Stand up for medical neutrality in war zones, international community urged

The international community needs to stand up for medical neutrality in war zones, and mandate the UN Security Council to act in the face of persistent and blatant breaches of the Geneva Convention, urge global health experts in an editorial in the online journal BMJ Global Health.

Some 196 countries ratified the International Humanitarian Law, which specifically promotes medical neutrality and protection of medical services for people in war zones, as set out in the four Geneva Conventions of 1949.Breaches of the law, which was modified in 1977 and 2005 to strengthen it further, are regarded as war crimes, because of their impact on civilians and medical staff who have a duty of care to those wounded in war-torn countries.

"But over the years, war crimes have persisted with little or no definitive action by the international community to stem the tide," insist the authors, Drs Soumitra Bhuyan, School of Public Health, University of Memphis, Ikenna Ebuenyi, King's College London and London School of Hygiene and Tropical Medicine, and Jay Bhatt, The Health Research and Educational Trust, Chicago.

The inaction dates back to the 1970s in Mozambigue, and is still evident today in Syria, Iraq, Afghanistan and South Sudan, they point out. And the destruction of healthcare facilities around the world shows no sign of abating. In 2015-16, 600 such attacks were recorded—228 of them in Syria alone—killing1000 people and injuring more than 1500 others.

According to data from the World Health Organization, 113 healthcare facilities in 17 countries were attacked in the first 6 months of the 2016 alone. And as of the first week of October, every hospital in eastern Aleppo in Syria has been hit at least once, with one of the main trauma hospitals hit four times within a 5-day period. Since the war in Syria started, 654 doctors and nurses have lost their lives.

The impact of these attacks is "enormous," say the authors, outlining the psychological trauma for the survivors and the erosion of preventive healthcare, such as vaccinations and infectious disease control.

"The [International Humanitarian Law] is explicit and provides for the protection of patients, health facilities, health personnel and patients in times of war as long as they are not directly involved in hostilities," they write.

"The international community needs to rise to the occasion and match action with words by mandating the United Nations Security Council to provide protection for health facilities in war zones and enter into dialogue with government and warring groups to respect the principles of medical neutrality in conflict areas," they urge.

This means that the Council and governments of all nations need to develop some form of punishment that would deter aggressors from further breaches of the legislation and educate armed forces personnel to respect medical neutrality and the Geneva Convention, they say.