The world is witnessing a sustained assault on the provision of health care in times of conflict. A United Nations Security Council resolution vote on Tuesday hoped to ensure hospitals and patients would cease to be a target, write Peter Maurer and Dr Joanne Liu
A week ago, the al-Quds hospital in the north Syrian city of Aleppo came under attack.
The 34-bed hospital, which served as the city’s main referral centre for paediatrics, was completely destroyed.
Surrounded by darkness and dust, surviving patients, staff and volunteers began to dig out those trapped in the rubble. Two doctors who worked full-time at the hospital, were among the 14 confirmed dead.
Sadly, this is not an isolated case. From Afghanistan to the Central African Republic, from South Sudan to Yemen and Ukraine, ambulances, hospitals and health centres have been bombed, looted, burned and destroyed. Patients have been killed in their beds and health workers have been attacked as they rescued the wounded.
A dangerous complacency is developing where such attacks are regarded as the norm. They are part of the tapestry of today’s armed conflicts where civilians and civilian infrastructure are targeted, and marketplaces, schools, homes and health facilities are “fair game”.
In South Sudan’s Upper Nile region in July last year for example, a barrage of rockets landed near a hospital compound early one morning.
An adult male patient, a 12-year-old boy and a 3-year-old girl died instantly. In the days that followed more than 20 other people would die of their wounds.
As the fighting intensified, hospital staff, patients and civilians fled. Suddenly, an area of 75 000 people was without a major medical facility. Many more people died as a result.
Who has been carrying out these attacks? Well, just about everyone.
Armed forces, armed groups, even governments that sit around the table at the UN.
And let us be clear. It is not always “collateral damage”. It can be systematic, planned, deliberate and illegal. An attack on health care, whether intended or “accidental”, is an attack on humanitarian law.
What we are witnessing is a sustained assault on, and massive disregard for, the provision of health care during times of conflict.
Under international humanitarian law and principles, health workers must be able to provide medical care to all sick and wounded regardless of political or other affiliation, whether they are a combatant or not. And under no circumstances should they be punished for providing medical care which is in line with medical ethics.
The doctor of your enemy is not your enemy.
But we are confronted with violations of these fundamental rules, with serious humanitarian consequences, for entire communities and health-care systems that are already stretched to the limit.
We welcome the proposal for the landmark UN resolution to protect health care. But we urge the UN security council to make the resolution effective.
The resolution must send a powerful political message that health care needs to be protected by all parties to an armed conflict, who must fully comply with their obligations under international law, including humanitarian law.
Underpinning everything has to be the acceptance that the medical needs of people – no matter who they are, where they are from or what side they support or fight for – must take precedence.
Medical staff are present in areas of conflict in order to care for the sick and wounded, on the basis of need. And only need.
This is the fundamental principle of impartiality and the basis of medical ethics. It is the very fact that doctors treat on the basis of need – and are not involved in hostilities – that they can claim protection under international humanitarian law.
The UN resolution provides an opportunity to draw a line in the sand and prevent further attacks like that in Aleppo.
States have the moral and legal responsibility to act, to protect people caught up in armed conflict.
The time to act is now.
* Peter Maurer is president of the International Committee of the Red Cross and Joanne Liu is International President of Médecins Sans Frontières. This article was first published in The Guardian newspaper. We have permission from Doctors Without Borders to reprint it here.