Resolution 4 : Health Care in Danger: Continuing to protect the delivery of health care together | Power of humanity: Red Cross Red Crescent

State

Name, position and email of the focal person

Name: Ms. Ana Pereira
Function: Legal counsellor at the Department of Legal Affairs of the Ministry of Foreign Affairs of Portugal
Email: ana.costapereira@mne.pt

1. What legislative, regulatory and practical measures have you put in place and implemented domestically to ensure the protection of the wounded and sick, health-care personnel and facilities, medical transport, as well as their identification (including through the distinctive emblems)?

The National Platform for Disaster Risk Reduction has conducted a national assessment of building safety at public hospitals in 2016.
As for identification of healthcare personnel and facilities, Portugal signed the Additional Protocol to the Geneva Convention of 12 August 1949, and relating to the Adoption of an additional distinctive Emblem (Protocol III), on December 8th 2005, and has deposited its instrument of ratification on 22 April 2014.
Portugal and the Portuguese Red Cross have made a joint pledge concerning the integrity of the distinctive emblems. Portugal and its national society have agreed on a joint action plan involving relevant governmental departments (e.g. the Ministry of Health, the Ministry of Education, the Ministry of Internal Administration) and including the following legislative, regulatory and practical measures:
- assessing relevant legislation on the use of distinctive emblems;
- designing a road-map of the current misuses of distinctive emblems in Portugal;
- creating a national monitoring system for preventing the misuse of distinctive emblems;
- promoting campaigns on the recognition and correct use of distinctive emblems by relevant authorities and the general public;
- exchanging good practices to prevent and discipline the misuse of distinctive emblems;
- translating the comic book 'The Story of an Idea: A Comic by Moebius' to Portuguese.

What about the measures to ensure the violations of international law related to the protection of health-care delivery are effectively sanctioned? Which ministry, government agency, legislative or regulatory organ has been responsible for implementing these measures?

Portugal is strongly committed to fully implement international justice related to any violations of International Humanitarian Law, namely to the full implementation of the Rome Statute of the International Criminal Court. Law nr. 31/2004, of 22 July 2004, has established legislation adapting Portuguese Criminal Law to the Statute of the International Criminal Court, approving the Criminal Law Concerning Offences against International Humanitarian Law.
The Portuguese Criminal Code and the Portuguese Code of Military Justice subsidiarily apply to violations of International Humanitarian Law, including those related to the protection of healthcare delivery. Criminal proceedings related to war crimes or crimes against humanity have no limitation period under Portuguese law.
As a member of the European Union, Portugal fully supports European action on preventing, combating and providing remedy for violations of International Humanitarian Law, notably the implementation of the EU Guidelines on Promoting Compliance with International Humanitarian Law.
The Public Prosecution Service is a constitutional body entrusted with powers to prosecute and to take part in the implementation of criminal policy in Portugal. From a procedural standpoint, it is an autonomous magistracy competent to criminally prosecute and lead criminal investigation. The Public Prosecution Service also promotes crime prevention initiatives.

2. What concrete actions have you conducted to collect and analyze data related to violence against the wounded and sick, health care personnel and facilities, and medical transport? How did you use this information to develop practical measures to address such violence?

The National Institute of Statistics (a public institute) publishes annual online reports on healthcare in Portugal (disaggregated data and data analysis). The General Directorate of Health’s website provides online registration forms for the laying of information regarding threats, physical assault and verbal assault of nurses, medical doctors and other healthcare personnel. All these data and information have proved crucial in the designing and implementation of public policies on the safety of healthcare personnel.

3. What actions has your government undertaken to enhance the understanding by health care personnel of their rights and responsibilities resulting from applicable law?

The Ministry of Health has signed protocols with the Portuguese Red Cross to enhance the understanding by healthcare personnel of their rights and responsibilities under International Law. The Portuguese Red Cross also trains the military health services on the protection of wounded and sick combatants, castaways, prisoners of war, civil victims of international and non-international conflicts and other exceptional situations.

What specific measures has your government taken to ensure that health care personnel can safely fulfil their medical duties in line with their professional code of ethics?

Name: Ms. Ana Pereira
Function: Legal counsellor at the Department of Legal Affairs of the Ministry of Foreign Affairs of Portugal
Email: ana.costapereira@mne.pt

4. How have you been cooperating across various Ministries of Government, and with other relevant stakeholders, including the Red Cross Red Crescent Societies, health-care professional associations and civil society, in your country to increase the safety of provision of and access to health care?

In Portugal, the National Health Service (the public healthcare system) provides universal, general and tending-towards-free health services. There is a hospital network and a healthcare center network (proximity healthcare) across the territory. Rapid response healthcare is provided by the Integrated Medical Emergency System (in emergencies such as accidents or sudden illnesses).
The General Inspectorate of Health Activities (from the Ministry of Health) monitors the safety and quality of provision of healthcare in the public and private sectors. Safety of provision of healthcare stems also from the fact that higher medical education in Portugal is highly scrutinized and is only provided by public medical schools (connected to the hospital national network).
The Portuguese Medical Association (i.e. professional order of medical doctors) disciplines the safety and quality of medical care by medical doctors in Portugal, as well as respect for the medical code of ethics. Registration with the Association is mandatory for practicing medicine and the Association’s decision on disciplinary actions is binding.
The General Directorate of Health (from the Ministry of Health) is implementing the National Plan for the Safety of Patients (2015-2020) and the National Strategy for Quality in Health (2015-2020). Both the National Plan and the National Strategy involve security and safety measures for patients and healthcare professionals. These actions are expected to strengthen a culture of security and safety, preventing security and safety hazards in the National Health Service (including primary care, surgeries, drug prescription and distribution, etc.) and upholding high-quality standards in healthcare provision.

5. How do you ensure that the protection of the wounded and sick and healthcare services is integrated into training, doctrine and operational orders and procedures for your armed and security forces whether at the national level or in the context of international operations they are contributing to?

The Portuguese Red Cross and the Armed Forces have signed several protocols establishing cooperation in the fields of training and support of survival in emergency situations at national and international levels and healthcare.
The protection of healthcare personnel and facilities was one of the subjects of the public conference “Humanitarian Assistance and the Protection of Civilians in Situations of Armed Conflict– Current challenges” (jointly organized by the Ministry of Foreign Affairs and the Portuguese Red Cross and held on 7 April 2017), attended by members of the Armed Forces and representatives from the Ministry of National Defense.
Portuguese military officers receive training on International Humanitarian Law throughout their instruction and career: as part of basic instruction at the military academies and when they attend preliminary courses for the promotion to the ranks of superior officer (rank of major and above) and general officer (major-general and above). Special training on protection of the wounded and sick and healthcare services is also provided prior to their deployment to international operations.
Engagement rules designed for each operation and mission take the rules and principles of International Humanitarian Law into consideration.

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