In conflicts around the world, healthcare is increasingly under threat of attack, despite this being in clear violation of international humanitarian law.
According to the Safeguarding Health in Conflict Coalition, 2024 saw the greatest number of attacks on healthcare in conflict ever recorded in a year, with 3,623 incidents verified, including the killing of nearly a thousand healthcare workers. Alarmingly, this number is likely to be an underestimate given the difficulties confirming information in conflict zones.
The details of these egregious attacks – violations of international humanitarian law – are appalling. Doctors, nurses and allied healthcare professionals have been beaten, arbitrarily arrested, kidnapped, tortured and killed. Patients have been shot in their beds or dragged away to detention centres, while others have been forced out of hospitals to make space for injured combatants.
Hospitals have been deliberately bombed and raided. They have been illegally re-organised as centres of military operations instead of care. Ambulances have been destroyed and hijacked. Medical supplies have been looted, destroyed, or blockaded to deny crucial resources to those who need them most.
While the number of attacks is particularly acute in large-scale conflicts, such as Gaza, Sudan, Syria, Ukraine and Yemen, it would be erroneous to claim such atrocities are limited to these wars: healthcare attacks have been recorded in conflicts around the world, including in Colombia, Ethiopia, Myanmar and Pakistan.
Since the first iteration of the Geneva Conventions in 1864, attacks on healthcare have been clearly codified as unacceptable and illegal under the laws of war. One would think that those governments, including our own – who claim international humanitarian law to be sacrosanct – would be vociferous in their condemnation of violations.
Unfortunately, this is not the case. Some have obfuscated, choosing political expediency over their duties and others have offered only tepid responses, with the result that perpetrators are allowed to act with impunity, continuing the violence which plagues healthcare facilities and staff and patients in conflict settings.
Medicine Under Attack: the increasing assault on healthcare in conflict zones is the latest human rights report published by the BMA under the auspices of its medical ethics committee.
The report highlights the gravely concerning contemporary trends regarding attacks on healthcare, framing the discussion firmly within international humanitarian law and the principle of medical neutrality, which can be understood as the concept that doctors must practise and be permitted to practise medicine fairly and justly without the threat of violence or undue interference from belligerents.
It further analyses the effects such attacks can have on individual clinicians, such as PTSD and moral distress, as well as on population health, including reducing access to healthcare and discouraging patients from seeking healthcare for fear of attack. These effects can continue to be felt long after a war has ended.
Medicine Under Attack also provides a number of important recommendations for reasserting the importance of the protections for healthcare contained within international humanitarian law. The report considers the role of governments and supranational organisations such as the UN and International Criminal Court.
Additionally, the report examines the role medical representative organisations, such as the BMA, have to play. Too many, in our view, have remained regrettably quiet, while their colleagues and patients in other parts of the world faced the most difficult of circumstances.
When I was chair of the BMA medical ethics committee, I was incredibly proud of the BMA’s decades of work standing up for health and human rights across the world. This new report continues this tradition.
It is the perspective of the BMA and our members – evidenced clearly through the litany of motions passed at many annual representative meetings through the years – that it is incumbent on us to speak out on the rights of doctors, the rights of patients, and disgraceful violations of accepted standards of medical ethics and health-related human rights. We do this for a number of reasons.
Not only is it moral and right but also medicine is an international enterprise which knows no borders. As a result, our advocacy on behalf of our colleagues and patients knows no boundary.
John Chisholm is president of the BMA