Preventing Attacks on Healthcare and Humanitarian Workers in Armed Conflict

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The growing number of attacks on humanitarian workers and the provision of health care in armed conflict has become what Christoph Heusgen, the Permanent Representative of Germany to the United Nations, called “a weapon of warfare. The situation is very dire,” he told an IPI audience. “We must not accept that this becomes the new normal.”

Ambassador Heusgen was speaking to a May 24th policy forum that IPI organized in partnership with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), the World Health Organization (WHO), the Safeguarding Health in Conflict Coalition (SHCC) and the Permanent Missions to the UN of Poland, France, Iraq, Germany and Afghanistan. The forum focused on the implementation of Security Council Resolution 2286, the 2016 measure that reaffirmed the relevance of international humanitarian law and its rules relating to the protection of the wounded and sick.

“The resolution’s adoption represented a strong political commitment to protect the sanctity of healthcare delivery in armed conflict,” said Jake Sherman, director of IPI’s Brian Urquhart Center for Peace Operations, who moderated the event. He acknowledged that since its passage, it had received sustained attention from the Council but, “unfortunately, mostly because of violations. The Council’s political commitment in 2016 has yet to translate into significant and concrete change on the ground…research shows that attacks on health care continue unabated.”

Joanna Wronecka, the Permanent Representative of Poland to the UN, lamented that “while international humanitarian law clearly states that any attacks against medical care in armed conflict are prohibited, the gaps between the international humanitarian law principles and real life situations unfortunately exist and are even expanding. Attacks on healthcare continue around the world with impunity, and we need to support and advocate towards full compliance with international humanitarian law obligations that protects the wounded and sick, medical personnel and humanitarian personnel.”

Illustrating the widespread nature of the attacks, Leonard Rubenstein, Chair of Safeguarding Health in Conflict Coalition, said that in 2018 in Syria and Yemen at least 18 hospitals were destroyed by air strikes, in Gaza and the West Bank, 500 health workers were injured in violent protests, vaccinators were killed in six different countries, and in the Central African Republic there were 47 incidents of violence against health workers, a number that he said was a “severe undercount.” The Coalition’s just published annual report shows that in 2018 there were at least 973 attacks on health workers, health facilities, and health transports in 23 countries in conflict and that some 167 health workers died and some 170 were injured as a result of attacks.

Except for some “isolated cases,” he said, most countries have not shown national-level leadership in implementing the resolution. “Three years after the adoption of Resolution 2286, we see little or no movement at the national level in other countries on reform of laws governing conduct toward healthcare, changes in military doctrine and training, and the guarantee of adequate and thorough investigations and robust accountability.” Each year, he said, the Security Council solicits positive information on how the resolution is being implemented in the Secretary-General’s annual report on the Protection of Civilians (POC). “Last year’s report and this year’s drew a blank,” he said.

As a result, he said, “many suspect that the rhetoric that attacks on healthcare are unacceptable has been replaced by acceptance. But we must insist that the Council play its proper role, especially to ensure investigation and accountability where states fail to act.”

Anne Gueguen, Deputy Permanent Representative of France to the UN, said there had to be a “quantum leap in our collective efforts” to ensure the training of combatants to respect the rules protecting medical personnel and infrastructure and to forestall impunity by insisting on having an impartial, independent and prompt investigation of every incident. In particular, she said, “It’s essential to educate armed groups to ensure that these groups who are warring parties and who are in zones of conflict understand their obligations under international humanitarian law and understand the consequences of attacking medical care.”

Hansjoerg Strohmeyer, Chief of the Policy Development and Studies Branch of the UN Office for the Coordination of Humanitarian Affairs (OCHA), recalled the incredulity with which he and other UN officials first greeted reports of deliberate attacks on health care fifteen years ago. “We were startled very honestly. There was disbelief that people would go as far as killing humanitarian workers or [attacking] medical facilities, but sadly this has become not only a routine feature of today’s conflicts, it feels like it’s become one of the primary targets and purposes.” In addition to the harassing, abduction, and targeting of medical workers, he said his office now receives many reports of the premeditated destruction of medical facilities and aid convoys, looting of supplies, takeovers of medical clinics for military purposes, and intentional disruption and denial of access and supply lines. He said his three main “asks” of member states was that they keep calling attention to these abuses, that they make sure they are always investigated, and that they clearly condemn arbitrary denials of access.

Adela Raz and Mohammad Hussein Ali Bahr Aluloom, the Permanent Representatives of, respectively, Afghanistan and Iraq, said that efforts are deployed to ensure armed forces of their two countries observed the principles of international humanitarian law, despite the “brutal” treatment of health personnel by rebels. Ambassador Raz explained that Afghanistan’s national security strategy now includes strict guidelines to avoid unintended consequences on the medical mission and the civilian populations, and described the Ministry of Health’s active engagement with security forces on these issues. She also said that so far this year in Afghanistan five health workers had been killed, 18 abducted, and “many more” injured in attacks which she attributed to the Taliban. Ambassador Aluloom said that Iraqi forces had worked to relocate civilians and doctors to safe places and reopen hospitals and clinics that had been bombed, set on fire or used by ISIS to build explosives.

Taking note of these comments, Ambassador Heusgen of Germany said, “This denial of access—this is linked to one thing I think is very important, which is, of course, difficult to do—but we have to somehow convey to the armed groups that we have been mentioning, even the Taliban, we have to talk to these armed groups as well so that they respect international humanitarian law.”