Sometimes there is no easy answer: Health care protection in conflict zones

Abstract

Globally, health care providers and facilities are facing growing risks due to political instability, sieges, and warfare. Public health is indisputably at the forefront of saving lives during military operations. In the current climate of global adversity, public health professionals have the responsibility to be prepared at all times and well-informed when responding to medical crises in conflict situations. Complex humanitarian emergencies cause great disruption, disabling, damaging, destroying community well-being. Public health services are evidently at the leading edge of health planning and provision in mass casualty incidents. This editorial letter draws attention to the critical and current subject of health care and medical workers under attack in war zones. Criminal violence is against the law and an action that requires punishment. Lawful conduct that is part of a legally legitimate military operation must comply with the fundamental principles that govern armed conflict. It is important not to confuse the two actions in terms of clarity and purpose. As for the extremely topical and vital issue, this editorial letter calls upon all parties in relevant fields to refresh and update their knowledge of the International Humanitarian Law, the Geneva Conventions and the additional protocols in relation to current crises. Particular emphasis is placed on alerting both national and international audiences at this seminal turning point in history. When health care is faced with war-torn ethical damage, it is incumbent upon every professional to understand the context, to refrain from getting caught up in dilemmas, avoid getting carried away by popular tabloid trends.

Keywords

• War
• Warfare
• Combat
• Armed Conflict
• Complex Humanitarian Emergency
• Mass Casualty Incident (MCI)
• Public Health Crisis

References

1. van der Heijden MR. Attacks on hospitals: current legal protections are insufficient. Lancet. 2023;402(10419):2293-4. doi:10.1016/S0140-6736(23)02632-6
2. Baruch PS, Neuman N. Warning civilians prior to attack under international law - theory and practice. Israel Yearbook on Human Rights. 2011;41:137-96. doi:10.1163/9789004226449_007
3. Mahase E. Ukraine: Over 700 recorded attacks on health facilities and workers in year since Russia invasion. BMJ. 2023;380:451. Published 2023 Feb 23. doi:10.1136/bmj.p451
4. Nickerson JW. Ensuring the security of health care in conflict settings: An urgent global health concern. CMAJ. 2015 Aug 11;187(11):E347-8. doi:10.1503/cmaj.140410. Epub 2015 May 19.
5. Hakki L, Stover E, Haar RJ. Breaking the silence: Advocacy and accountability for attacks on hospitals in armed conflict. International Review of the Red Cross. 2020;102(915):1201-26. doi:10.1017/s1816383121000382
6. Vuorio A, Bor R. Safety of health care workers in a war zone - A European issue. Front Public Health. 2022 Mar 30;10:886394. doi:10.3389/fpubh.2022.886394
7. Sommario E. United Nations Bodies (2018). Yearbook of International Disaster Law Online. 2019;1(1):305-13. doi:10.1163/26662531-01001015
8. Murray CJ, King G, Lopez AD, Tomijima N, Krug EG. Armed conflict as a public health problem. BMJ. 2002 Feb 9;324(7333):346-9. doi:10.1136/bmj.324.7333.346.

9. American Public Health Association. The role of public health practitioners, academics, and advocates in relation to armed conflict. Policy Statement. Published Tuesday, November 10, 2009. Accessed Monday, July 22, 2024. Available from: https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/22/13/29/the-role-of-public-health-practitioners-academics-and-advocates-in-relation-to-armed-conflict