Unacceptable when doctors under attack

WAR is Hell. And in Hell, indescribable acts of brutality are normalised, if not condoned. War is not clean. It is not neat and it is certainly never clear. In war, decisions to apply violence are made in the opacity of chaos. Information is misunderstood and mistakes are made. Innocent people pay for these mistakes with their lives.

They always have. Perhaps they always will.

War may be Hell, but it has rules. And they are being forgotten or ignored.

The latest seemingly deliberate and targeted airstrike on an unarmed, clearly marked Medécins Sans Frontières (MSF) hospital in Syria represents a cynical disregard for the laws of armed conflict.

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Who did it? No one knows for sure yet – although monitoring groups say Russian jets were seen in the area. Doesn’t mean they did it. Doesn’t mean they didn’t. In a way it doesn’t matter.

What does matter is that this is the latest in a long line of hospitals to be attacked in the last year in the Middle East. Kunduz in Afghanistan was most publicised. Since then, airstrikes have hit hospitals in the Shiara, Taiz and Haydan districts in Yemen, Dara’a and Azaz in Syria, and now Maarat al-Numan near Idlib, also in Syria, to name a few.

Attacking hospitals is not new. Hospitals and health care workers have been attacked in war for as long as war has existed.

Indeed, both the International Committee for the Red Cross and Human Rights Watch have released independent reports detailing this. Thousands of attacks on health care workers across continents and contexts have occurred between 2012 and 2015 – well before the Kunduz attack ever happened.
 
So why is now any different?

Now is one of the first times in history that immediate information about an atrocity in a high-profile conflict can be made widely available, without first being scrubbed and heavily edited by victorious forces. Almost as the attacks happen, video feeds, audio and photos of the carnage are available online.

If, with this fresh information, we cannot be affected to absolutely condemn these attacks, and encourage our leaders to meaningfully do the same, then some aspect of our humanity is forever lost.

International humanitarian law is not antiquated and it is not a set of quaint rules that are no longer relevant. It is the law that determines how we preserve our humanity while engaging in this most inhuman of acts – war. And it sets aside certain protections for so-called protected persons.

It mandates, despite the chaos, what is never acceptable.

Bombing a hospital. Burning patients alive in their beds. Killing doctors and nurses. These things are never acceptable.

As a medical officer with the Australian Army in Afghanistan and Iraq, I have relied – perhaps naïvely – on these protections to some extent. Although I personally doubted whether our adversaries would have afforded those protections to me, it was and is essential that we afford them universally. Or we are no different. My colleagues and I certainly did.

Maybe it is naïve of me to believe international humanitarian law is important and that purposefully bombing a hospital is one of the most heinous of war crimes.

If it is, then equally, it is cynical of major players to flaunt these laws. In doing so, they are counting on our indifference.

These attacks were not a lone madman with a Kalashnikov. Like Kunduz, these were airstrikes. And whether by accident or design, they have not been perpetrated by a gang of insurgents.

As global citizens we give our tacit consent to the continued and flagrant disregard for the rules of war by ignoring attacks like these when they occur.

I have had some pretty scary moments in war zones. Thankfully I’ve never been properly blown up, but I’ve certainly seen and treated the effects of bombs and blasts on the human body, so I can imagine the horror on the ground in Kunduz and Dara’a and Maarat al-Numan.

I am truly devastated when I read about attacks like these. MSF is independent, impartial and humanitarian. Whoever the wounded may be, MSF is there to treat them. And so to blow their people up is an abomination.

If it’s okay for attacks like these to happen there, then it’s okay for them to happen anywhere. And if we all think about what it would be like for that to happen during our own morning rounds or in our operating theatres, then maybe international humanitarian law doesn’t seem so quaint anymore.

Without respecting the line in the sand that says no matter what horrible things can happen in a war zone, that hospital over there is off-limits, we make it acceptable for it to happen again.

And through our indifference, we become complicit.

Dr Simon Hendel is a Melbourne-based anaesthetist and aeromedical retrieval consultant. He has served as a medical officer in the Australian Army in Afghanistan and Iraq.