{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:15:50Z","timestamp":1785406550388,"version":"3.56.0"},"reference-count":15,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"unspecified","delay-in-days":89,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Disaster med. public health prep."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S193578932610336X_sec1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Violence against health workers and health care facilities in conflict settings is a major public health concern, disrupting service delivery and undermining humanitarian response. While attacks on health care have been widely documented, standardized multicountry comparisons using consistent surveillance metrics remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S193578932610336X_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective, descriptive observational analysis was conducted using incident-level, open-source records curated on the United Nations Humanitarian Data Exchange (HDX) from 2016 to 2024, covering 20 conflict-affected settings. Incidents involving harm to aid and health workers and attacks on health care facilities were summarized descriptively and standardized per capita to enable cross-setting comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S193578932610336X_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across the 20 settings, reported harm to health systems increased after 2021. PSE exhibited the highest per-capita burden, with 407 aid and health-worker fatalities and 420 reported attacks on health care facilities, while Ukraine recorded the highest absolute number of facility attacks (1,060). Myanmar demonstrated a distinct pattern characterized by large-scale arrests of health care workers following the 2021 military coup. Other settings demonstrated variable burdens and harm modalities, including personnel-lethal, infrastructure-destructive, and coercive patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S193578932610336X_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Reported attacks on health care in conflict settings are widespread and heterogeneous. This descriptive, per-capita comparison highlights variability in harm modalities across settings and identifies high-burden contexts that may warrant prioritization for surveillance strengthening, preparedness planning, and protection-focused operational coordination. Further research is needed to examine drivers, impacts on service delivery, and prevention strategies using attribution-aware, mixed-methods approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/dmp.2026.10336","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T07:56:24Z","timestamp":1774943784000},"source":"Crossref","is-referenced-by-count":0,"title":["A Decade of Reported Attacks on Health Care and Aid Workers Across 20 Conflict-Affected Settings (2016-2024): A Descriptive, Per-Capita Comparison Using Open-Source Incident Data"],"prefix":"10.1017","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1844-3439","authenticated-orcid":false,"given":"Dana","family":"Mathew","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00wftym42","id-type":"ROR","asserted-by":"publisher"}],"name":"Burrell College of Osteopathic Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2212-6969","authenticated-orcid":false,"given":"Jamla","family":"Rizek","sequence":"additional","affiliation":[{"name":"Adventures with Nurse Jamla"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"S193578932610336X_r4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31328-4"},{"key":"S193578932610336X_r7","doi-asserted-by":"publisher","DOI":"10.4018\/979-8-3373-0066-5.ch005"},{"key":"S193578932610336X_r2","unstructured":"2. International Committee of the Red Cross. Rule 25: medical personnel. Customary IHL Database. Accessed June 12, 2025. https:\/\/ihl-databases.icrc.org\/en\/customary-ihl\/v1\/rule25"},{"key":"S193578932610336X_r13","doi-asserted-by":"publisher","DOI":"10.54724\/lc.2022.e11"},{"key":"S193578932610336X_r15","doi-asserted-by":"publisher","DOI":"10.1186\/s13031-021-00355-8"},{"key":"S193578932610336X_r11","unstructured":"11. World Bank. Population, total (SP.POP.TOTL). World Development Indicators [database online]. Accessed January 16, 2025. https:\/\/databank.worldbank.org\/reports.aspx?country=&series=SP.POP.TOTL&source=2"},{"key":"S193578932610336X_r3","doi-asserted-by":"publisher","DOI":"10.1017\/9781108649544"},{"key":"S193578932610336X_r1","doi-asserted-by":"publisher","DOI":"10.7196\/SAJBL.2023.v16i3.1764"},{"key":"S193578932610336X_r5","doi-asserted-by":"publisher","DOI":"10.1186\/s13031-021-00372-7"},{"key":"S193578932610336X_r8","article-title":"Defense Department updates its law of war manual","volume":"31","year":"2023","journal-title":"Published July"},{"key":"S193578932610336X_r9","article-title":"DoD Instruction 3000.17: Civilian Harm Mitigation and Response","volume":"21","year":"2023","journal-title":"Published December"},{"key":"S193578932610336X_r6","unstructured":"6. World Health Organization. WHO\u2019s response to health emergencies: annual report 2023. Published July 18, 2024. Accessed June 5, 2025. https:\/\/www.who.int\/publications\/i\/item\/9789240097452"},{"key":"S193578932610336X_r10","volume-title":"Human Code Exchange (HCX): A Community-Value-Driven Framework for Data Governance in Humanitarian Crises","author":"Vibbi","year":"2023"},{"key":"S193578932610336X_r14","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)02476-0"},{"key":"S193578932610336X_r12","unstructured":"12. Physicians for Human Rights. Our Health Workers Are Working in Fear: After Myanmar\u2019s Military Coup, One Year of Targeted Violence against Health Care. January 2022. Accessed June 25, 2025. https:\/\/phr.org\/wp-content\/uploads\/2022\/01\/PHR_Report_Our-Health-Workers-Are-Working-in-Fear_One-year-anniversary-of-the-Myanmar-Coup_January-2022-Reduced.pdf"}],"container-title":["Disaster Medicine and Public Health Preparedness"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S193578932610336X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T07:56:26Z","timestamp":1774943786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S193578932610336X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":15,"alternative-id":["S193578932610336X"],"URL":"https:\/\/doi.org\/10.1017\/dmp.2026.10336","relation":{},"ISSN":["1935-7893","1938-744X"],"issn-type":[{"value":"1935-7893","type":"print"},{"value":"1938-744X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e72"}}