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Hospitals Cannot Be Targets in War

7 minute read
Jason Cone is executive director of Doctors Without Borders—USA.

On April 27, a series of airstrikes hit Al Quds hospital in the embattled Syrian city of Aleppo, killing upwards of 50 people, including at least 29 women and children, and wounding scores more. The hospital—its emergency room, its intensive care unit, its operating theater, all of it—was destroyed. Doctors were among the dead as well, including one of the very few, if not the last, pediatrician in Aleppo.

Doctors Without Borders/Médecins Sans Frontières (MSF) supported Al Quds hospital with supplies and funding to help its remarkably brave staff assist patients. The bombing was shocking news. But, like a painfully recurring nightmare, it was not surprising. There have been far too many of these attacks in recent years, in far too many places. It seems obvious enough that people, even people at war, should not attack hospitals and kill medical workers and patients. And yet in Syria, Yemen, Afghanistan, South Sudan and elsewhere, it happens over and over again—a man-made, and eminently avoidable, epidemic of death and destruction.

Surveying just 11 countries, the International Committee of Red Cross documented 2,400 attacks on health workers, patients, medical facilities and medical transports between 2012 and 2014. In 2015, hospitals MSF ran or supported in Syria were targeted 94 times, often by “double tap” attacks in which a second wave of strikes aim to kill first responders to initial salvos. In Yemen, three MSF-managed or supported health facilities were bombed over the past six months. Hospitals and clinics in South Sudan have been attacked and pillaged—and staff and patients killed—on numerous occasions over the past three years. And last October, an American AC-130 gunship repeatedly fired on MSF’s trauma center in Kunduz, killing 42, wounding many more, and destroying the only facility of its kind in northern Afghanistan.

Read more: Hospitals and Medical Personnel Are Under Attack in Yemen’s War

MSF projects have been robbed and looted, and staff have been assaulted and harassed in places such as Central African Republic, Ukraine, Myanmar, Democratic Republic of Congo, Lebanon and Honduras, as well. And other organizations have their own catalogs of incidents—with local health workers bearing the brunt in almost every case. The tolls are never limited to the immediate casualties, either. The loss of health services at the precise moment care is most needed means that expectant mothers die in child birth, children go unvaccinated or perish from treatable diseases like malaria or diarrhea, and others lose all access to the treatments they require to survive.

It is offensive that we have to keep saying this, but not only are attacks on medical facilities and personnel completely outrageous and profoundly immoral, they are also grave breaches of the laws of war and international humanitarian law. Hospitals, staff and patients enjoy protected status, even in conflict. They lose this status only if the grounds are actively used to wage war, which was not the case in any of the incidents listed above. These were facilities that treated the people who needed treatment, as medical ethics dictate. Yes, this includes wounded combatants, too, because wounded combatants who lay down their arms when they seek care are no longer considered combatants. That is why we have strict “no weapons” policies at all our facilities. This why American military medics treat “enemy” fighters on the battle field—they, too, are duty bound to care for the wounded based on health status alone. To deny care or discriminate against patients because of their beliefs or affiliations is itself a war crime.

And, on a practical level, if we treated one group but not another, we could never claim to be independent and impartial—and we would then never be able to work across frontlines to provide emergency and often lifesaving medical services to hundreds of thousands, if not millions, of civilians in conflict zones.

Last Friday, the U.S. released its report into its bombing of MSF’s trauma center in Kunduz. The investigation was neither independent nor sufficient in terms of the accountability imposed for the deaths of our staff and patients; it’s absurd to expect objectivity when perpetrators investigate themselves, after all. And it was launched because the target was a well-known international humanitarian group and not a group of anonymous villagers in the hinterlands of some faraway country. That said, however, few other nations or non-state groups go even this far to account for attacks on health care. Many just write off incidents as “collateral damage” or “the fog of war.” Some ignore international humanitarian law altogether, reserving the right to attack whomever and whenever they want. Or they say they didn’t mean to hit a hospital, even though negligence or recklessness leading to strikes on medical facilities can also meet legal definitions of a war crime.

These dynamics are particularly complex today, when multinational coalitions are fighting in Afghanistan, Syria, Yemen and elsewhere, their members all hewing to their own rules of engagement and interpretations of the laws of war. The result is an environment wherein bombing medical facilities seems like some shockingly perverse new normal in times of war. This must change.

The U.N. Security Council has an important opportunity to make a statement this week. Although it’s ridiculous that it’s come to this, a resolution before the Council offers member states the chance to reaffirm their commitments to the protected status of medical facilities, staff and patients. The nations of the world—and the permanent Security Council members in particular—must back this resolution without reservation or qualification.

Actually, they must do more than just vote for it. They need to make sure the resolution recognizes that a sick or wounded individual, even a combatant, has the prerogative to seek and receive care in conflicts. It must call on all warring factions—state and non-state forces alike—to uphold their obligations toward civilians and the medical mission as dictated by international law. This means that the medical act cannot be criminalized, that medical facilities and staff enjoy protected status and will not be interfered with, instrumentalized or targeted when they lawfully provide health services.

Governments and militaries should enshrine these principles in their national laws and codes of conduct. What’s more, attacks need to be catalogued, their frequency and perpetrators recorded. And, crucially, there must be real and consistent repercussions for those who destroy medical facilities and kill those inside. Perpetrators cannot be the sole adjudicators of these crimes. Transgressors must be held accountable, their actions investigated by an independent body empowered to report its findings at the highest levels.

Most of this is already law. But given the serial nature of attacks on medical facilities today, states must explicitly assert that they will tolerate it no more. They must no longer condone acts that deprive medical care to populations in need. And they must demand an end to craven tactics—and outright war crimes—that kill both in an instant and in the days that follow, when no one is there to respond to the medical emergencies inevitably arise.

Protecting the wounded and sick and those who care for them is the last front line for humanity in the otherwise inhumane and brutal reality of war. A strong Security Council resolution is an important statement for humanity and the rule of law. But without action, the words will be meaningless.

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