Addressing the crisis in protection of health workers and facilities in armed conflict

Purpose: Assaults on patients and medical personnel, facilities, and transports, denial of access to medical services, and misuse of medical facilities and emblems have become a feature of armed conflict despite their prohibition by the laws of war. Strategies to improve compliance with these laws, protection, and accountability are lacking, and regular reporting of violations is absent. Methods: Using uniform search criteria, three global sources of human rights reports in armed conflicts for 2003–08, and in-depth reports on violations committed in armed conflict during 1989–2008 were reviewed to determine the nature and extent of attacks on health workers, patients, medical transports and facilities. Findings: There were serious deficiencies in the extent and methods of reporting, but from the existing reports, three major trends in such assaults were identified: attacks on medical functions appear to be part of a broad assault on civilians; assaults on medical functions are used to achieve a military advantage; and combatants do not respect the ethical duty of health professionals to provide care to patients irrespective of affiliation. Recommendations. Improvements are needed in documentation of violations, adherence to norms, and accountability for violations. The WHO should systematically document these violations, and states and the medical community need to take steps to improve compliance with law, protection, and accountability.