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An Anatomy of a Grenade Attack: Good Health and Well-Being

SDG 3: Good Health and Well-Being

3.1.1 – Number or proportion of health facilities damaged or destroyed by explosive weapons
Case Study

None. 

Global

Between 2011-2020 AOAV’s EVM recorded 12 grenade attacks on hospitals, the majority of which took place in Pakistan (4) and India (4). Hospitals are targets for grenade attacks since they are visible arms of the state or local governance, they treat injured soldiers, and sometimes, as in the case of a 2003 grenade attack in Baqubah, Iraq, civilian hospitals are targeted because they are guarded by armed forces.  

There are currently several organisations which monitor attacks on healthcare facilities, resources and professionals throughout the world. These include the Safeguarding Health in Conflict Coalition (SHCC) and the World Health Organization’s Surveillance System for Attacks on Healthcare (SSA). However, published datasets compiled by these organisations do not currently disaggregate depending on weapon type, although they do provide information on whether attacks were carried out by ground-launched or air-launched explosive weapons.

3.1.2 – Number of health workers killed or injured by explosive weapons, disaggregated by gender
Case Study

The first health workers arrived at the scene 15-20 minutes after the attack, as such there were no health care workers among the casualties. If healthcare workers were among those killed and injured by the blast, this would have been incidental.  

Global

In the 12 grenade attacks recorded on hospitals in the last decade there were 44 civilian casualties, including 6 women and 12 children. We can assume that a number of these casualties were healthcare workers.

3.1.3 – Shortages in essential medical supplies
Case Study

The attack itself did not cause a shortage in medical supplies, but the high number of casualties put pressure on Nairobi’s medical services. Photographic evidence obtained by AOAV shows blood transfusions being conducted on the hospital floor of Kenyatta Hospital (see Figure 19), suggesting that there were not enough beds available for all patients. AOAV’s interviewees described the strain on emergency medical resources given the high number of casualties. A Red Cross volunteer told AOAV that the most seriously injured were treated at Kenyatta National Hospital, less severe cases were transferred to Mbagathi District Hospital. 

Figure 19: Scenes from Kenyatta Hospital on 12 March 2012. Photo credit: Billy Mutai.
Global

When a grenade is launched onto a hospital, it is typically thrown from the outside into the inside, such as the 2018 attack on Durrat al-Dar Hospital in Aden, Yemen, when the grenade was thrown at the hospital gate causing panic and fear but no casualties. As such, medical supplies stored in hospitals are rarely compromised in grenade attacks. However, the links between grenade attacks and shortages in medical supplies requires further investigation. 

3.1.4 – Number or proportion of ambulances destroyed (locally)
Case Study

None.  

Global

AOAV found no instances of ambulances destroyed by hand grenades. WHO SSA records incidents that impact on health transport; however, as mentioned previously, weapon type is not mentioned.

3.2.1 – Number or proportion of health facilities with service disruptions
Case Study

Kenyatta Hospital was close to being overwhelmed by the influx of injured people on the night of the Machakos attack.  Some patients were transferred to Mbagathi County Hospital to relieve the pressure on Kenyatta and reduce disruptions. 

Global

When a grenade damages a hospital it typically brings about some disruption to their services. This disruption is exemplified by the 2014 attack on Marlin Hospital in Jalozai, Pakistan. Unidentified motorcyclists hurled a hand grenade at an NGO-run hospital, and though there were no casualties reported, the hospital was closed after the attack and it was not known by local journalists whether this was to be temporary or permanent. 

Figure 20: Kenyatta Hospital (March 2021). Source: Verity Hubbard, 2021.
3.2.2 – Health worker density and distribution per 10,000 population, compared with pre-conflict
Case Study

N/A

Global

There is currently insufficient information available to present causal links between grenade attacks and changes in health worker density and distribution. 

3.2.3 – Difference in proportion of births attended by skilled health personnel, compared with pre-conflict
Case Study

N/A

Global

While national data is available on the proportion of births attended by skilled health personnel in some countries, there is insufficient evidence to draw relationships between the use of grenades and this indicator. 

3.2.4 – Difference in proportion of the population with access to affordable medicines and vaccines, compared with pre-conflict

Case Study

N/A

Global

In the two countries with the highest number of grenade attacks in the past decade – Pakistan and India-  there are issues with the supply and coverage of vaccines and medicines. However, in both cases, there is not the evidence to precisely identify how grenades may have contributed to these concerns.

3.3
1 – Difference in maternal, neonatal and under-five mortality, compared with pre-conflict
2 – Difference in mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease, compared with pre-conflict
3 – Difference in reported cases of and number of deaths from preventable diseases such as cholera, measles or polio or changes in the life expectancy of HIV-positive patients, compared with pre-conflict
Case Study

N/A

Global

The area-impact radius of a grenade is smaller to that of other explosive weapons; most grenades have a casualty-inducing radius of approximately 15m and a kill radius of 5m, compared to the 120-mm mortar which has a kill radius spanning 38m. Thus, structural and systematic damage to key healthcare infrastructure is unlikely so that it would affect infant mortality, chronic diseases and preventable diseases.

Report continues:

Chapter 6: SDG 4 – Quality Education
Chapter 7: Other Considerations
Conclusion and Recommendations