Silahlı Çatışmalarda Sağlık Unsurlarının Bir Savaş Taktiği Olarak Hedef Alınması: Uluslararası İnsancıl Hukuk ve Uluslararası Ceza Hukuku Açısından Bir İnceleme

Öz

Sağlık altyapısı, silahlı çatışmalarda geleneksel olarak korunan sivil nesne olarak sınıflandırılmış olsa da, son çatışmalar endişe verici bir eğilimi ortaya koymuştur: Sağlık tesisleri, tıbbi nakil araçları ve sağlık çalışanları, çatışan taraflarca giderek daha fazla kasıtlı olarak hedef alınmakta ve taktiksel araç olarak kullanılmaktadır. İşgal altındaki Filistin toprakları, Ukrayna, Demokratik Kongo Cumhuriyeti, Myanmar ve Suriye gibi yerlerde, sağlık sistemlerine yönelik saldırılar münferit olaylar değil, daha geniş kapsamlı savaş stratejilerinin bir parçası olarak karşımıza çıkmaktadır. Bu durum, hem uluslararası insancıl hukukta öngörülen koruma mekanizmalarının etkinliği hem de bu eylemlerin uluslararası ceza hukuku bakımından bireysel ceza sorumluluğu doğurup doğurmadığı konusundaki tartışmaları derinleştirmektedir. Bu çalışma, silahlı çatışmalarda sağlık altyapısının hem hedef hem de taktik olarak kullanılmasının hukuki sonuçlarını, 1949 Cenevre Sözleşmeleri, 1977 Ek Protokoller, uluslararası teamül hukuku ve Roma Statüsü tarafından oluşturulan çerçeveye odaklanarak incelemektedir. Sağlık tesislerine, sağlık çalışanlarına ve tıbbi nakil araçlarına sağlanan korumanın hukuki kapsamını analiz etmektedir. Çalışma, sağlık hizmetlerinin günümüz çatışmalarında giderek artan bir şekilde çatışma aracı haline geldiğini ve insani alanların korunmasına ilişkin düzenlemeler ve çatışma alanı uygulamaları arasındaki boşlukları vurgulamaktadır. Sağlık hizmetlerine yönelik saldırıların yalnızca insancıl hukuk ihlali değil, aynı zamanda uluslararası ceza hukuku bakımından savaş suçu, insanlığa karşı suç hatta soykırım suçunu teşkil edebileceği yönündeki değerlendirmeleri ele almaktadır

Anahtar Kelimeler

• Silahlı Çatışmalar
• Sağlık Altyapısının Hedef Alınması
• Uluslararası İnsancıl Hukuk
• Uluslararası Ceza Hukuku
• Savaş Suçları

Targeting Healthcare Services as a Warfare Tactic in Armed Conflicts: An Analysis Under International Humanitarian Law and International Criminal Law

Öz

Although healthcare infrastructure has traditionally been classified as a civilian object protected during armed conflicts, recent conflicts have revealed a troubling trend: hospitals, medical transport vehicles, and healthcare workers are increasingly being deliberately targeted and used as tactical tools by warring parties. In contexts such as the Occupied Palestinian Territories, Ukraine, the Democratic Republic of the Congo, Myanmar, and Syria, attacks on healthcare systems are not isolated incidents but part of broader war strategies. This situation deepens debates surrounding both the effectiveness of the protection mechanisms provided under international humanitarian law and the question of whether such actions give rise to individual criminal responsibility under international criminal law. This study examines the legal consequences of the use of healthcare infrastructure as both a target and a tactic in armed conflicts, focusing on the framework established by the 1949 Geneva Conventions, the 1977 Additional Protocols, customary international law, and the Rome Statute. It analyzes the legal scope of the protection granted to medical facilities, healthcare personnel, and medical transport vehicles. The study highlights how healthcare services are increasingly becoming instruments of conflict in contemporary warfare and underscores the gaps between the regulations concerning the protection of humanitarian spaces and their implementation on the battlefield. It also evaluates the view that attacks on healthcare services may constitute not only violations of humanitarian law but also war crimes, crimes against humanity, or even genocide under international criminal law.

Anahtar Kelimeler

• Armed Conflicts
• Targeting of Healthcare Infrastructure
• International Humanitarian Law
• International Criminal Law
• War Crimes

Kaynakça

1. Acer Y ve Kaya İ, Uluslararası Hukuk (9. Baskı, Seçkin 2018)
2. Afghanistan Resilience Trust Fund (ARTF) https://www.wb-artf.org/ Erişim Tarihi: 20 Kasım 2025
3. Africanews, “Rebels in Eastern Congo Abducted 130 Hospital Patients, UN Says” Africanews (16 February 2025) https://www.africanews.com/2025/03/04/rebels-in-eastern-congo-abducted-130-hospital-patients-un-says// Erişim Tarihi: 30 Eylül 2025
4. Aljazeera, “Timeline: Israel’s Attacks on Hospitals Throughout its War on Gaza” AlJazeera (13 April 2025) https://www.aljazeera.com/news/2025/4/13/timeline-israels-attacks-on-hospitals-throughout-its-war-on-gaza Erişim Tarihi: 2 Eylül 2025
5. Amon J J and Rubenstein L, ‘Drone Attacks on Health in 2023: Humanitarian Law and the Rights to Health’, Health and Human Rights Journal, Vol. 26:1, June 2024, 143
6. Attacks on Healthcare in Ukraine https://www.attacksonhealthukraine.org/ Erişim Tarihi: 7 Eylül 2025
7. Baldan M, Health Care in Danger: Making the Case (ICRC, Geneva 2011) Erişim Tarihi: 9 Ekim 2025
8. Bhuyan S S, Ebuenyi I ve Bhatt J, Persisting Trend in the Breach of Medical Neutrality: A Wakeup Call to the International Community (BMJ Global Health, 22 November 2016) 1–2 https://gh.bmj.com/content/bmjgh/1/3/e000109.full.pdf Erişim Tarihi: 8 Eylül 2025

9. BMA, Medicine Under Attack: The Increasing Assault on Healthcare in Conflict Zones (July 2025) https://www.bma.org.uk/what-we-do/working-internationally/our-international-work/medicine-under-attack-the-increasing-assault-on-healthcare-in-conflict-zones Erişim Tarihi: 10 Eylül 2025
10. BMJ Group, New Term for Systematic, Deliberate Attacks on Healthcare as Acts of War: “Healthocide” (August 2025) https://bmjgroup.com/new-term-for-systematic-deliberate-attacks-on-healthcare-as-acts-of-war-healthocide/ Erişim Tarihi: 30 Ağustos 2025
11. Brennan R ve Sheraz M, The International Community is Failing to Protect Healthcare in Armed Conflict (BMJ 2024) https://www.bmj.com/content/387/bmj.q2474 Erişim Tarihi: 8 Eylül 2025
12. Briody C / Rubenstein L / Roberts L / Penney E / Keenan W / Horbar J, ‘Review of Attacks on Health Care Facilities in Six Conflicts of the Past Three Decades’, Conflict and Health (2028) 12–19
13. Britannica, Siege of Sarajevo – Bosnian War (1992–1996) https://www.britannica.com/event/Siege-of-Sarajevo Erişim Tarihi: 24 Kasım 2025
14. Carruth L, ‘Medical Neutrality’, in Antonio De Lauri (ed), Humanitarianism (Brill 2020)
15. Cookman L, “Russia is Targeting Us Deliberately: How Attacks on Maternity Hospitals Fuelled a Birth-Rate Crisis in Ukraine” The Guardian (London, 21 August 2025) https://www.theguardian.com/world/2025/aug/21/russia-ukraine-war-childbirth-demographics-targeting-attacks-maternity-hospitals-kharkiv-sloviansk-khersonbirth-crisis Erişim Tarihi: 7 Eylül 2025
16. Crawford J, State Responsibility: The General Part (Cambridge University Press 2013)
17. De Vos C / Rusnak D / Zarei K, “Russia’s Attack on Health Care in Ukraine are War Crimes”, Harvard Public Health (2023) https://harvardpublichealth.org/global-health/russias-attacks-on-health-care-in-ukraine-are-war-crimes/ Erişim Tarihi: 5 Eylül 2025
18. Cullian K, “Ban All Attacks on Hospitals as Shielding Has Become a Tool of Genocide” (2025) Health Policy Watch https://healthpolicy-watch.news/ban-all-attacks-on-hospitals/ Erişim Tarihi: 14 Ekim 2025
19. Dinstein Y, The Conduct of Hostilities under the Law of International Armed Conflict (Cambridge University Press 2022)
20. Dörmann K ve Serralvo J, ‘Common Article 1 to the Geneva Conventions and the Obligation to Prevent International Humanitarian Law Violations’ (2014) 96 International Review of the Red Cross 707–736
21. Fisher M ve Nader E, “Israeli Double Strike on Gaza Hospital – What We Know” BBC (London, 26 August 2025) https://www.bbc.com/news/articles/c80d2zrdj7vol Erişim Tarihi: 2 Eylül 2025
22. Garbo G L, Russia Targets Ukrainian Hospitals (University of Oslo, 17 February 2025) https://www.sv.uio.no/isv/english/research/news-and-events/news/2025/ukraine--targeted-attacks-on-hospitals.html Erişim Tarihi: 6 Eylül 2025
23. Giordano E, “Zelensky says Russia Struck Maternity Hospital in Huge Overnight Attack” Politico (10 June 2025) https://www.politico.eu/article/volodymyr-zelenskyy-russia-struck-odesa-maternity-hospital-huge-overnight-attack/ Erişim Tarihi: 7 Eylül 2025
24. Gostin L O ve Rubenstein L, ‘Attacks on Healthcare in the War in Ukraine: International Law and the Need for Accountability’ (2022) 327(16) JAMA 1541 https://pubmed.ncbi.nlm.nih.gov/35363248/ Erişim Tarihi: 5 Eylül 2025
25. Haar R vd., ‘Violence Against Healthcare in Conflict: A Systematic Review of the Literature and Agenda for Future Research’ (2021) 15 Conflict and Health
26. Henckaerts J M ve Doswald-Beck L, Customary International Humanitarian Law, Vol. I: Rules (Cambridge University Press 2005)
27. ICRC, Health Care in Danger: A Sixteen-Country Study (2011) https://www.icrc.org/sites/default/files/external/doc/en/assets/files/reports/4073-002-16-country-study.pdf Erişim Tarihi: 8 Eylül 2025
28. ICRC, Interpretive Guidance on the Notion of Direct Participation in Hostilities (2020) https://www.icrc.org/en/publication/0990-interpretive-guidance-notion-direct-participation-hostilities-under-international Erişim Tarihi: 8 Eylül 2025
29. Kolb R ve Nakashima F, ‘The Notion of “Acts Harmful to the Enemy” in International Humanitarian Law’ (2019) 101:912 International Review of the Red Cross 1171
30. Pazarcı H, Uluslararası Hukuk (22. Bası, Turhan Kitabevi 2023)
31. Pictet J, ‘The Medical Profession and International Humanitarian Law’ (1985) 25 International Review of the Red Cross 191–209
32. Sassòli M, International Humanitarian Law: Rules, Controversies and Solutions (Edward Elgar Publishing 2019)
33. Shaw M N, International Law (Cambridge University Press 2017)
34. Solis G D, The Law of Armed Conflict (Cambridge University Press 2010)
35. Taşdemir F ve Albayrak G, Uluslararası İnsancıl Hukuk (Adalet Yayınevi 2018)
36. Tezcan D / Erdem M R / Önok R M, Uluslararası Ceza Hukuku (7. Baskı, Seçkin 2023)
37. Uluslararası Ceza Mahkemesi Roma Tüzüğü https://www.ceidizleme.org/ekutuphaneresim/dosya/459_1.pdf Erişim Tarihi: 24 Kasım 2025
38. United Nations Security Council Resolution 2286 (3 May 2016), UN Doc. S/RES/2286 https://digitallibrary.un.org/record/827916?ln=en&v=pdf Erişim Tarihi: 8 Eylül 2025
39. Von Glahn G ve Taulbee J L, Law Among Nations (Routledge 2017)
40. WHO, In the Line of Fire: Protecting Health in Armed Conflict (November 2024) https://cdn.who.int/media/docs/default-source/health-workforce/hwp/in-the-line-of-fire-(1).pdf Erişim Tarihi: 8 Eylül 2025
41. World Bank, The World Bank Group in Afghanistan: ARTF Support for the People of Afghanistan https://www.worldbank.org/en/country/afghanistan/brief/world-bank-afghanistan-resilience-trust-fund-artf-support-for-the-people-of-afghanistan Erişim Tarihi: 20 Kasım 2025