22] Novye Atagi, Chechnya – December 17, 1996 – Six ICRC workers are killed in an attack on the local hospital. As a result, ICRC withdraws all expatriate staff from Chechnya.[23] Guatemala, 1996 – One Costa Rican Salvation Army officer is attacked by demobilized guerrilla members while transporting a senior citizen with a broken leg to the hospital. The vehicle was taken. 1997 Somaliland region of Somalia – November 23, 1997 – UN negotiates with clan elders for release of five kidnapped aid workers. Mogadishu, Somalia – November 26, 1997 – All foreign aid workers withdraw from the city following the abduction of two Italian aid workers. Guatemala – 1997 – When returning from mission, one Costa Rican Salvation Army officer was hijacked by gunmen and held hostage for a short time. The vehicle was taken. 1998 Somalia – April 21, 1998 – 10 aid workers held hostage. Bujumbura, Burundi – June 10, 1998 – One Danish aid worker killed by car thieves in capital. Central Sudan – June 10, 1998 – Three Sudanese UN staff killed and three wounded when gunmen fire on a UN vehicle. Arua, (North West) Rwanda – July 10, 1998 – Ugandan driver for UN World Food Programme (WFP) killed by rebels. Bujumbura, Burundi – July 24, 1998 – One Italian World Food Programme (WFP) staff member killed in the capital. Congo-Brazzaville – November, 1998 – Major Eugene Nsingani The Salvation Army on a peace mission with eight people, gunned down and killed along with five more. 1999 South Sudan – January 4, 1999 – Four ICRC staff killed by SPLA (abducted in February, murdered in April). Southern, Somalia – January 27, 1999 – One Kenyan aid worker killed by gunmen. Lesotho – February 4, 1999 – Irish aid worker (Ken Hickley) robbed and murdered. Bundibugyo, Uganda – April 23, 1999 – Many aid workers flee area to avoid attacks by Allied Democratic Forces. Belgrade, Serbia – May 26, 1999 – Three aid workers put on trial for spying. Angola – June 15, 1999 – Two aid workers killed when gunmen ambush and rob them. Tajikistan – October 2 – French aid worker killed. Northern Kosovo – November 12, 1999 – 24 people on board a WFP aid flight died when Si Fly Flight 3275 crashed. 2000 Balad, Somalia – January 3, 2000 – One local CARE staff shot dead in an ambush. North of Mogadishu, Somalia – January 4, 2000 – One CARE worker shot dead in an ambush. Sudan – January 9, 2000 – 2 CARE staff killed and 2 missing after an ambush. Somalia – January 31, 2000 – Attacks on a convoy of aid vehicles leave 20 people dead. Ethiopia – February 9, 2000 – A medical organisation suspends operations in part of Ethiopia after the killing of a staff member. Ambon, Indonesia – May 22, 2000 – Foreign aid workers pulled out of Ambon to escape growing inter-communal violence. Sierra Leone – June 19, 2000 – One British aid worker (Alan Smith) freed after being held for one month by rebels. Baghdad, Iraq – June 28, 2000 – Two FAO workers shot and killed. South Sudan – August 6, 2000 – Eight aid workers killed when vehicle was attacked near the border with Uganda. Atambua, Belu District, West Timor, Indonesia – September 6, 2000 – Five UNHCR staff members, Mr Samson Aregahegn (Supply Officer); Mr Carlos Caceres-Collazo (Protection Officer); and Mr Pero Simundza (Telecommunications Operator) and two Indonesians were killed when their office was attacked by militia. Macenta, Guinea – September 17, 2000 – The death of one UNHCR staff member and the abduction of another. Southern border Guinea – December 7, 2000 – Hundreds of people are left dead as rebels destroy the UNHCR centre. Afghanistan – December 9, 2000 – Seven people working for UN mine clearance programme killed in ambush. Aceh, Indonesia – December 10, 2000 – Three aid workers killed. Burundi – December 30, 2000 – A British voluntary worker is one of 20 people killed by gunmen. 2001 Eastern Democratic Republic of Congo – February 27, 2001 – Six ICRC staff killed. Mogadishu, Somalia – March 27, 2001 – MSF compound attacked by gunmen. Alkhan-Kala, Chechnya – April 18, 2001 – Viktor Popkov fatally wounded and two others injured in a shooting attack. Tajikistan, – June 16, 2001 – Kidnappers ask for release of detained militants after taking a group of aid workers hostage. Banda Aceh, Indonesia – October 4, 2001 – Three more people, including a Red Cross worker who had been tortured were killed. Afghanistan – November 15, 2001 – Eight western aid workers released after three months captivity by Taliban. 2002 Mogadishu, Somalia – February 23, 2002 – A Swiss woman who ran a small aid agency was shot dead. Mogadishu, Somalia – February 28, 2002 – One Somali UN worker kidnapped hours after region declared too dangerous for permanent UN presence. Dagestan - August 12, 2002 - A Dutch MSF worker is abducted in Makhachkala. He is released 20 months later.[24] 2003 Gaza Strip – March 16, 2003 – Rachel Corrie an American member of ISM was killed by an Israel Defense Forces (IDF) bulldozer when attempting to prevent the demolition of a Palestinian's home. Gaza Strip - April 11, 2003 - Tom Hurndall was a British photography student and member of ISM who was killed by an Israel Defense Forces (IDF) sniper. Hurndall was left in a coma and died nine months later. His killer Taysir Hayb was sentenced to eight years imprisonment for manslaughter and obstruction of justice but was released after serving six and a half years of his sentence. Baghdad, Iraq – August 19, 2003 – The bombing of the UN Headquarters at the Canal Hotel killed at least 24 people including Sérgio Vieira de Mello and wounded over 100. Baghdad, Iraq – October 27, 2003 – An attack on the ICRC building kills at least 12 people. Ghazni, eastern Afghanistan – November 16, 2003 – UNHCR staff person Bettina Goislard was shot dead by motorcycle-borne gunman while travelling by car. Kandahar, southern Afghanistan – March 24, 2003 – ICRC staff member Ricardo Munguia shot and killed in ambush north of Kandahar City. He was working as a water engineer in Afghanistan and travelling with local colleagues on March 27, 2003 when their car was stopped by unknown armed men. He was killed execution-style at point-blank range while his colleagues were allowed to escape. He was 39 years old. The killing prompted the ICRC to temporarily suspend operations across Afghanistan.[25] 2004 Kabul, Afghanistan – February 26, 2004 – Five Afghans working for the Sanayee Development Foundation were killed when their vehicle was ambushed northeast of Kabul. Mosul, Iraq – March 15, 2004 – Larry Elliott, Jean Dover Elliott, Karen Denise Watson, and David McDonnall were killed in a drive-by shooting. They were US missionaries for Southern Baptist International Mission Board. Kabul, Afghanistan – April 28, 2004 – Two Afghan aid workers and a soldier were killed in an attack in the Panjwayi district of southern Kandahar city. Badghis province, Afghanistan – June 2, 2004 – Five staff working for Médecins Sans Frontières were killed on the road between Khairkhana and Qala i Naw, resulting in the complete withdrawal of MSF from Afghanistan. The names of the murdered staff were: Hélène de Beir, Willem Kwint, Egil Tynaes, Fasil Ahmad and Besmillah. Darfur, Sudan – October 10, 2004 – A Save the Children vehicle was hit by an anti-tank landmine in the Um Barro area of North Darfur, Sudan. Two members of staff travelling in the vehicle were killed, Rafe Bullick (British, Programme Manager, North Darfur) and Nourredine Issa Tayeb (Sudanese, Water Engineer). 2005 Baghdad, Iraq – April 16, 2005 – Marla Ruzicka and her Iraqi translator, Faiz Ali Salim, were killed by a suicide car bombing on Airport Road in Baghdad. South Sudan/Uganda, – November 5, 2005 – Collin Lee who worked for International Aid Services died when his jeep, containing his wife and driver, was ambushed by the LRA in South Sudan. 2006 Vavuniya, Sri Lanka – May 15 – An employee of the Norwegian Refugee Council is shot dead on his way back from work. Muttur, Sri Lanka – August 4 or August 5–17 workers from the aid group Action Against Hunger were found murdered on August 6 in northeastern Sri Lanka. They were working on post-2004 tsunami reconstruction. There had been fierce fighting the area for more than a week. (See Muttur massacre.) 2007 2007 Mogadishu TransAVIAexport Airlines Il-76 crash Darfur – between 1 January 2006 and 31 August 2007 – A total of 12 humanitarian workers were killed, including four working for the Government's water project. Colombo, Sri Lanka – June 3, 2007 – Two Red cross workers were abducted and murdered in Sri Lanka. El Bared refugee camp, Lebanon – June 11, 2007 – Two Lebanese Red Cross workers were killed and a third wounded.[2] South Sudan – A driver of the World Food Program was killed in an ambush. Central African Republic – June 11, 2007 – An MSF logistician was killed when her car was hit by gunfire during an assessment mission near Paoua [3]. Algeria – 11 December 2007, 10 United Nations staff died in a double car bombing in the Algerian capital, Algiers, which killed at least 26 people and injured 177. Somalia – December 26, 2007 – A nurse and a doctor working for MSF in Bossaso were abducted. After one week, they were released [4]. Burundi – On Monday, December 31, 2007, at 6:30 pm, an Action Against Hunger vehicle was targeted by shooters in the city of Ruygi in the East of Burundi. Five people, including three female expatriate staff of Action Against Hunger, were inside the targeted vehicle. One of them, a French psychologist of Action Against Hunger, died upon arrival at the hospital in Gitega as a results of her injuries. The second victim suffered a gunshot wound and underwent surgery in Gitega. The third Action Against Hunger expatriate escaped uninjured from the shooting. 2008 Kabul, Afghanistan – January 14 – Six people, including at least one aid worker from the USA named Thor Hesla, was killed in an attack on the Serena Hotel. Kandahar, Afghanistan – January 26 – An aid worker and her Afghan driver were kidnapped in Kandahar and are presumed dead. Kismayo, Somalia – January 28 – A surgeon, a logistician and a driver working for Médecins Sans Frontières (MSF) were killed

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