In conflict areas, Médecins Sans Frontières / Doctors Without Borders (MSF) gives medical care to people without asking which side they are on. This cannot justify any of the attacks.
Although hospitals are supposed to be protected under international humanitarian law, attacks have always happened.
Especially in Syria, a worrying number of these attacks on medical personnel and infrastructure follow the barbaric tactic known as “double‐tap”, which aims to maximise the number of casualties by targeting rescue services, including medical responders. That is a clear violation of international humanitarian law. Medical reports from MSF-supported facilities show four casualty influxes in the last two months of 2015 with all the characteristics of a double-tap event.
There may be a number of reasons, none of them good or legal. Perhaps to stop a whole community who are being directly targeted in a conflict from getting medical care, or to loot and steal the resources found in the facilities, or because there is a “scorched earth” policy in which health facilities (including MSF’s) are destroyed in a general attack. Or the strike may be intended to kill one or more specific patients in the hospital.
But one thing is clear: whether the attack is intentional or not, bombing a known functioning hospital is not acceptable. Under International Humanitarian Law (IHL), it is mandatory for warring parties to take all precautions to ensure medical staff and facilities are not attacked.
In the case of the MSF Trauma Centre attack in Kunduz, Afghanistan in October 2015, the bombing took place despite the fact that MSF had provided the GPS coordinates of the hospital to Coalition and Afghan military and civilian officials as recently as four days before the attack.The hospital was repeatedly hit very precisely during aerial raids, while surrounding buildings were left mostly untouched.
While in Syria, many medical facilities go to great lengths to make sure they are not and cannot be identified as medical structures to avoid being deliberately targeted in bombing or shelling. But even then, there is no real justification for hitting those buildings just because they are not marked as hospitals. Warring parties must identify their targets specifically and precisely as legitimate military targets, not just because it’s a building that might have some people in. Bombing and shelling un-marked and clandestine medical facilities is a clear indication of indiscriminate bombing, which is also entirely forbidden by the rules of war.
These attacks against medical facilities cause intolerable suffering and death among doctors, medical staff, patients, care takers and communities. They are a double attack on the people already made vulnerable by war and violence. Apart from those maimed or killed in the direct attack, those who survive, as well as many others trapped in the conflict, are then deprived of the medical help they desperately need, as the health services are put out of action by the attacks.
This shows a complete disregard for the protection of impartial health care delivery in conflict. It strikes at the obligations of health care workers to treat all sick and wounded without discrimination or interference, including wounded combatants. So it is an attack on international humanitarian law.
The duty of treating the wounded and sick, and the protection of medical personnel and facilities, has been at the core of international humanitarian law (IHL) since its inception in 1864. This was further enshrined in the Four Geneva Conventions of 1949 and the Two Additional Protocols of 1977.
Under IHL, as soon as people are wounded, they are protected, no matter how they were wounded. A combatant who is wounded and ceases fighting can no longer be considered a combatant. They must be collected and given medical care with the minimum delay possible.
Also, under IHL, medical personnel have a duty to treat all patients without discrimination. They are triaged only according to their medical needs and the urgency with which they need to be seen. Withholding care or providing care in a discriminatory fashion is strictly prohibited—it is a breach of medical ethics as well as the Geneva Conventions, and can amount to a war crime.
MSF demands that:
State and non-state actors publicly and concretely recommit to respecting the protection of impartial provision of health care in conflict.
State and non-state actors support the obligations of health care workers to treat all sick and wounded without discrimination or interference, including wounded combatants and those designated as enemies or terrorists.
Whenever and wherever an attack on health care occurs, enact an impartial and independent fact finding mechanism.
Following pressure from MSF amongst others, in May 2016 the UN Security Council unanimously adopted a resolution which strongly condemned attacks and threats against the wounded and sick, medical personnel and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment, as well as hospitals and other medical facilities
The Council also demanded that all parties to armed conflict comply fully with their obligations under international law, including the Geneva Conventions which protect people who do not take part in the fighting (civilians, medics, aid workers) and those who can no longer fight (wounded, sick and shipwrecked troops, prisoners of war).
However, attacks continue. Medical facilities, Resolution 2886 and international humanitarian law are not respected at all. Four of the five permanent members of the Security Council are actively engaged in the conflicts that continue to show this disrespect.
We are ordinary people and we cannot stop attacks in wars. MSF as a medical humanitarian organisation was not set up to stop wars but to provide medical assistance to people in need and to ease suffering amid the brutality of war. Still, we can all draw attention to abuses and start by spreading this message of “Hospitals are #NotATarget” and sharing this website on social media, to let people around you know the unacceptable suffering and threats that medical staff and patients are facing in conflict zones.
