Humanitarian Action and Healthcare Under Fire

In 2000, there were just over 40 significant attacks on aid workers recorded across the globe. By 2014, that number had risen to 190. In just 15 years, over 3000 aid workers have been killed, injured or kidnapped. Since 2015 alone, over 100 medical facilities belonging to or supported by Médecins Sans Frontières (MSF) have been bombed. Looking only at the conflict in Yemen, more than 70 health facilities have been destroyed by a series of airstrikes.

These numbers are frightening and should be a cause for concern, not only because they are increasing, but because they are part of an increasing trend in attacks on healthcare facilities and humanitarian aid activities in some of the most conflict affected areas in the world. The vast majority of attacks were in Syria, Yemen, Afghanistan and Sudan, all countries which are currently affected by long running conflicts.

Lately the barrage of attacks not only on humanitarian actors but also on healthcare facilities has been brought to the public eye, with a recent example being the bombing of an MSF run hospital in Kunduz Afghanistan. In October 2015, a US Air Force plane attacked the Kunduz Trauma Centre, injuring over thirty people and killing forty-two others. MSF immediately condemned the incident and called it a breach of international humanitarian law, as all warring parties had been notified of the hospitals location ahead of time.

In response, the US military initially claimed the airstrike was carried out to defend US forces on the ground, however later President Barack Obama issued an apology and announced the US would be making condolence payments to the families of those killed in the attacks. Whilst this gesture is noble, it is equally important and pertinent to work out why this attacked occurred, and indeed what can be learned from it to prevent a similar attack in the future.

A little over 4 months later, in February of 2016, the MSF supported Ma’arat Al Numan hospital in Syria was hit by rocket fire. The attack resulted in twenty-five casualties, including an MSF staff member, and eleven others being wounded. After the attack the president of MSF France Dr Terzian, publicly accused the Russian-Syrian coalition of being responsible for the bombings. A conviction based on analysis of the context, the military forces present at the time and testimonies from Syrian civilians.

These are but two examples of the increasing nature of such attacks, and one must begin to question the legality of this under international humanitarian law, to say nothing about the morality and ethics behind this issue. One would imagine that any form of attack or violence against a healthcare facility would be both morally and ethically wrong, and be condemned under international law. As a matter of fact whilst attacks against medical facilities are forbidden, they cease to take hold if the facilities are “being used, outside their humanitarian function, to commit acts harmful to the enemy.”

This raises multiple questions about the rigorous testing in place, if any, of whether a facility is being used for purposes other than their humanitarian function and the transparency involved to prove it. At the end of the day, how can perpetrators be taken to task if they deny, contest or minimise their responsibility and describe their attacks as simple errors?

It is here that the International Humanitarian Fact Finding Commission (IHFFC) comes into play. Following an attack on a healthcare facility, such as the one in Kunduz, a humanitarian agency can file a complaint with the court in the relevant country and ask the IHFFC to carry out an independent and impartial inquiry. However herein lies a flaw, that to carry out the inquiry the IHFFC needs consent from all those involved. As was the case with Kunduz, the commission was unable to launch an inquiry as the US did not give its consent.

Conflicts in today’s changing world are wars against populations rather than simply against armies. Definitions of military warfare and civilian conflict are beginning to blur and the absence of response from professional bodes to recent attacks (many of which go unreported) makes provision of humanitarian aid in conflict areas difficult. It is time for nations and politicians to face punishment for such attacks and for transparency regarding decisions and outcomes of such decisions. In the end the real question is what does this increasing trend mean for the provision of humanitarian action in conflict areas, and whether states can be trusted not to act against those simply providing help in desperate situations.