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Attacks on health care workers in conflict zones are increasing, prompting calls for physicians and medical organisations to advocate for greater protections.
A new perspective published in the Medical Journal of Australia calls on medical professionals and organisations to advocate for the protection of health care workers in conflict zones.
Protections for hospitals and medical personnel during war were codified in the 1864 Geneva Convention, and further strengthened by subsequent conventions and treaties such as the 1949 Geneva Convention and the Rome Statute of the International Criminal Court (1998).
Despite these protections, attacks on health care workers and infrastructure during conflicts are increasing.
“Health care is protected under international humanitarian law but there are challenges faced with its enforcement,” Dr Irma Bilgrami and co-authors write.
“Consequently, we opine that physicians and medical societies have a moral imperative to advocate for the enduring protection of health care workers, patients, and health care infrastructure in conflict zones.”
Increasing attacks on health care workers
Attacks on health care workers have risen dramatically in the past few years, largely due to ongoing conflict in Israel–Palestine, Myanmar, Ukraine and Sudan.
There were 2500 incidents of violence against or obstruction of health care recorded in 2023, which was a 25% increase in the number of incidents reported in 2022, which in turn saw a 45% increase in incidents compared to 2021.
“The attacks reported include bombings, looting, occupation and deliberate targeting of health facilities, with health care workers killed, kidnapped or arrested,” the authors write.
“Medical supplies were hijacked, patients obstructed from accessing care, and hospitals were repurposed for military use, leading to injuries and deaths of patients and staff.”
Enforcing international humanitarian law is challenging, with most prosecution of crimes only occurring in the aftermath of conflict.
One particular challenge is the potential use of hospitals to shield military forces and objectives, which is a war crime itself under the Rome Statute.
“This has led to claims that hospitals have become militarised in order to justify attacks, refute criticism, and even to accuse the other party of violating international law,” the authors write.
“The truth of such claims remains disputed and unresolved.”
Why advocacy is vital
The perspective authors argue that physicians have been “unconscionably silent” in the wake of this growing violence, and greater advocacy is needed by physicians and medical organisations.
They cite notable physician advocates such as Nobel Peace Prize recipient Herbert Adams, who described activism as the “fourth dimension” of biomedicine, and Dr Kathleen Thomas, whose account of the Kunduz Trauma Centre attack in Afghanistan led to the Colombo Declaration.
Medical organisations have been inconsistent in their advocacy for health care workers in conflicts, often citing the need to remain apolitical, but the authors argue, “advocacy by its very nature must be political if it is to effect real and sustained change.”
“Medical organisations should create initiatives to educate their members about violence against health care workers in conflict zones, speak out to publicly condemn attacks on health care personnel and facilities, and call for action from their respective governments,” the authors write.
“Furthermore, the medical community, and especially those in leadership positions, should create and protect forums for colleagues with lived experience of working in conflict zones to bear witness to the atrocities and share the difficulties they encountered, as well as permitting those clinicians to acknowledge the political landscape contributing to health, for example, at annual scientific meetings.”
The authors note that international humanitarian law cannot be relied upon as the only instrument of prevention when it comes to attacks on health care in conflict zones.
“Medical associations and specialty societies must lead advocacy efforts to ensure that hospitals, health care workers, and patients are protected and not viewed as military targets.”
Read the perspective in the Medical Journal of Australia.
The authors of the perspective note that their statements and opinions reflect their views alone and do not represent policies or views of their institutions.
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The time for being soft on human rights is long past. Institute a global human rights violation tax. Thus if a health care worker is killed due to military action, the responsible nation must pay a hefty recurring fine for the next 200 years as restorative justice. This will make it uneconomical to target military facilities near hospitals and simultaneously prevent the aggressor from claiming undue hardship from justice measures. Refusal to pay such fines can then be declared as reason to deny said rouge nation from speaking at any international body including the UN, thus downgrading their sovereignty as appropriate to their behaviour. This is but part of an overall plan to deliver a better form of global governance as part of a more human centred approach. Those against a human centred approach should ask themselves if they are worthy of being treated like an adult.
My only concern on reading this is the suggestion that health care workers are somehow to blame for these war crimes for failing to demand action. I find this bizarre. The only possibility to prevent both the illegal militarisation of hospitals and their illegal targeting, would be the deployment of armed peacekeepers. The evident lack of preventative action is an international leadership failing, not a medical one, since these crimes are already extensively documented as they occur.