The Appalling Rise in Attacks on Health Care in Conflict in 2018

This past week, I took a decisive step towards realizing my dream of becoming a doctor by taking the grueling medical school admissions test (MCAT). I was told that the hazards of the MCAT – the nights and weekends spent studying at the library, the personal sacrifices, and the stress – would prepare me for the challenges of a medical education and practicing medicine. But the release of the Safeguarding Health in Conflict Coalition (SHCC) report this week brought home to me the actual deadly perils that increasing numbers of doctors and health care professionals face in conflict zones around the world.

The SHCC sixth annual report, “Impunity Remains: 2018 Attacks on Health Care in 23 Countries in Conflict,” details a total of 973 reported attacks on health care facilities and personnel across 23 countries in 2018. The most dangerous countries for health care facilities and personnel last year included Afghanistan, South Sudan, Syria, and Yemen. The report provides a grim accounting of unlawful military attacks on health care facilities and personnel, including aerial and surface-to-surface attacks, the burning and looting of hospitals, and attacks on ambulances and other health transports.

The impact of those attacks goes beyond the 173 health facilities that were destroyed or damaged across 11 countries. Their legacy includes a debilitating effect on health care accessibility in conflict zones resulting from the closure of health care facilities and the attendant denial of health care to untold numbers of civilians. In Afghanistan alone, attacks forced the closure of 140 clinics between the summers of 2017 and 2018, effectively denying access to health care to an estimated two million people.

The direct death toll from attacks on health care also rose significantly in 2018. The report documents the deaths of 167 health care workers in 17 countries. Those deaths worsened the already serious shortage of health workers in conflict zones.

The most appalling example of intentional, systematic targeting of health care facilities and workers in the world is Syria. The Syrian government of Bashar al-Assad has for the past eight years systematically and deliberately targeted medical infrastructure and personnel, preventing Syrian women, men, and children from accessing critical medical care in blatant violation of international humanitarian and human rights law. From March 2011 through May 2019, Physicians for Human Rights (PHR) confirmed 566 attacks on at least 350 separate facilities, in 12 out of Syria’s 14 governorates.

This systematic targeting of doctors in conflict zones must cease, as it stands in clear violation of international humanitarian and human rights laws. These laws have established special protections for medical personnel and facilities to ensure that the delivery of care can continue safely through conflict. Any deliberate attacks against health facilities, or attacks carried out without appropriate measures to avoid destruction of these facilities, can be considered war crimes. Protecting the lives of civilians and health care providers in conflict zones hinges on accountability for these crimes and the development of new international human rights mechanisms that can be deployed to help prevent further attacks.

The systematic brutality of this targeted violence is made appallingly clear on PHR’s interactive Syria map, which displays attacks by date, perpetrator, and governorate and provides details about specific incidents and patterns of violence. An interactive timeline is also available to selectively view attacks within a certain timeframe or to compare different time periods during the conflict. As PHR’s most recent resource compiling data on attacks on health care workers demonstrates, at least 890 medical professionals have been killed in Syria in the past eight years. PHR’s data shows that 90 percent of these crimes were committed by the Syrian government and its allies. PHR covers the specific ways in which the Syrian regime has undercut medical access and provision through targeting its providers and facilities in numerous case studies, and discussions of recent developments can be found in our blog archive.

As I contemplate my own future career in medicine, I stand in awe of the immense risks and sacrifices of health providers in conflict zones and the need to hold accountable those who unlawfully target them and their patients.

Natalia Melnyk is a pre-med student in the Macaulay Honors College at Hunter College in New York City and served as an intern in the Research and Investigation unit at Physicians for Human Rights from February to May 2019.

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