How Should Health Systems Help Clinicians Manage Bias Against Ex-combatants?

Abstract

Clinicians in postconflict health care settings can be tasked with caring for patients who are ex-combatants. This commentary responds to a case of a health worker with duties to care for ex-Revolutionary Armed Forces of Colombia combatants. Specifically, this article considers clinical, ethical, and legal demands of reincorporating ex-combatants in compliance with a peace agreement on systems and individual health workers.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. CaseCH is a health worker who has long served rural community members of Vista Hermosa, Colombia. CH travels to veredas (remote, limited-resource clinical settings) as an employee of a local health organization's outreach program, without which, hundreds of people-including ex-Revolutionary Armed Forces of Colombia (Fuerzas Armadas Revolucionarias de Colombia, or FARC) combatants-would lack access to clinical evaluations and health services. CH is haunted by having been kidnapped by FARC members years before. "It was horrible," CH relates. "They kidnapped and held us for 3 days without food or water. We had no idea when we would be released. They are overtaking our hospitals and have more rights than their victims." Despite a peace agreement, CH and other health workers traumatized by years of conflict struggle to maintain clinical neutrality and execute professional duties to care for all patients their hospital serves. CommentaryUntil 6 years ago, FARC was a guerrilla group that had operated in Colombia since the 1960s and had been known to kidnap health care workers for ransom or medical assistance. 1 In 2016, Colombia and FARC signed the Acuerdo Final para la Terminación del Conflicto y la Construcción de una Paz Estable y Duradera (peace agreement), 2 ending the longest conflict in the Western hemisphere and reincorporating 13 000 excombatants into society. With the agreement, FARC ex-combatants were guaranteed access to services, including health care. 3 However, as ex-FARC members began