Attacks on health workers and facilities have become a feature of modern war; they are not simply committed by rogue countries or forces.
It’s time for an organized international system for reporting attacks on hospitals and health workers in armed conflicts and to hold perpetrators of such acts accountable, say PHR’s past President, Leonard Rubenstein, and Melanie Bittle in an important recent article in The Lancet. The authors have conducted a review of reporting by governments, human rights organizations and the International Committee of the Red Cross over the past 20 years, looking for incidents and descriptions of bombing and shelling of hospitals, attacks on ambulances and medical convoys, harassment, arrest, torture and killing of medical workers, and more.In reviewing the violations of international law that these acts entail, Rubenstein and Bittle find little or no accountability for perpetration of these human rights violations and war crimes, and conclude that reporting by NGOs, UN agencies and governments is also deficient.Disturbingly, but not surprisingly, their review identified three trends in such assaults. The authors report:
Attacks on medical functions seem to be part of a broad assault on civilians; assaults on medical functions are used to achieve a military advantage; and combatants do not respect the ethical duty of health professionals to provide care to patients irrespective of affiliation.
Given the obvious health threats for affected populations when medical care itself comes under attack, Rubenstein and Bittle call on the World Health Organization (WHO) to lead a “robust and systematic documentation of these violations, and demand accountability.” Since many, if not most, of these violations and war crimes are perpetrated by government actors, this may be a tall order for the WHO, which works largely through government ministries of health. Nonetheless, this ambitious review is most welcome to PHR and our colleagues, many of whom have documented violations of “medical neutrality” since the 1980s or sustained these outrageous attacks themselves. For two decades, PHR has probed violations of medical neutrality and advocated for protection against them–most recently in Iraq, Sri Lanka, former Yugoslavia, Chechnya, El Salvador, occupied Palestine and Kashmir. An excellent appendix attached to the Lancet article provides citations to major existing studies, including PHR’s.PHR supports the call to the health community to speak out more vigorously when systematic attacks on patients and medical functions occur in war. It is indeed high time for a much more robust and concerted global effort to protect medical care and patients in armed conflicts.