Attacks on Hospitals: An Alarming Problem for Military Medicine as Well as for Humanitarian Medicine

Abstract

As part of International Humanitarian Law (IHL), Additional Protocols I and II of 1977 to the Geneva Conventions and other treaties provide for the protection of patients, medical personnel and health infrastructures during armed conflicts. They recognize the primacy of medical ethics in times of war, notably the principle of non-discrimination. Attacks against hospitals or health care providers during armed conflicts signal a blatant disregard for such protections. A state of affairs where IHL is ignored, denied or revisited has far-reaching consequences for the medical profession. It affects primarily the security of patients and health personnel, but also it impacts on the integrity and the independence of doctors and other healthcare personnel worldwide. In this paper, I analyze the case of the bombing of Kunduz Hospital (Afghanistan, 2015), considering historical, legal, and moral perspectives. Regardless of the difficulty to relate deliberate attacks against health care facilities to a single pattern of aggression, upholding the principles of IHL remains a historical responsibility of states parties. Beyond Kunduz and similar incidents, a close examination of emerging military doctrines and revisionist ‘Just War’ theories reveal how not only medical care, but also the core principles IHL are under threat. The delivery of impartial medical care in warfare situations is at risk of becoming impossible, illegitimate, and irrelevant. Such a risk can equally affect all medical professionals – military or civilian – assisting victims of armed conflicts.

Appendices

Appendices

1.1 Appendix 1: Protocol Additional to the Geneva Conventions of 12 August 1949, and Relating to the Protection of Victims of International Armed Conflicts (Protocol I), 8 June 1977

• Article 16 – General protection of medical duties

• 1. Under no circumstances shall any person be punished for carrying out medical activities compatible with medical ethics, regardless of the person benefiting therefrom.

• 2. Persons engaged in medical activities shall not be compelled to perform acts or to carry out work contrary to the rules of medical ethics or to other medical rules designed for the benefit of the wounded and sick or to the provisions of the Conventions or of this Protocol, or to refrain from performing acts or from carrying out work required by those rules and provisions.

• 3. No person engaged in medical activities shall be compelled to give to anyone belonging either to an adverse Party, or to his own Party except as required by the law of the latter Party, any information concerning the wounded and sick who are, or who have been, under his care, if such information would, in his opinion, prove harmful to the patients concerned or to their families. Regulations for the compulsory notification of communicable diseases shall, however, be respected.

1.2 Appendix 2: Protocol Additional to the Geneva Conventions of 12 August 1949, and Relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II), 8 June 1977

• Article 10 – General protection of medical duties

• 1. Under no circumstances shall any person be punished for having carried out medical activities compatible with medical ethics, regardless of the person benefiting therefrom.

• 2. Persons engaged in medical activities shall neither be compelled to perform acts or to carry out work contrary to, nor be compelled to refrain from acts required by, the rules of medical ethics or other rules designed for the benefit of the wounded and sick, or this Protocol.

• 3. The professional obligations of persons engaged in medical activities regarding information which they may acquire concerning the wounded and sick under their care shall, subject to national law, be respected.

• 4. Subject to national law, no person engaged in medical activities may be penalized in anyway for refusing or failing to give information concerning the wounded and sick who are, or who have been, under his care.