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From Solferino to Sri Lanka: health workers, health information, and international law

The 24th of June this year marked the 150th anniversary of the Battle of Solferino. It was the number of wounded and dying and the lack of medical care that led Henry Dunant to call for the formulation of ‘some international principle, sanctioned by a convention inviolate in character, which, once agreed upon and ratified, might constitute the basis for societies for the relief of the wounded . . .’. The health workers – from doctors to orderlies – who would provide that care, were then, along with their provisions and supplies, given special status in the Geneva Conventions. In any conflict, the diverse carers of the wounded and dying collect potentially powerful information. The number of amputees can indicate continued landmine use; certain types of burns reveal the use of white phosphorus in a built up area. Mortality data can form the basis of judgment of proportional response. Different actors have decided to use this information in different ways – Médecins Sans Frontières speaks out more openly, the International Committee of the Red Cross in quiet diplomacy – but all see it as essential for accountability in relation to international humanitarian law. Although the theory of international humanitarian law has increasingly received greater attention, the information which is needed to support it appears increasingly disputed. In Solferino, the estimated 6000 who died in one terrible day goes relatively unchallenged; but from Iraq to Gaza to Sri Lanka there is no agreement on the number of dead or injured and how many were combatants or civilians. This is despite increasingly sophisticated communication and visualization technology. This puts the health worker as messenger increasingly in danger. At the time of writing three Sri Lankan doctors who cared for the sick and wounded and were for several weeks the sole source of mortality and