War is the deliberate killing of people and destruction of infrastructure.
Even so, more than half a century ago, world governments agreed on rules to ensure that war would not be purposefully destructive of those who do not fight. These rules, known as international humanitarian law, were designed to lessen civilian suffering, and carve out particular protections for the provision of health care to anyone not actively engaged in the war. At the most basic level, international humanitarian law asserts that, while war unquestionably jeopardizes civilian wellbeing, it should not prevent the maintenance of health care amidst the chaos of the conflict. The end goal is to minimize cruelty.
Cruelty, however, has been a defining feature of the conflicts currently raging in Syria and Yemen. International humanitarian norms have been flouted through the bombing and shelling of health care facilities, blocking of humanitarian aid, besiegement, and the use of chemical weapons against civilians.
The extent to which these norms have been disrespected is remarkable. Over the course of the Syrian conflict, Physicians for Human Rights (PHR) has corroborated 492 attacks on health care sites, including 79 hospitals that were struck at least twice. Over a three-month period in 2017, PHR received reports of 10 attacks on health care facilities in Yemen, of which researchers were able to independently confirm four so far. In both Syria and Yemen, active parties to the conflict are allowed to unilaterally control access to humanitarian aid, leading to the denial of adequate care to civilians who are perceived as sympathizing with other parties.
But what is even more remarkable is the steady erosion of international humanitarian law that these recent conflicts has caused. Successive U.S. administrations have laid down various “red lines,” delineating just how egregious a violation of humanitarian norms they would tolerate before intervening. Warring parties in both Syria and Yemen have deployed shifting definitions of terrorism to justify broad carve-outs of what and who is an acceptable military target. Weapons sales to Saudi Arabia, which has led a three-year bombing campaign in Yemen, have skyrocketed, despite evidence of violations of the rules of war.
While international law has plenty to say about unilateral military action, internal conflicts, and acceptable weapons, the point here is that the clearest red line of all – the prohibition of attacks on health care facilities – has not featured clearly as a litmus test for when enough is enough in either conflict.
And that is as terrifying as the violations themselves.
International humanitarian law has not changed, of course. Attacks on hospitals and other health care facilities continue to be prohibited. Warring parties continue to have responsibility to allow unfettered access to humanitarian aid for those who need it.
But unless we insist on strict accountability for continued violations of the law – unless we treat it as the red line that it truly is – future conflicts will be characterized by even more flagrant disregard of norms. War will undoubtedly always be cruel. We, however, play a role in deciding to what extent.