Health centers in wartime should not be a target. And yet, it is difficult to miss the attacks on health systems and centers in 2024. Due to their protection by the Geneva Conventions, attacks on health centers have constituted a violation of international humanitarian law since 1949 (article 18). of the Fourth Geneva Convention, as well as Additional Protocols I and II). Furthermore, the Rome Statute of the International Criminal Court qualifies them as war crimes (article 8), and the United Nations Security Council strongly condemns them.
One would expect that, under the protection of these laws, attacks on health centers would become increasingly rare. However, the reality is very different. According to the World Health Organization (WHO), 1,520 attacks against health structures were recorded last year. Until September 3, 2024, 1,701 attacks – including assaults, assaults and bombings – have already been recorded across the world.
This violence is mainly concentrated around four major centers of conflict. Two of them are regularly in the media spotlight: the Middle East and the Russian-Ukrainian conflict. The other two, although quieter, are just as destructive: Sudan and Myanmar.
In Myanmar, a historic conflict pitting the Rohingya Muslim minority, unrecognized by the Burmese authorities, against the Buddhist populations, has periodically resurfaced since the beginning of the 19th century. This conflict has disrupted the lives of thousands of people, with a major resurgence in 2017, which led to the displacement of more than 700,000 Rohingya towards Bangladesh, considered by the Burmese authorities to be their country of origin.
In this climate of permanent conflict, attacks against health centers are frequent. Bombings by the army, disruptions in the supply of medicines due to blockades, missiles targeting hospitals, assassinations of medical personnel, occupations of hospitals, and obstacles to access to care are becoming commonplace. Last August, a joint attack by the People’s Defense Forces (PDF) and the armed group Myanmar National Democratic Alliance Army on a hospital left nine medical staff and 21 patients dead. In 2024, 234 attacks were recorded against health centers, making the conflict in Rakhine State one of the most neglected by Western and French-speaking media.
In Sudan, the conflict pits the Sudanese Armed Forces (SAF) against the paramilitary Rapid Support Forces (RSF) militia, in an open struggle for control of power. This standoff broke out after the fall of Omar El-Bashir’s regime in 2019, leaving a political vacuum exploited by these two rival factions. The conflict, which is currently ravaging the country, has caused more than 12,000 deaths and displaced nearly 8 million people, worsening an already alarming humanitarian crisis.
This conflict tends to take on an ethnic dimension, in particular against the Masalit community in the Darfur region, where targeted violence is intensifying. Clashes are moving into public spaces, severely impacting civilian infrastructure, particularly the health system. The latter, already fragile, has suffered heavy setbacks, exacerbated by shortages of medicines across the capital, Khartoum. In 2023, an attack on the National Medical Center in Khartoum precipitated this health crisis, illustrating the scale of the nationwide chaos. This conflict threatens regional stability and fuels an increasingly uncontrollable dynamic of violence.
In Ukraine, as of August 19, 2024, the WHO has recorded 1,940 attacks against health centers since the start of the conflict, marking a clear escalation, in particular due to the increased use of heavy weapons. Since 2023, these attacks have become almost daily, particularly near the front line. This situation often forces health centers to relocate to secret locations, which complicates access to emergency care, both for soldiers and civilians in critical need. In July, a missile attack on a maternity hospital in the Dniprovskyi district left five medical staff dead, illustrating the brutality and increasing intensity of violence targeting the medical sector.
In the Middle East, the situation in Gaza remains critical, and the conflicts do not spare healthcare establishments. Since the start of hostilities last October, more than 1,000 attacks have been carried out against health centers. In the war between Hamas and Israel, hospitals are particularly targeted and used by the belligerents, whether to hide there or to hold hostages, which seriously aggravates 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 functioning. These hospitals suffer from a severe lack of medicines, equipment and fuel, which seriously threatens vital services such as intensive care, neonatology and maternity wards. The situation is similar in primary health centers: 57 of the 132 are now inoperable. Medical personnel are paying a heavy price, with more than 500 health professionals killed since the start of the conflict.
This conflict extends beyond the borders of Gaza, with the potential for a regional conflagration. In Lebanon, health infrastructure is also being targeted, with 45 attacks recorded in 2024, causing the death of 41 medical personnel.
Health centers, although protected by international law and humanitarian conventions, are therefore often targeted during conflicts. Indeed, the attack on a healthcare center is of strategic importance for several reasons:
– Weakening of the enemy: depriving the adversary of essential medical care weakens his ability to maintain himself on the ground. Attacks on these establishments also affect the civilian population by depriving them of access to vital care, essential in times of insecurity. These actions have not only physical, but also psychological consequences, exacerbating distress within communities. Health centers, often not militarily protected and relying on the international legal framework, thus become vulnerable targets. Additionally, these locations may harbor valuable resources, such as medicines, medical equipment, fuel, vehicles or generators, which can be diverted for military or economic purposes.
– Symbolism and politics: paramilitary forces sometimes attack health centers for symbolic reasons. These establishments can represent the authority of the power in place or be perceived as vectors of foreign interference, particularly when Western non-governmental organizations (NGOs) manage care. These attacks then aim to weaken the influence of these actors or to challenge their legitimacy on the ground.
The trend regarding this type of attack 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 against health structures and systems in 2016, 1,013 in 2019, then 2,406 in 2022. In 2024, this figure will reach already 1,701 attacks, without any sign of appeasement emerging from these four major conflicts, giving hope for a more favorable end to the year.
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