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What Is Happening to Medical Neutrality?

Since 2018, the United Nations (U.N.) has claimed that approximately 90 percent of victims in modern wars are civilians. This staggering statistic, though quite controversial, has perpetuated the presumption that wartime civilian casualties are both unstoppable and inevitable. With advancements in technology and increased public access to information, our screens are filled with violent reports of armed conflict. A spike in urban warfare and human rights abuses indicate the highest number of violent conflicts since 1945 of which civilians suffer the most. Attacks on civilians have, of course, existed before widespread access to social media. However, the internet has drastically changed the way in which we can view what goes on during armed conflict. Both the nature and scale of civilian attacks, which may have otherwise been hidden from the world, have become increasingly more visible. For example, medical war crimes and attacks on healthcare in particular have become increasingly more normal in armed conflicts since the Second World War. With almost two thousand attacks on health care facilities and professionals in 2022. 


The World Health Organisation (W.H.O.) defines an attack on health care as the act, threat, obstruction, or interference of the availability, access, and delivery of health services during emergencies. These attacks often take the form of assaults on hospitals (especially cyberattacks), medical personnel, and the interference with transportation of medical aid. According to international humanitarian law, chiefly the 4th Geneva Convention, hospitals, health establishments, and the wounded or sick are protected under the notion of medical neutrality. Attacks on healthcare have a long and tragic history in conflict all over the world. And, as demonstrated by armed conflicts of the present day, medical neutrality is still almost impossible to track, much less enforce. 


Furthermore, it is estimated that over a thousand attacks on healthcare have occurred since February 24, 2022, in Ukraine. Over four hundred attacks were on hospitals and over a hundred on healthcare workers. In the Israeli-Palestinian conflict, health facilities in the Gaza Strip have been attacked more than six hundred times since October. These attacks, coupled with a serious lack of medical supplies due to an over sixteen-year blockade, have left the population of Gaze in dire need of aid. The November 15 Al-Shifa hospital siege, in particular, caused an international outcry with over a thousand people either killed or taken hostage. These interruptions and lack of resources not only cause harm to at-risk populations but worsen long-term public health. The W.H.O. has named the conflict in the Gaza Strip, the deadliest conflict for children as worsening conditions spread widespread famine and disease. So what is being done? 


Doctor and researcher at Physicians for Human Rights, Dr Houssam al-Nahhas, believes the most important methods to stop attacks on health care are documentation, prevention, and prosecution. According to al-Nahhas, exact and concrete statistics are the first step to protecting healthcare workers and facilities. According to the W.H.O.’s Surveillance System for Attacks on Health Care (SSA), authenticating and publicising reports increases the likelihood of prosecution, draws global attention, and puts pressure on governments to take action. However, information can be both manipulated and misused. Therefore, experts recommend that in an armed conflict, hospitals retain security and metal detectors to keep weapons outside. Additionally, the International Committee of the Red Cross (ICRC) strives to educate and train medical professionals to employ de-escalation techniques and engage their community to prevent attacks. In 2013, a Nigerian Civilian Joint Task Force (CJTF) joined, in part, to protect local healthcare professionals and warn medical teams of ambushes. 


As of 2022, almost one-quarter of the world’s population lives in conflict zones. As military technology advances, so too do global institutions to protect global health amid humanitarian crises. However, current threats to public health amid armed conflicts are developing faster than international aid can match. Global health officials are concerned that the norm of medical neutrality is “eroding”, with attacks in the Gaza strip pushing global health institutions to the breaking point. As we learn more about attacks on health care around the world, global institutions and leaders must adapt to ensure accountability. 

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