THE BMA is urging organisations around the world, from governments and the United Nations to NGOs and medical representative groups, to all play a role in taking action against attacks on healthcare staff, patients and facilities – and public health more widely – in global conflicts.
In a comprehensive new report ‘Medicine Under Attack: The increasing assault on healthcare in conflict zones’, the first of its kind by any national medical association, the BMA discusses the rise in assaults in conflict zones, despite the protection of healthcare under international humanitarian law (IHL).
The report documents how healthcare workers, facilities, transports, and patients, as well as humanitarian aid, are being attacked in conflicts around the world, with perpetrators doing so with impunity.
The report highlights this upward trend, illustrated by examples from the last few decades, including Syria, Sudan, Ukraine and Gaza.
It explores the impact of this on the ability of healthcare workers to care for patients and on population health, as well as analysing the evolving nature of warfare and how this impacts healthcare in conflict zones.
The report makes a number of recommendations, for governments, the UN, the International Criminal Court, NGOs and healthcare providers, the World Medical Association, and medical representative organisations, outlining steps they should take to protect healthcare in conflict zones, and condemn attacks on healthcare.
These include governments, the UN and the ICC all holding states and armed groups accountable when they are found to have broken international humanitarian law with attacks on the wounded and sick, health facilities and health workers.
BMA medical ethics committee chair Dr Andrew Green said: ‘No one should fear for their life as they go to work, nor when they go into hospital to receive medical treatment; these should be places of safety where people go to get better, not be put at risk of attack.
‘Yet in recent years we’ve seen appalling and increasing examples of healthcare, patients and staff coming under direct attack.
‘Whether it’s doctors being killed in Syria, patients being murdered in their beds in Sudan and Democratic Republic of Congo, or aid being systematically blocked from entering Gaza for months on end, people’s access to medical care in conflict zones, and the ability of medical professionals to provide it, are under existential threat, while the prospect of populations being able to live a healthy life is rendered on the whole impossible.
‘We know how long it takes to educate and train a doctor; killing and disappearing them is a direct assault on the very functioning and sustainability of a health system.
‘Patients come to doctors with their injuries, wounds, and stories. Attacks on healthcare workers undermine the documentation of truth and information, erasing critical testimonies and evidence necessary for accountability, justice and long-term reconciliation. Protecting them is not optional, it’s a legal and moral imperative.
‘Some may question why a GP from Yorkshire, or any doctor working in the UK, is concerning themselves with conflicts or geopolitical issues thousands of miles away.
‘To that I’d say it cuts to the core of what being a doctor is about; we do this job because we want to help and heal people. We have a professional and moral duty to care and speak out when we see harm being done.
‘And we must all be concerned when international law is sidestepped and healthcare protections ignored – such violations ignore global norms that threaten the safety and dignity of us all.’
The report recommends governments should:
- reinvest political capital into compliance with IHL as a priority
- reinvest financial capital into compliance with IHL as a priority
- recommit to the protection of healthcare, including but not limited to patients, medical personnel, and facilities
- hold other nation states accountable when medical units protected under IHL are attacked as demanded of them by IHL. This could include calling out perpetrators, taking cases to the International Court of Justice (ICJ) or utilising their own courts, ending arms sales, and imposing suitable sanctions
- allow international humanitarian organisations, such as the International Committee of the Red Cross (ICRC), sufficient and safe access to conflict zones and other relevant spaces, such as detention centres, in order to comply with IHL and encourage their allies to do the same
- invest appropriately in humanitarian aid
- support local aid organisations in gaining sufficient and safe access to conflict zones and other relevant spaces
- recommit to international treaties and customary law through official statements or actions, such as carrying out duties in investigations or prosecutions of war crimes, and exerting financial or other types of pressure to hold states accountable where necessary
- cooperate fully with International Criminal Court (ICC) investigations, including sharing any evidence
- ensure that national security and military forces are well versed in their obligations under IHL to protect patients, medical personnel, supplies, and facilities and to not target and attack them (acknowledging situations in which protections may be lost)
- ensure their armed forces are educated on the IHL protections for healthcare.
The United Nations (UN) should:
- refer allegations of war crimes and crimes against humanity involving attacks on the wounded and sick, health facilities, and health workers to the ICC where the court has jurisdiction
- name all member states and armed groups that engage in recurrent attacks or threats of attacks on hospitals and protected persons in the UN Secretary General’s annual report on Children and Armed Conflict, without regard to political considerations and pressures by UN member states
- establish a UN Special Rapporteur on the Protection of Health in Armed Conflict.
The ICC should:
- prioritise investigations and prosecutions of war crimes and crimes against humanity involving attacks on the wounded and sick, health facilities, and health workers in instances where it has jurisdiction.
NGOs and health providers should:
- collate and share data and information regarding attacks on healthcare in conflict zones.
The World Medical Association (WMA) should:
- proactively engage with state actors which are implicated in health-related human rights abuses
- use its voice to raise awareness of such abuses, including with supranational organisations such as the UN
- continually and repeatedly express solidarity in situations where medical personnel are facing such abuses and reiterate that parties in conflict must respect IHL, medical impartiality, and medical neutrality
- call to account any national medical association which is implicated in such human rights abuses.
Medical representative organisations should:
- highlight attacks on healthcare in conflict zones, expressing solidarity with those affected
- pressurise their national governments to take action where the rights and protections afforded to healthcare have been violated in conflict zones
- collaborate with organisations working to protect healthcare in conflict
- build coalitions with similar organisations to raise awareness and lobby appropriate actors
- offer support to members who work in conflict zones, including appropriate mental health support for those who may have suffered trauma such as Post Traumatic Stress Disorder (PTSD) or moral distress.