Intended for healthcare professionals


Health sector response to security threats during the civil war in El Salvador

BMJ 1996; 313 doi: (Published 07 December 1996) Cite this as: BMJ 1996;313:1470
  1. Paula E Brentlinger, volunteer physiciana
  1. a El Salvador
  1. Correspondence to: Department of Emergency Medicine, St Anne's Hospital, Fall River, Massachusetts 02721, USA.
  • Accepted 18 November 1996

During the recent civil war in El Salvador, as in other modern wars, human rights abuses adversely affected health workers, patients, and medical facilities. The abuses themselves have been described in reports of human rights advocacy organisations but health sector adaptations to a hostile wartime environment have not. Agencies engaged in health work during the civil war adapted tactics such as training of community based lay health workers, use of simple technology, concealment of patients and medical supplies, denunciation of human rights abuses, and multilevel negotiations in order to continue providing services. The Salvadorean experience may serve as a helpful case study for medical personnel working in wars elsewhere.

The recent civil war in El Salvador was notorious for human rights abuses, which affected sick and wounded people, lay and professional medical personnel, and relief workers. The health related human rights problems of the war, often termed “abuses of medical neutrality,” were periodically reported by medical professionals and human rights advocates1 2 3 4 5 6 and were described in medical memoirs.7 8

There have been few published accounts of the means by which medical personnel and others sought to preserve war threatened health services in El Salvador. As this information might prove useful to others working in similar circumstances I describe my observations and review information from published reports.

Dangers faced by health workers and patients

Certain difficulties experienced by medical personnel and patients served the strategic ends of the parties to the Salvadorean conflict. In general, health workers became targets when their activities were interpreted as logistical or moral support to the opposing party, and patients became targets when they were suspected of being enemies or enemy sympathisers. Patterns of abuse were thus detectable. The box lists the most common categories of violations. The scheme9 is based on the 1949 Geneva conventions …

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