Healthcare Should Not Become a Casualty of War

Amidst the furore over the alleged use of chemical weapons in Syria, it is easy to overlook the subsequent bombing of the hospital where the victims were taken – itself a potential serious violation of international humanitarian law. As the war in Syria drags on, the question of how to ensure protection for the wounded and sick, as well as their doctors and nurses, in conflicts around the world is one that must not be neglected. The obligation to allow access to medical care in war is important because it defends the most vulnerable – the protection of the wounded and sick is the protection of our wider humanity.

The entitlement of the wounded and sick to receive the medical care required by their condition is a foundational rule of international humanitarian law. Equally foundational is the rule protecting those providing medical assistance from being harmed, prosecuted or otherwise punished for having provided medical care, regardless of the nationality, religion, status or affiliation with a party to the conflict of the person receiving such care. States have a legal and moral duty to comply with these rules of war.

But documenting attacks on healthcare is difficult. Evidence is hard to validate and reports may be challenged. The bombing of the Médecins Sans Frontières (MSF) hospital in Kunduz, Afghanistan in October 2015 by the US Air Force is one such example. MSF’s claims and supporting evidence that the hospital was deliberately targeted have been refuted by the US, which claims the bombing was due to human error.

A damaged hospital room in Aleppo on 14 August 2012. Photo: Getty Images.

In Syria, a UN Commission of Inquiry has been established to investigate alleged violations of international human rights law. However, the Syrian government has not yet officially allowed the commission access and, although a UN mechanism has been established to collect, preserve and analyse evidence of violations of international humanitarian law and human rights law in order to facilitate and expedite criminal proceedings, it is not clear if or how any evidence gathered will be used to bring cases involving attacks on healthcare. In relation to possible action at the International Criminal Court,  Russia’s veto power in the UN Security Council could block any  referral.

With direct and repeated targeting of health workers, facilities and ambulances, Syria has been called ‘the most dangerous place on earth’ for health-care providers. According to the preliminary findings of the Lancet Syria Commission, over 800 health workers have been killed, incarcerated or tortured, while hundreds of health facilities have been systematically attacked since the start of the war in 2011.

In recognition of this proliferation of attacks in Syria and elsewhere in recent years, the protection of healthcare in conflict was reinforced in May 2016 by the adoption of UN Security Council resolution 2286. The resolution strongly condemned attacks on medical personnel in conflict situations and demanded an end to impunity for those responsible and respect for international law on the part of all warring parties.

Yet although it was widely acclaimed and co-sponsored by 80 states, it has so far not been implemented as planned. Then-UN secretary general Ban Ki-Moon made concrete recommendations for implementation but these have not been actioned in any systematic or effective way by member states. Practical steps are being taken by frontline organizations to minimize risks, but without corresponding political will at the highest levels, doctors and their patients remain in peril.

We are not lacking in knowledge, nor are we lacking in law, nor in practical recommendations for helping protect healthcare; hopefully, we are not yet lacking in pity. What we are lacking is global leadership that can stand up and support the rules that govern conflict and protect vulnerable people caught up in it. Citizens must urge their leaders to respect, adhere to and promote compliance with the legal frameworks that have the power to bring justice in the future, and the power to protect healthcare in the present.

The international system is being tested, and is struggling – but this does not diminish responsibility from states to take action to protect healthcare in conflict now; it is a legal, moral and humanitarian imperative.

Rachel Thompson, Research Associate, Centre on Global Health Security.

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