How can the world stop attacks on health care?

On Wednesday, Ukrainian officials accused Russia of hitting a maternity and children's hospital in the city of Mariupol, killing three people and wounding some 17 others, the latest in a series of attacks against health care since the Russian invasion began on Feb. 24. The World Health Organization has so far verified 24 attacks against health care facilities, ambulances, and health workers in the country. Health and human rights organizations have condemned the attacks and expressed concerns about the impact on Ukraine’s health system, which is already under “severe pressure,” according to Dr. Hans Kluge, WHO’s regional director for Europe. They have called for all parties to respect international humanitarian law and not to make health workers or medical facilities a target amid the war. “The world is still witnessing these [attacks on health care] … take place across the world without taking the necessary steps to end them.” --— Dr. Houssam al-Nahhas, Middle East and North Africa researcher, Physicians for Human Rights Dr. Houssam al-Nahhas, a Middle East and North Africa researcher at Physicians for Human Rights, or PHR, described the attacks on health care in Ukraine as “extremely concerning” and said they reflect “a pattern seen in other conflict zones.” In Ukraine, verified attacks on health care within the past two weeks have resulted in 12 deaths and 34 injuries. Amid international condemnation over attacks against health care — such as in Ukraine — Devex asked al-Nahhas what else can be done to protect health care during conflict and how perpetrators can be held accountable. This conversation has been edited for length and clarity. How does the situation in Ukraine compare to the situations in places like Afghanistan, Myanmar, and South Sudan? Forty-seven incidents of conflict-related attacks on health care were reported in Myanmar since the beginning of 2022, with eight facilities being damaged, four health workers being killed, and two being injured. According to the WHO, these numbers are already higher in Ukraine in terms of the casualties and deaths reported within a very short period. Attacks on health care committed by Russia’s armed forces are very painful and outrageous, but unfortunately not surprising. [In the conflict in Syria,] the Syrian and Russian governments have been responsible for at least 244 attacks on health care facilities since 2015, according to Physicians for Human Rights. Attention to such violations should lead to a vigorous response, but the world is still witnessing these violations take place across the world without taking the necessary steps to end them. The problem is that attacks on health care not only have direct impacts on health services, but also long-term impacts on the availability of and the accessibility to these services, which deprives people of their right to safe access to health care. PHR studied the long-term impact of attacks on health care facilities in one case in Syria and studied the impact on a macro level. Myanmar is another situation PHR has followed where attacks are also not receiving enough attention. The evidence is clear: People will suffer and die, and the health care system will eventually collapse if such attacks continue. There’s a lot of condemnation of attacks against health care, and several aid groups have spoken about respect for international humanitarian law. But beyond these calls, what else can be done to enforce the protection of health care during conflict wherever it may be happening? We have heard a lot of talk about respect for international humanitarian law in the Syrian context, but nothing was done to actively change the reality on the ground. [There] has been one condemnation after another, without concrete actions to stop these violations. Ensuring protection requires setting and implementing clear penalties for any party that violates international humanitarian law, including criminal prosecution. Fortunately, we have thus far seen a rapid and unified global response to the situation in Ukraine. We hope to see the world hold the Russian government accountable not only for the crimes it is perpetrating in Ukraine, but for the many violations it has committed in Syria as well. Has anyone been held accountable for attacks against health care? If not, how can this change? Unfortunately, attacks on hospitals have rarely been prosecuted by international criminal tribunals. The International Criminal Court, which has jurisdiction for war crimes and crimes against humanity committed in Ukraine, has yet to pursue a case for attacks against health care. Ensuring that such attacks are fully investigated by the ICC and by other accountability mechanisms — in Ukraine, as well as other countries, like Myanmar and Syria — is critically important to reinforce the gravity of these crimes. Failure to do so only makes health care — and the ability to access health services — more vulnerable in conflict. The world cannot allow this. Civil society organizations also have a key role to play in supporting documentation and investigation efforts, as PHR has done in numerous countries to date.