By: Emily Webster
In many modern conflicts we are witnessing an increasingly troubling issue: the flagrant disregard by state and military actors for the protection of healthcare in conflict zones. Painting a grim picture, in 2015, the World Health Organisation (WHO) released a report affirming ‘with alarming frequency a lack of respect for the sanctity of healthcare, for the right to healthcare and for international humanitarian law: patients are shot in their hospital beds, medical personnel are threatened, intimidated or attacked and hospitals are bombed’.[i] In May 2016, the United Nations Security Council unanimously adopted Resolution 2286, strongly condemning violence against health-care workers and facilities, and diagnosed the problem as an ‘epidemic of attacks’. This alarming pattern of violent activity against healthcare providers blatantly undermines and violates International Humanitarian Law, and threatens a degradation of respect for both humanitarian principles and medical neutrality. The growing destruction of healthcare systems in conflict-affected countries is an unnerving example of contemporary military encroachment into the ‘humanitarian space’.
A commonly cited example of this is the attack on Medecins Sans Frontieres (MSF) trauma hospital at Kunduz in Afghanistan, which was hit by a series of aerial bombing raids on 3rd October 2015. The main hospital building, that housed an intensive care unit, emergency rooms and physiotherapy wards, was repeatedly hit with precision munitions while surrounding buildings were left mostly untouched.[ii] When the aerial attack occurred, there were 105 patients in the hospital and more than 80 MSF international and national staff present. A total of 42 people were killed, including 14 MSF staff, 24 patients and 4 caretakers.[iii] Crucially, MSF’s hospital was the only facility of its kind in north-eastern Afghanistan, where it provided free and important life-saving healthcare.
The attack was the latest episode in a trend of increasingly strained relations between the military forces and humanitarian and health workers. In the immediate aftermath of the attack, it was unclear which party was responsible and thus who had violated International Humanitarian Law. However, it later came to light that United States military personnel had committed the strike, with General John Campbell, the US commander in Afghanistan, saying in November the strike was ‘caused primarily by human error’.[iv] A leading MSF official commented on the perceived lack of impartiality in the follow-up inquiry into the bombing, citing it was carried out by the same people who ‘committed the attack’.[v] Subsequently, MSF demanded that the White House conduct an independent inquiry into the airstrike, but received no response.[vi] The attack intensified strained relations between the military and humanitarian and health workers. Afghan workers stated that the US military targeted the hospital intentionally.[vii] But attacks on healthcare facilities purportedly caused by human error are only part of the problem.
Intentional shelling by government militaries has also exacerbated the difficulty for humanitarian workers to operate. Sri Lanka provides a practical illustration of this model. In 2009, many humanitarian workers were forced to pull out of providing relief to affected victims in the Sri Lankan government’s fight against the Tamil Tiger Liberation Front (LTTE) due to the insecure environment. Although the Sri Lankan government formally denied it, the United Nations found they had ‘systematically shelled hospitals on the frontline’.[viii] Further inquiry confirmed several government artillery shells struck a hospital in Puthukkudiyiruppu. This has led many in the humanitarian community to attempt to place more pressure on states to take stronger action to prevent violence against healthcare personnel. The ICRC stressed militaries recognise ‘how violence disrupting the delivery of healthcare is becoming a serious and widespread humanitarian challenge’. In Sri Lanka, the government shelling rendered the provision of healthcare services extremely challenging with lack of staff and resources, high mortality, and reduced ability to travel.[ix] The incessant attacks provide physical evidence of a widening divide between the priorities of states and humanitarian actors. By destroying healthcare facilities, state and military actors are making humanitarian work subordinate to strategic purposes, while damaging the humanitarian workers’ capacities to maintain neutrality and impartiality.
Cited as one of the most dangerous places in the world to be a health-care provider, Syria is a frightening example of how conflict actors direct attacks against health systems to further their own goals. The medical research journal Lancet recently released a preliminary report on the ‘weaponisation’ of healthcare in Syria. The Syrian regime is reported to have increasingly targeted health facilities, with the Syrian Network for Human Rights reporting 289 attacks on medical facilities, ambulances, and Syrian Arab Red Crescent bases – 96 per cent of which were by Syrian or Russian forces.[x] The complex situation provides a difficult but essential question for the international community, how best to respond to ever-increasing attacks on medical neutrality in one of the most brutal conflicts in recent history?
Conflict is already known to trigger a ‘brain drain’ on affected-countries, and the decreasing respect for health services is likely to only exacerbate this situation. This World Health Day, it is vital to pay attention to the struggles of health and humanitarian workers in conflict, and highlight the ever-dangerous situations they face. With depression the theme of this World Health Day, it is ever more important to focus on the strengthening of health systems in conflict. With the basic tenets of healthcare becoming a more prevalent strategic objective in modern warfare, the burden of non-communicable diseases and mental health will only be exacerbated even further in post-conflict societies by this loss of infrastructural capability.
Emily Webster (@emilylwebster) is currently pursuing her Master’s in Conflict, Security and Development at King’s College London. She previously graduated from King’s with a BA in War Studies and History.
[i] World Health Organisation, “Attacks on Healthcare 2014 and 2015”, p.3, accessed April 3rd 2017.
[iii] Chris Johnston and Agencies, “MSF Afghanistan Hospital Airstrike Deathtoll Reaches 42”, The Guardian, 12th November 2015.
[iv] Chris Johnston and agencies, “MSF Afghanistan Hospital Airstrike”, 12th November 2015.
[vii] Spencer Ackerman and Sune Engel Rasmussen, “Kunduz hospital attack: MSF’s questions remain as US military seeks no charges”, The Guardian, 29th April 2016.
[viii] Report of the Secretary General’s Panel of Experts on Accountability for Sri Lanka, Executive Summary, United Nations, 31st March 2011, accessed March 31st 2017.
[ix] Mahinda Kommalage & Harshani Thabrew, “Running an ETU in a newly established IDP camp in Sri Lanka”, Medicine, Conflict and Survival, (2010), p.93.
[x] Fouad, Fouad M et al, “Health workers and the weaponisation of healthcare in Syria: a preliminary inquiry for American University of Beirut Commission on Syria”, The Lancet, 14th March 2017.