The Guardian view on healthcare in war: protect those who aid others


Show caption Yangon general hospital, Myanmar. The country has become one of the most dangerous places on Earth for medics. Photograph: Lynn Bo Bo/EPA Opinion The Guardian view on healthcare in war: protect those who aid others Editorial The shameful litany of attacks on medical facilities and workers continues to grow Tue 15 Feb 2022 18.48 GMT Share on Facebook

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Those who save the lives of others need protection themselves. At least 415 attacks against health workers and facilities have been carried out since last year’s coup in Myanmar, according to a report published recently. It has become one of the most dangerous places on Earth for medics, with half of all such global attacks in the first six months of last year. The war in Ethiopia’s Tigray region has seen the large-scale destruction of facilities. With the crisis deepening in Sudan, last month the UN reported 15 healthcare attacks since November.

It is over a century and a half since the agreement of the first Geneva convention, an international prohibition on attacking the sick and wounded, assaulting or punishing those who offer them healthcare, and inflicting violence on hospitals and ambulances. Those protections have since been broadened and strengthened repeatedly.

Yet attacks on healthcare facilities and workers, often deliberately targeting them, have come to seem like a new normal, from the former Yugoslavia to Syria to Central African Republic. In 2019, at least 1,200 of these acts took place across 20 countries. Hatred, dehumanisation and genocidal thinking as well as the military demand for rapid victory have contributed. Sickeningly, measures meant to protect hospitals and clinics – such as giving their locations to combatants – have in the worst cases facilitated attacks on them. Accountability is vanishingly rare. When Human Rights Watch examined 25 major cases, it found that 16 involved potential war crimes. Just five cases saw a full investigation with published findings. In only one were soldiers disciplined.

The Assads of this world are the most obvious culprits, but the US, UK and others are hardly without taint. In October 2015, a US attack on a hospital in Kunduz, Afghanistan, killed 42 civilians. Countries also bear responsibility when their partners and allies carry out attacks with the weapons they supply. They almost always seek to duck it: “The support by the US and UK for Saudi Arabia’s war in Yemen, and the rationalisations 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 shifted to attention in the last decade, though action remained limited. Campaigning by civil society and the medical community has had a measurable impact at times. Some governments have made improvements. In 2018, the World Health Organization introduced a system for monitoring and reporting attacks, though it has not proved as effective as anticipated. The International Committee of the Red Cross has brought together military representatives, armed groups, experts and healthcare workers to discuss pragmatic measures such as running checkpoints in a way that does not unduly interfere with medical care.

We know what needs to be done. In 2016, the then UN secretary general, Ban Ki-moon, sent a detailed and lengthy set of recommendations for tackling the issue to the security council. Members took the opportunity to trade recriminations, but no action resulted. Even countries that pledged support failed to follow through, for example, by ensuring that domestic laws incorporate the Geneva conventions. Protecting healthcare is not an utterly hopeless task – but the ongoing attacks it faces show how desperately sustained effort is needed.