Deadly attacks raise fears of breakdown in rules of war
Governments and armed groups are being pressured to ensure the safety of patients and health workers in conflict zones amid a spate of high-profile attacks that have left dozens dead and injured.
The World Medical Association, the International Committee of the Red Cross, the World Health Organisation and several other peak health groups have jointly called on national governments and non-state combatants to adhere to international laws regarding the neutrality of medical staff and health facilities, and ensuring this commitment is reflected in armed forces training and rules of engagement.
The call follows the shelling of a Red Cross/red Crescent hospital in Yemen on Sunday, and the release of the initial results of a Medecins Sans Frontieres investigation into the deadly bombing of its hospital in Kunduz which found that there was no fighting occurring in or around the facility at the time of the attack, and that all armed groups, including the Afghan Army and the US Defence Department, had been given the accurate GPS coordinates of the hospital.
MSF said when the hour-long attack began soon after 2am on 3 October, 140 of its staff were at the hospital – including on 80 on duty – and they were treating 105 patients.
The humanitarian charity said at least 30 people were killed in the bombing raid, including 10 patients, 13 staff and seven whose remains were burnt beyond recognition. One MSF staff member and two patients are still missing and presumed dead.
Describing the attack in chilling detail, the charity reported that the intensive care unit, which was full at the time, was the first part of the hospital to be bombed. Several patients burned alive in their beds, a doctor had his leg blown off and a nurse had his arm virtually severed. One MSF staffer was decapitated by shrapnel, and several people were shot from the air as they attempted to flee the burning building.
As soon as the attack start, MSF made multiple calls to the Afghan Army and US armed forces, both in Kabul and to the Defence Department in Washington DC.
MSF International President Dr Joanne Liu said the internal review confirmed that MSF rules, including its strict ‘no weapons’ policy was in force and respected at the time of the attack, that the charity was in full control of the facility, that there were no armed combatants within the hospital compound, and there was no fighting from or in its vicinity before the airstrikes.
“We were running a hospital treating patients, including wounded combatants from both sides – this was not a ‘Taliban base’,” Dr Liu said.
The MSF President said the incident showed the deadly consequences of any ambiguity about how international humanitarian law applied to medical work in war.
“What we demand is simple: a functioning hospital caring for patients, such as the one in Kunduz, cannot simply lose its protection and be attacked,” Dr Liu said. “The attack…destroyed out ability to treat patients at a time when we were needed the most.
“We need a clear commitment that the act of providing medical care will never make us a target. We need to know whether the rules of law still apply.”
The United States and Afghan governments are yet to announce whether they will consent to an International Humanitarian Fact Finding Commission inquiry into the bombing.
But the Kunduz attack has nonetheless added to the urgency for action to be taken to ensure the safety of medical staff and hospitals in combat zones.
The International Committee of the Red Cross (ICRC), through its Health Care in Danger project, recorded 2398 attacks on health workers, facilities and ambulances in just 11 countries between January 2012 and the end of last year.
Policy and Political Affairs Officer for the ICRC’s Australian mission, Natalya Wells, said such attacks were not new, and were virtually a daily occurrence.
Ms Wells often health workers were caught in the cross-fire, particularly as a result of indiscriminate attacks in urban areas.
But she said that on occasion they were also being deliberately targeted, underlining the need for all combatants to respect the Geneva Conventions.
Ms Wells said that through the Health Care in Danger project, the ICRC was working with governments, armed forces and non-state combatants to improve awareness of, and respect for, laws and conventions around the protection of patients, health workers and medical facilities, particularly in conflict zones.
As part of the effort, governments attending the 32nd International Conference of the Red Cross and Red Crescent between 8 and 10 December are expected to back a resolution reaffirming their commitment to international humanitarian law and a prohibition on attacks on the wounded and sick as well as health care workers, hospitals and ambulances.
In addition, Ms Wells said the ICRC had held meetings with 30 non-state combatant groups from four continents about international humanitarian law and the rules of armed conflict.
The discussions have included incorporating knowledge of these conventions into their training, backed by sanctions for any breaches.
Promisingly, Ms Wells said that so far “one or two” non-state armed groups, though not signatories to the Geneva Conventions, have discussed creating a similar code of conduct for their forces.