Médecins Sans Frontières

The Battle for Healthcare in the Quagmire of War

Hospitals reflect the narrative of suffering in war. Working under pressure to treat the victims of war, there is always the threat that doctors will suffer the tragedy of war. Safe zones for medical humanitarian operations are shrinking, despite protection under international law.

As doctors flee Syria, civilians in Idlib province in northern Syria have limited access to medical care. There is no guarantee that facilities located in a safe zone will not be subjected to attacks as part of a military strategy to foment fear and encourage flight of the civilian population. The latest attack in Syria was particularly devastating, completely destroying an MSF-supported hospital in Ma’arat al-Nu’man that left 25 people dead, including children.

MSF International President, Dr. Joanne Liu, described the attacks: “According to accounts from medical staff onsite, four missiles struck the hospital in an attack lasting about two minutes. Forty minutes later, after rescuers arrived, the site was bombed again.” A nearby hospital that was receiving the wounded from the first strike was hit an hour later. The hospital did not provide its location to the Syrian government for fear of being deliberately attacked by Russian or Syrian air missiles. Yet, it was bombed anyway. Monday’s attack means the “local population of 40,000 is now without medical services in an active zone of conflict,” said Massimiliano Rebaudengo, MSF’s head of mission in Syria.

Russia has been mostly responsible for aerial bombardments of soft targets like schools and hospitals despite the fact that this clearly violates international humanitarian law.

MSF has provided essential healthcare in Syria since the start of the civil war and from the beginning their facilities and staff have come under fire. Over 60 MSF hospitals across Syria have been bombed in aerial and shelling attacks, and 81 of their staff have been killed or injured since 2011. In all, 12 hospitals have been completely destroyed. MSF withdrew international staff from Syria in 2014 following the abduction of staff members, but they continue to provide funds and support from Turkey to a network of around 150 clinics and hospitals throughout the country.

MSF still operates two hospitals near Aleppo and one in Atmeh. In an unpublished letter to the U.N. Security Council, U.N chief, Ban Ki-moon, the strongest criticism yet was levied against Moscow’s military airstrikes in Syria, accusing Russia of carrying out airstrikes that have “severely disrupted” humanitarian operations around Aleppo since the beginning of the year and prevented the delivery of life-saving assistance to entire towns and cities in Syria. The MSF letter said the strikes included “indiscriminate and disproportionate” bombings, carried out “with total impunity, depriving civilians of basic and essential services and further driving humanitarian need across the country.”

The collapse of healthcare in Syria means lifesaving treatment is almost impossible to deliver safely. The unrelenting quagmire of war and the fragility of last week’s agreement on the “cessation of hostilities” from all actors involved in Syria has only served to place civilians and medical staff in the crosshairs of bombs and airstrikes.

Liu’s statement epitomizes the absolute misery in Syria where “the abnormal is now normal. The unacceptable is accepted. Relentless, brutal, and targeted attacks on civilians are the dominant feature of this war.” As bombs reign down on cities and towns across the country, the number of times hospitals have been attacked must be considered as an assault on all medical services, facilities and personnel.

Healthcare workers and civilians have no weapons. Attacks in Afghanistan, Yemen and Syria fundamentally undermine international law on the protection of civilians and medical staff in war. Last year, 42 people died when an American missile hit a MSF hospital in Kunduz, Afghanistan.

In the under-reported war in Yemen, the UK-backed Saudi coalition has been responsible for devastating attacks against civilians. Russia has been primarily responsible for the civilian casualties in Syria. In the case of Kunduz, US tanks forcibly entered and destroyed the crime scene and with it potential evidence of a war crime.

The lack of concern for civilian deaths in war-weary countries has set a disastrous precedent for the lack of regard for international humanitarian law that specifically calls on states to fully comply with their international obligations to protect civilians, medical facilities and personnel.

While U.N. Security Council members will continue to denounce the suffering of the innocent victims of war, they are directly participating in the death toll. The darkest days of the Syrian revolution is unfolding. As the regime advances, backed by the full force of the Russian military, the country crumbles to dust at the cost of the Syrian people.

In war, medical humanitarian organizations face daunting challenges to save as many lives as possible in destabilized environments. The US, as a signatory to the Geneva Conventions, has an obligation to protect civilians and ensure that hospitals remain sanctuaries in areas of conflict.