Jthose who save the lives of others need protection themselves. At least 415 attacks on health workers and facilities have been carried out since last year’s coup in Myanmar, according to a recently released report. It has become one of the most dangerous places on Earth for doctors, with half of all such global attacks in the first six months of last year. The war in Ethiopia’s Tigray region has resulted in the large-scale destruction of facilities. As the crisis in Sudan worsened last month, the UN reported 15 attacks in the health sector since November.
More than a century and a half have passed since the agreement of the first Geneva Convention, an international ban on attacking the sick and wounded, assaulting or punishing those who give them care and inflicting violence to hospitals and ambulances. These protections have since been expanded and strengthened several times.
Yet attacks on health facilities and health workers, often deliberately targeting them, have become a new norm, from the former Yugoslavia to Syria to the Central African Republic. In 2019, at least 1,200 such acts took place in 20 countries. Hate, dehumanization and genocidal thought as well as the military demand for a quick victory contributed to this. Sickeningly, measures to protect hospitals and clinics – such as giving fighters their locations – have, at worst, facilitated attacks on them. Accountability is extremely rare. When Human Rights Watch reviewed 25 major cases, it found that 16 involved potential war crimes. Only five cases have been fully investigated with published results. In only one case were the soldiers disciplined.
The Assads of this world are the most obvious culprits, but the US, UK and others are hardly free from taint. In October 2015, a US attack on a hospital in Kunduz, Afghanistan, killed 42 civilians. Countries are also responsible when their partners and allies carry out attacks with the weapons they supply. They almost always seek to dodge it: “The US and UK support for Saudi Arabia’s war in Yemen, and the justifications offered for it, is the quintessential example of this conduct” writes Leonard Rubenstein, a human rights lawyer who has investigated many such atrocities, in his recent book Perilous Medicine.
It would be easy to despair. Yet Mr Rubenstein argues that such attacks are now more likely to be reported and that global indifference has focused on attention over the past decade, even as action has remained limited. Campaigns by civil society and the medical community have sometimes had a measurable impact. Some governments have made improvements. In 2018, the World Health Organization set up an attack monitoring and reporting system, although it did not prove to be as effective as expected. The International Committee of the Red Cross has brought together military representatives, armed groups, experts and health care workers to discuss pragmatic measures such as managing checkpoints in a way that does not unduly interfere with medical care.
We know what to do. In 2016, then-UN Secretary-General Ban Ki-moon sent the Security Council a long and detailed set of recommendations to address the problem. The members took the opportunity to exchange recriminations, but no action was successful. Even countries that had pledged support have failed to follow through, for example by ensuring that national laws incorporate the Geneva Conventions. Protecting health care is not an entirely hopeless task, but the continued attacks it faces show how desperately sustained efforts are needed.