Another Year of Impunity for Attacks on Healthcare

Publication Date: 
Monday, May 15, 2017
Blast victims receive treatment at a hospital in Lahore, Pakistan © Abdul Majeed Goraya/IRIN

It’s been over a year since the UN Security Council adopted Resolution 2286 condemning attacks on medical facilities and personnel in conflict, and calling for an end to impunity. Yet as a series of new reports indicate, attacks on healthcare are more prevalent than ever, and accountability remains just as far afield.

Tracking violence against healthcare

In 2016, “the sheer number of countries and the intensity of attacks on health facilities, health workers, ambulances, and patients are staggering,” notes the Safeguarding Health in Conflict Coalition in its newly released report documenting widespread attacks on, and interference with, healthcare in 23 countries in conflict. Collectively, the report emphasized, these attacks “threaten the health, well-being, and the lives of people who may number in the millions.”

Syria is by far the worst case of violence against healthcare in recent years, with one attack on health care “every 34 hours and 45 minutes” in 2016, according to a new report by the Syrian American Medical Society (SAMS). Aptly titled “The Failure of UN Security Council Resolution 2286 in Preventing Attacks on Healthcare in Syria,” the report calls out this “89 percent increase” since Resolution 2286, which SAMS President Dr. Ahmad Tarakji rightly calls “shocking and deplorable.”

While these and a variety of other sources are contributing to a much fuller picture of the problem, and fueling calls to reverse the assault on healthcare in conflict, there nonetheless remains a need for enhanced data collection, reporting and monitoring mechanisms to track violence against healthcare. As Safeguarding Health cautions, it is difficult to make definitive statements about global trends in attacks on healthcare due to insufficient data, and a lack of standardized reporting mechanisms or uniform definitions what constitutes an attack on healthcare.

Widespread impunity

Whatever the trends in numbers of attacks, deliberate attacks against hospitals and other medical facilities or transports constitute war crimes under international law, for which Resolution 2286 sought to bring accountability. As the Resolution warns, the “prevailing impunity” for attacks on healthcare, “may contribute to the recurrence of these acts”. That much is clear, one year later, as little progress has been made toward accountability.

Resolution 2286 “Emphasizes the responsibility of States to comply with the relevant obligations under international law to end impunity and to ensure those responsible for serious violations of international humanitarian law are held to account.” To accomplish this, it “Strongly urges States to conduct, in an independent manner, full, prompt, impartial and effective investigations […] and, where appropriate, take action against those […] with a view to reinforcing preventive measures, ensuring accountability and addressing the grievances of victims.”

Yet as the Safeguarding Health writes, “attempts at accountability have largely failed due to national and international government inaction, dismissal of complaints, or failure to impose appropriate sanctions.” According to a review by Human Rights Watch of 25 attacks on health care in ten countries from 2013 to 2016 – resulting in over 230 deaths and over 180 casualties and the destruction or closure of six hospitals - “either no proceedings for accountability were undertaken at all or the results of proceedings were flawed or inadequate. Governments that ignored, denied, or justified attacks on health facilities, potentially involving their military forces, include Afghanistan, Iraq, Israel, Libya, Russia, Saudi Arabia, Sudan, Syria, Ukraine, and the United States.”

As Resolution 2286 emphasizes, enforcing international norms such as the protection of healthcare in conflict remains the primary responsibility of states. In some cases, states may lack the capacity to pursue adequate investigations or prosecutions of attacks on healthcare, e.g. in war-torn Yemen, Libya, or Syria. In many other cases, however, national and international capacity exists to pursue accountability for attacks against healthcare, but political will is lacking.

The case of the US airstrikes on the Médecins Sans Frontières (MSF) hospital in Kunduz, Afghanistan in October 2015 serves as an illustrative case: while MSF, the US military, NATO and Afghan authorities all carried out investigations of the incident, MSF’s calls for an independent international investigation, e.g. by the International Humanitarian Fact-Finding Commission, have gone unmet. Instead, the Pentagon disciplined 16 service members for the attack, which it called “a tragic mistake”, but refrained from criminal charges, a step criticized by many as insufficient. According to an MSF statement,

The administrative punishments announced by the US today are out of proportion to the destruction of a protected medical facility, the deaths of 42 people, the wounding of dozens of others, and the total loss of vital medical services to hundreds of thousands of people. The lack of meaningful accountability sends a worrying signal to warring parties, and is unlikely to act as a deterrent against future violations of the rules of war. At the same time, it has become clear that the victims and their families have neither the option to pursue legal action against the US military, either in Afghanistan or in the US, nor to claim compensation for loss of life and livelihood. This has only compounded the devastation of the attack.

In the words of executive director of Physicians for Human Rights, Donna McKay:

The decision to dole out only administrative punishments and forego a thorough criminal investigation of October’s deadly strike in Kunduz is an affront to the families of the more than 40 men, women, and children who died that night, punished merely for being in a hospital, a supposed safe haven in a time of war.

Five months after the passage of Resolution 2286, and in light of the continuing lack of accountability, MSF International President Dr. Joanne Liu implored the Security Council to make its resolution operational: “the resolution has plainly failed to change anything on the ground. This failure reflects a lack of political will – among member states fighting in coalitions, and those who enable them.”

Of course, Kunduz is far from being the only serious case of violence against healthcare – as this article attests – yet it serves to highlight the challenges of seeking accountability for such violations, even among states with the capacity to do so.

Namely, when states fail to take action, international mechanisms should have the capacity to pursue accountability for serious violations of international norms such as attacks against healthcare. This includes pursuing alternative mechanisms for accountability, as well as utilizing existing ones. The Security Council, for instance, highlighted its own role in passing Resolution 2286; but has refrained from referring the situation in Syria – including the systematic attacks on healthcare – to the International Criminal Court for prosecution, due to opposition from Russia and China. Speaking to the UN Security Council in 2014, then Deputy Secretary-General Jan Eliasson reinforced the “clear role” of the Security Council in protecting aid workers:

It could call on parties to comply with international legal obligations and condemn then when they do not, imposing targeted measures on grave violators. It could make sure the lines between political, military and humanitarian objectives were not blurred in peace negotiations and peacekeeping mandates. It could finally use a variety of tools to ensure accountability for those who committed attacks.

In the absence of such measures to punish those who attack health care and other humanitarian aid workers, the international community continues to send the signal that such violence can continue without consequence.


With violence against healthcare continuing to accelerate, and impunity continuing to prevail, dedicated action by states and the international community is needed more than ever to translate the words and spirit of Resolution 2286 into reality. Foremost among these efforts should be concrete measures toward accountability for the perpetrators of attacks on healthcare. This means timely and independent investigations and documentation of incidents; effective punishment for individual perpetrators; referral by the UN Security Council of serious alleged cases for prosecution by the International Criminal Court; where appropriate, the creation of alternative mechanisms for investigation and prosecution, including for example the appointment of a UN special mandate holder for the protection of humanitarian aid and healthcare workers; and the imposition of serious costs on states that perpetrate, support or tolerate violence against healthcare within their jurisdictions, by their armed forced or by their allies. Together, such measures can make a significant contribution to reasserting international humanitarian norms in conflict, combating impunity for the perpetrators of violence against healthcare, and ultimately, safeguarding access to healthcare for millions of people affected by conflict around the globe.

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