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Patients and doctors must never become targets of war

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The writer is professor of Global Health at McGill University and the former international president of Médecins Sans Frontières

“What are individuals in wars today? Expendable commodities, dead or alive. Patients and doctors are legitimate targets. Women, children, the sick, the wounded and their care givers are condemned to death. Stop these attacks.”

I spoke these words in front of the UN Security Council in May 2016, in my previous capacity as the head of Médecins Sans Frontières. My speech was met with applause. Years later, as healthcare workers and patients find themselves caught up in conflict once more in both Gaza and Ukraine, I wonder if the world was truly listening. 

In the early hours of October 3 2015, five air strikes hit the MSF-supported Kunduz trauma centre in Afghanistan. Patients and staff did not have time to escape, those who were wounded and immobile burnt alive in their beds. At MSF, we channelled our shock and outrage into requests for an independent investigation. The US took responsibility, concluding that it was a mistake made in the fog of war. Together with others, we demanded the international community understand that wars must stop at the doorsteps of hospitals.

One year later, the UNSC passed resolution 2286 unanimously. This condemned attacks on the sick and the wounded, medical and humanitarian personnel, medical transport and equipment, hospitals and other medical infrastructures, in line with international humanitarian law.

But this Kumbaya moment was shortlived. Now, in 2023, all that effort, anger and work feels hollow. Attacks against healthcare workers have once again become commonplace during the Ukraine-Russia and Israel-Hamas conflicts. And while every case is different, targeting patients and their caregivers must remain a non-negotiable red line.

As I write, medical staff and those who need their help are swept up in the relentless attacks across the Gaza Strip. There have been constant bombardments around the al-Shifa hospital complex, the largest medical facility in Gaza. On November 15, Israeli forces entered the hospital while medics and 600 patients remained inside, including babies in incubators. An MSF surgeon sent this message: “We don’t have electricity. There’s no water in the hospital. There’s no food. People will die in a few hours without functioning ventilators. In front of the main gate, there are many bodies, there are also injured patients. We can’t bring them inside.” 

Hundreds of patients left al-Shifa on November 18, as Israeli officials urged civilians to make for a “safe zone” in the south-west of the Gaza Strip. On the same day the relative of an MSF staff member died and another was injured in an attack on an MSF convoy trying to evacuate 137 people from the organisation’s premises near the hospital.

Israeli authorities have previously cited Hamas operations in al-Shifa as the reason for entering the hospital. Health worker colleagues do not have any direct information as to such presence and we reiterate our call for the respect and protection of health facilities, healthcare workers and patients.

The rules of war are very clear: civilians must be spared. States waging war have the responsibility to appropriately control the conduct of hostilities and, in so doing, avoid attacking hospitals and those who desperately need them. They also have a responsibility to facilitate medical evacuations when needed. Such evacuations are impossible for doctors on the ground to co-ordinate when patients are wounded or unable to leave or when hospitals are surrounded or ambulances struck, leaving no logistical means or security assurances for safe evacuations. Hospitals must not be deliberately transformed into a place of death.

In any conflict situation, medical staff must be protected and given unhindered access to patients. Doctors in Gaza right now are completely exhausted and overwhelmed. But they continue to work tirelessly to care for people with horrific injuries, while lacking essential resources and worrying about their own safety. In late October, an MSF emergency physician sent us a photo of the whiteboard at Al-Awda hospital. It had been wiped clean of surgical cases, leaving only this message: “We did what we could. Remember us.”

I have worked as a doctor in conflict zones. I know that in the chaos of waging war, hospitals are often the very last patch of humanity available. Depriving civilians of access to healthcare when they need it most obliterates the last glimpse of hope in a world of destruction. The international community must uphold the rules of war and not let anyone who harms vulnerable civilians off the hook. Our common humanity must win. I add my voice to the many now calling for an immediate ceasefire in Gaza. I can’t believe I need to write these words again: “Stop these attacks”.  

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