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Medical impartiality

medical camp in conflict zone

Medical impartiality is a fundamental ethical principle in medicine.

We believe a doctor’s right to safely practice medicine in humanitarian settings must be protected.

Doctors must be able to provide treatment to those in need irrespective of their political affiliation. All health professionals have a right to practice medicine without fear of reprisal or attack. Global conflicts in recent years, particularly in the Middle East and North Africa (MENA), have seriously undermined medical impartiality. Health infrastructure, and medical personnel have been targeted by both governments and non-state actors. Elsewhere, doctors have been subject to reprisals for treating the sick and injured.

International bodies, such as the United Nations, continue to document ongoing human rights violations - including the continued widespread and systematic targeting of healthcare facilities and medical personnel. Read our case studies outlining breaches below. 

 

The principle of medical impartiality

Defenders for Medical Impartiality (DMI) define medical impartiality as:

“The international principle that no person or group shall interfere with the access to or delivery of medical services in times of conflict and civil unrests, and that medical personnel shall not discriminate or refuse care to anyone injured or sick during times of conflict and civil unrest.”

 

BMA action to protect medical impartiality

The British Medical Association has signed the Colombo Declaration, which condemns attacks on medical personnel and facilities in conflict situations, and in February 2019 we joined the Royal College of Emergency Medicine and fourteen additional medical Royal Colleges in writing to the Foreign Secretary to request that the UK Government also signal its support for the Declaration.

Adding his support to the letter, Dr John Chisholm, chair of the BMA’s medical ethics committee said: “We condemn in the strongest possible terms the practice of intentionally targeting medical personnel and facilities in areas of conflict. Access to health care is a fundamental human right and it is essential that healthcare workers are at liberty to provide assistance in conflict zones without fear of being targeted.”

The Colombo Declaration – drafted in Sri Lanka in 2016 - condemns the targeting of medical facilities, patients and clinicians in areas of conflict and calls on United Nations member states to support the enforcement of UN Security Council Resolution 2286. This resolution demands that member states uphold and comply with the 1949 Geneva Conventions which criminalise targeted attacks on medical personnel and facilities under International Humanitarian Law.

Further reading

Read the letter to the Foreign Secretary Jeremy Hunt MP

Get involved

Sign the Colombo Declaration, or join the MSF #NotATarget campaign, a social media act of solidarity to stand up for the protection of civilians and civilian infrastructure, patients, medical staff and hospitals in conflicts.

Add your voice

 

  • Nicaragua

    Persecution of physicians for providing care to certain groups

    In November 2018, we learned that physicians in Nicaragua had been dismissed and, in some cases, criminalised for providing medical care to persons involved in anti-government protest activities. Further, that healthcare workers had been forced to prioritise care for certain groups based on their political affiliations.

    We wrote to the Nicaraguan Ambassador to raise our concerns, and to demand respect for the rights of the injured and wounded to appropriate medical treatment.

    Further reading

    Read our letter to the Nicaraguan Ambassador, Guisell Morales-Echaverry

  • Sudan

    Attack on Omdurman Hospital

    In January 2019, Sudanese security forces attacked Omdurman Hospital. Reports of the attack state that security forces opened fire inside the hospital whilst looking for individuals who had been injured whilst participating in protests earlier in the day.

    The intentional targeting of health professionals, including hospitals and medical facilities, is a clear breach of the Geneva Conventions of 1949 and of International Humanitarian Law, as well as accepted international human rights norms. Health professionals provide a necessary service, and it is essential that they are at liberty to provide that service, wherever they may be, without fear of being targeted.

     

    Further reading

    Read our letter to the Sudanese Ambassador, Mohammed Abdalla Ali Eltom

  • Gaza

    Shooting of paramedic

    In June 2018, Razan al-Najjar, a Palestinian paramedic, was killed by Israeli forces. The paramedic was unarmed and was providing medical support to injured Palestinians close to the border fence.

    This is an unacceptable breach of the Geneva Conventions and International Humanitarian Law (IHL).

    We wrote to the Israeli Ambassador to request that the Israeli Government commission a full investigation into the killing.

    Read our letter to the Foreign Secretary Jeremy Hunt MP

     

     

  • Afghanistan

    Coalition bombing of MSF hospital in Afghanistan

    On 2 November 2015, the BMA wrote to Foreign Office minister Tobias Ellwood MP to seek the support of the UK government in calling on President Obama to agree to an independent investigation into the sustained bombing by coalition forces of the Médecins Sans Frontières (MSF) trauma facility in Kunduz, Afghanistan on 3 October.

    Twelve hospital staff members and at least 10 patients, including three children were killed on that night, with a further two members of staff presumed dead. In addition, 37 people, including 19 staff members were injured. All parties to the conflict were given the accurate GPS co-ordinates of the hospital and yet it was precisely hit several times by coalition bombing.

    In his letter to Mr Ellwood, BMA medical ethics committee chair John Chisholm CBE backed MSF's call for a full and transparent investigation into what happened at Kunduz. 

    Dr Chisholm added: 'Only a fully independent investigation is appropriate for such an egregious and deadly violation of both the Geneva Conventions and the universally binding prohibition on breaches of medical neutrality. Relying on an internal investigation by a party to the conflict would be woefully inadequate.'

    Read our letter to Tobias Ellwood MP

    Read our blog: Remembering Kunduz: The week leading to the attack

     

    Survivors of the Kunduz bombing

    Kunduz: 6 months later

  • Syria

    Doctors' deaths in Syrian custody

    We are deeply concerned by the Syrian government's continued flouting of international human rights standards, including rights to a fair trial, and its complete disregard for medical neutrality.

     

    Dr Abbas Khan

    We have written to the Syrian authorities expressing our profound sadness and deep concern over the death of British national Dr Abbas Khan in Syrian custody.

    Dr Khan, an orthopaedic surgeon, had been imprisoned for 13 months after being, we understand, unlawfully arrested for peacefully attempting to provide medical treatment to injured civilians during the conflict in Syria.

    We have also expressed extreme alarm at reports that Dr Khan had been tortured in prison.

    Read our letter to Syrian president Bashar al-Assad

    Read our letter to Syrian ambassador Bashar Ja'afari

    Read our news coverage of Dr Khan's death

     

    Dr Osama Baroudi

    We have written to the Syrian authorities expressing our deep concern at the death in custody of Dr Osama Baroudi.

    Dr Baroudi, who suffered from a variety of chronic health conditions, had been held at several detention centres following his arrest in February 2012 for his involvement in co-ordinating efforts to provide medical relief to people injured during the Syrian uprising.

    According to Amnesty International, there is plausible evidence to suggest that Dr Baroudi and another doctor, Mahmoud al Refaal, were repeatedly tortured by the Syrian Intelligence Authorities in Damascus.

    Read our letter to Syrian president Bashar al-Assad

    Read our letter to Syrian ambassador Bashar Ja'afari

    Read our news coverage of Dr Baroudi's death

  • Bahrain

    Breaches of medical neutrality in Bahrain

    Physicians for Human Rights has highlighted ongoing violations of medical neutrality in Bahrain in the wake of popular unrest that began in early 2011.

    The lobbying group has documented attacks by the Bahraini security forces on medical institutions, including arrests and detention of medical workers providing care to protesters.

    More than two years after the start of the protests, the Bahraini government has not yet properly addressed medical neutrality violations. Those who were abducted, detained, abused and tortured have not received any reparation from the government, or even acknowledgement of wrongdoing. Some remain in prison. Others, released from prison, continue to face harassment or intimidation from state officials.

    Find out more and hear from Bahraini doctors at Physicians for Human Rights

    Read the BMA News article on the arrest of a Bahraini doctor for his use of social media

  • Gaza

    Shelling of medical facilities in Gaza

    In July 2014, BMA Council chair Dr Mark Porter said: "The BMA is deeply concerned by the loss of life in the current conflict in Gaza and by the recent shelling of medical facilities in Gaza.

    "All combatants must respect binding international standards of medical neutrality and support the common humanity of help for those people injured in war.

    "Medical personnel, patients, facilities and transports must be free at all time from attack or any form of military interference or misuse."

    On 6 August 2014, Dr Porter wrote to Israel's Prime Minister Benjamin Netanyahu expressing the BMA's grave concerns about the impact of recent hostilities on medical facilities and health personnel in Gaza.

    Dr Porter said the principle of medical neutrality was fundamental in international humanitarian law and called upon Israeli authorities to ensure that medical infrastructure was protected.

    Read Dr Porter's letter to Israel's Prime Minister, Benjamin Netanyahu

  • Turkey

    Breaches of medical neutrality in Turkey

    The BMA has written to the Turkish Prime Minister expressing grave concern at the reported breaches of medical neutrality there.

    We have asked for assurances that any medical personnel detained on the basis of providing emergency treatment to protesters be released immediately, and have emphasised that the primary obligation of all doctors is to provide medical treatment according to need.

    We have made clear that threatening or detaining medical personnel for carrying out their professional obligations constitutes a fundamental violation of both international humanitarian law and internationally-binding codes of medical ethics.

    What originally started in May 2013 as a demonstration against plans to redevelop Gezi Park in Istanbul, had, by June, escalated into nationwide anti-government protests. As street clashes between protestors and police grew, doctors and nurses were taken into custody by police. The Health Ministry was reported to be demanding the names of all medical volunteers, and threatening to remove the medical licences of doctors who have treated injured protesters.

    In November 2013, medical bodies from across the world, including the BMA, sent a letter to the Turkish health minister, expressing grave concerns about a draft health law that would criminalise the provision of emergency healthcare in Turkey. 

    The letter warned that such a law would "provide the Ministry of Health with unprecedented control over healthcare practices in Turkey" and put medical personnel in direct conflict with their primary professional obligations.

    The bill was passed by the Turkish parliament on January 2, 2014. The BMA subsequently co-signed a letter to Turkish president Abdullah Gül, urging him not to sign the bill into law.

    The letter warned Mr Gül that the bill would compromise the health of Turkish citizens in need of emergency care, undermine essential trust in medical personnel and violate international and Turkish law.

     

    Further reading

    Read our letter to the Turkish Prime Minister

    Read the letter, signed by the BMA, to the Turkish president

    Read the letter, signed by the BMA, to the Turkish health minister

    Read a BMJ editorial on attacks on medics in Turkey

    Read our letter to the Turkish Prime Minister

    Read our letter to the Turkish Prime Minister