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

Abstract Background 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. Methods 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. Results 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. Conclusions 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.