Healthcare Facilities in Wartime: This Is Not a Target

Health centres in times of war should not be a target. And yet, it is difficult to ignore the attacks on healthcare systems and centres in 2024. Due to their protection under the Geneva Conventions, attacks on healthcare centres have been a violation of international humanitarian law since 1949 (Article 18 of the Fourth Geneva Convention, as well as Additional Protocols I and II). Moreover, the Rome Statute of the International Criminal Court classifies them as war crimes (Article 8), and the United Nations Security Council condemns them unequivocally.

One might expect that, under the protection of these laws, attacks on healthcare centres would become increasingly rare. However, the reality is quite different. According to the World Health Organization (WHO), 1,520 offensives against healthcare facilities were recorded last year. By September 3, 2024, 1,701 attacks – including assaults, raids, and bombings – had already been reported worldwide.

These acts of violence are primarily concentrated around four major conflict zones. Two of them are regularly in the media spotlight: the Middle East and the Russo-Ukrainian conflict. The other two, although quieter, are equally destructive: Sudan and Myanmar.

In Myanmar, a historical conflict between the stateless Muslim Rohingya minority and the Buddhist population has resurfaced periodically since the early 19th century. This conflict has upended the lives of thousands of people, with a major resurgence in 2017, leading to the displacement of over 700,000 Rohingyas to Bangladesh, which the Myanmar authorities consider their country of origin. In this context of ongoing conflict, attacks on health centres are frequent. Bombings by the army, supply disruptions due to blockades, missiles targeting hospitals, assassinations of medical staff, hospital occupations, and obstruction of access to care have become routine. In August 2024, a joint attack by the People’s Defense Forces (PDF) and the Myanmar National Democratic Alliance Army on a hospital killed nine medical staff and 21 patients. In 2024, 234 attacks were recorded on health centres, making the conflict in Rakhine State one of the most overlooked by Western and Francophone media.

In Sudan, the conflict pits the Sudanese Armed Forces (SAF) against the paramilitary Rapid Support Forces (RSF) in an open struggle for control of power. This standoff erupted after the fall of Omar al-Bashir’s regime in 2019, creating a political vacuum exploited by these two rival factions. The conflict, which is ravaging the country, has caused more than 12,000 deaths and displaced nearly 8 million people, worsening an already alarming humanitarian crisis. This conflict is becoming ethnically charged, particularly against the Masalit community in the Darfur region, where targeted violence is escalating. The violence has moved into public spaces, severely impacting civilian infrastructure, especially the healthcare system. This fragile system has suffered heavy setbacks, worsened by medicine shortages in the capital, Khartoum. In 2023, an attack on Khartoum’s National Medical Center precipitated this health crisis, illustrating the extent of the chaos spreading nationwide. This conflict threatens regional stability and fuels an increasingly uncontrollable cycle of violence.

In Ukraine, as of August 19, 2024, the WHO has recorded 1,940 attacks on health centres since the beginning of the conflict, marking a sharp escalation, particularly due to the increased use of heavy weaponry. Since 2023, these attacks have become nearly daily, especially near the frontlines. This situation often forces health centres to relocate to secret locations, complicating access to emergency care for both soldiers and civilians in critical need. In July, a missile attack on a maternity hospital in the Dniprovskyi district killed five medical staff, illustrating the brutality and intensifying violence targeting the medical sector.

In the Middle East, the situation in Gaza remains critical, and conflicts continue to target healthcare facilities. Since the hostilities began last October, over 1,000 attacks have been launched against health centres. In the war between Hamas and Israel, hospitals are particularly targeted and instrumentalised by the belligerents, either for hiding or for taking hostages, which significantly worsens the human and material toll.

As of September 23, 2024, 19 of Gaza’s 36 hospitals are out of service, and the remaining 17 are partially operational. These hospitals suffer from severe shortages of medicines, equipment, and fuel, threatening vital services like intensive care, neonatology, and maternity care. The situation is similar in primary healthcare centres: 57 out of 132 are now inoperative. The medical staff has paid a heavy toll, with over 500 healthcare professionals killed since the beginning of the conflict. This conflict extends beyond Gaza, with a potential for regional escalation. In Lebanon, healthcare infrastructures are also being targeted, with 45 attacks recorded in 2024, causing the deaths of 41 medical staff members.

Despite being protected by international law and humanitarian conventions, health centres are frequently targeted during conflicts. Attacking a healthcare centre holds strategic importance for several reasons:

Weaken the enemy: Denying the adversary access to essential medical care weakens its ability to maintain forces on the ground. Attacks on these facilities also affect the civilian population by depriving them of access to life-saving healthcare, which is crucial during periods of insecurity. These actions have both physical and psychological consequences, exacerbating the suffering within communities. Health centres, often unprotected militarily and relying on international legal frameworks, become vulnerable targets. Moreover, these facilities may contain valuable resources, such as medicines, medical supplies, fuel, vehicles, or generators, which can be diverted for military or economic purposes.

Symbolism and politics: Paramilitary forces sometimes attack health centres for symbolic reasons. These facilities may represent the authority of the ruling power or be perceived as agents of foreign interference, especially when Western non-governmental organisations (NGOs) are managing the care. These attacks aim to weaken the influence of these actors or challenge their legitimacy on the ground.

The trend regarding such attacks has unfortunately been on the rise in recent years. According to data from the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), 475 attacks were recorded on health structures and systems in 2016, 1,013 in 2019, and 2,406 in 2022. In 2024, this figure has already reached 1,701 attacks, with no signs of easing from these four major conflicts, which could suggest that the year will not end more favourably.

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