Health Care Is War's First Casualty


In July, Khaled Khafaji, a volunteer with the Syrian Arab Red Crescent, was shot and killed while on ambulance duty in eastern Syria.

A month earlier, Bashar al-Youssef, a Syrian first aid volunteer, was killed despite the fact he was wearing a uniform clearly marked with the protected red crescent emblem. These deaths confirm the terrible truth that in armed conflict health care is often the first victim.

Foreign Minister Bob Carr is currently advocating a plan to protect medical workers and hospitals in Syria. Carr is right to highlight the importance of ensuring safe access to medical services in Syria. Violence, both real and threatened, against health care personnel, facilities and patients is one of the most serious and least recognised humanitarian issues facing the world today.

Protections already exist for the provision of medical care in times of conflict. The Geneva Conventions and their Additional Protocols set out the right of the wounded and sick — combatants and civilians alike — to be protected during armed conflict and to receive timely medical treatment. The emblems of the red cross, red crescent or red crystal are used to signify this protection.

This means that deliberate assaults on health care personnel, facilities and transports, as well as on wounded people, violate international humanitarian law.

Despite the existence of these well established principles of international humanitarian law, which have been ratified by all countries, armed groups continue to injure and kill health care personnel and patients and to destroy hospitals. The International Red Cross Red Crescent Movement’s current "health care in danger" campaign is bringing the world’s attention to the horrific consequences of attacks on the medical system during times of armed conflict.

A study by the International Committee of the Red Cross reported at least 1834 people were killed or injured as a result of 655 violent acts, either accidental or deliberate, against health care personnel and facilities between 2008 and 2010.

In Sri Lanka and Somalia, hospitals have been shelled; in Libya and Lebanon, ambulances have been shot at; in Afghanistan, the wounded languish for hours in vehicles held up in checkpoint queues; and five members of the Syrian Arab Red Crescent have been killed over the past year risking their lives to provide medical assistance and humanitarian relief.

The number of incidents is striking but these statistics represent only the tip of the iceberg. They do not capture the compounded cost of violence, such as health care staff leaving their posts, hospitals running out of supplies and vaccination campaigns coming to a halt. These knock-on effects dramatically limit access to health care for entire communities, right when they need it most.

People die in large numbers not necessarily because they are direct victims of a roadside bomb or a shooting but because the ambulance does not get there in time, because health care personnel are prevented from doing their work, because hospitals are themselves targets of attacks or simply because the environment is too dangerous for effective health care to be delivered.

Conditions in Syria are rapidly deteriorating and civilians are paying the price. 2.5 million people are now in need of humanitarian assistance. Syrian health workers are showing admirable courage carrying out their life-saving work in extremely difficult conditions. Still, many women, men and children who could be saved are dying on a daily basis because they lack access to medical care. Tragically these people are joining the millions of people around the world who are deprived of access to health care due to conflict.

There is an urgent need to improve the safety of wounded and sick people, and of health care personnel, facilities and medical vehicles during armed conflict and other violence, not just in Syria but around the world.

Deliberate violence against health care facilities and personnel is not only morally reprehensible, it is virtually always illegal. Upholding the core principle of international humanitarian law that health care facilities and personnel shall be respected and protected at all times is a huge challenge, but one that we must continue to pursue. Millions of lives depend on it.

Launched in 2004, New Matilda is one of Australia's oldest online independent publications. It's focus is on investigative journalism and analysis, with occasional smart arsery thrown in for reasons of sanity. New Matilda is owned and edited by Walkley Award and Human Rights Award winning journalist Chris Graham.