MEDICAL humanitarians are those who selflessly toil in trying humanitarian situations to provide much-needed medical aid to affected populations. Although humanitarian emergencies are growing complex, with the interplay of interconnected political, geographical and economic factors, the purpose of medical humanitarianism has stayed noble and impartial — to save lives, tend to injuries and ensure uninterrupted healthcare.

From Florence Nightingale’s medical mission in the Crimean War to today’s myriad humanitarian emergencies, medical humanitarians have commanded respect and admiration. That is why those engaged in providing medical care in conflict settings are afforded special protection by international humanitarian law. Often, conflicts are put on pause to allow medical humanitarians to evacuate the injured and dead.

However, in recent times, medical humanita­rianism as a concept has been under immense stress. Health workers are increasingly facing mortal threats as brazen violations of humanitarian law under the Geneva Conventions escalate. These violations are evidenced in the increasing tendency of warring factions to bomb hospitals and medical facilities.

The World Health Organisation reported 594 attacks on hospitals in 19 countries, resulting in 959 deaths and 1,561 injuries, between January 2014 and December 2015, showing how the sustained targeting of hospitals and health workers is an instrument of war. The International Committee of the Red Cross (ICRC) estimated that 2,400 attacks against patients, health personnel, facilities and transports occurred in 11 conflict-affected countries over three years.

Health workers face mortal threats.

The targeted escalation of attacks on health facilities and workers is the new normal in Syria and has killed more than 500 people. In recent months, eight functioning hospitals supported by Médecins Sans Frontières have been under constant bombardment in east Aleppo. Allied to this tendency is the practice of deliberately targeting organisations engaged in medical relief work.

Of all humanitarian organisations, MSF — which won the Nobel Peace Prize in 1999 — is the most targeted organisation. In northern Syria, five of its members were abducted last year. Beyond Syria, Saudi planes attacked an MSF-supported hospital in Yemen recently, resulting in 11 deaths. One recent report identified the bomb used as being US-made, triggering calls for a ban on arms supply to Saudi Arabia, which has been bombing Yemen’s civilian population with impunity. In South Sudan last year, an MSF hospital was also subjected to aerial bombardment by government forces.

In October 2015, an MSF-run hospital in Kunduz, Afghanistan, was bombed by the US military, killing at least 45 people. America’s brazen violation of international humanitarian law raised an outcry among humanitarian organisations worldwide. The criticism centred on the intentional bombing of the hospital, despite MSF alerting US and Afghan authorities of the GPS coordinates of the hospital beforehand.

MSF called for constituting a humanitarian fact-finding mission to determine whether the US was guilty of war crimes. The call was supported by other humanitarian agencies working in the area and beyond. The US military’s report cited human error as the cause of the tragic event. As of date, no independent inquiry has taken place, raising serious concerns among humanitarian organisations about the future of medical humanitarianism and the vital issue of medical spaces in humanitarian emergencies. This was not the first attack on MSF in Afghanistan. In 2004, when five members of MSF were killed in a rural clinic, it prompted the organisation to suspend its mission, resuming work in 2009.

As a result of the safety concerns of MSF-supported hospitals and healthcare staff, and the continuing violations of the Geneva Conventions, MSF pulled out of the world humanitarian summit in Istanbul this year. Its abstention also stemmed from its larger concerns about the disturbing conflation of humanitarian and development spheres, and the non-binding nature of humanitarian summits’ recommendations in relation to states’ obligations to international humanitarian law.

Against this backdrop, the ICRC has proposed a number of measures to address the emerging issue of protection of medical spaces in conflict or war-induced humanitarian situations. These measures consist of aligning domestic legislation with international humanitarian law and ethical principles of the medical sector; training military personnel to minimise disruption to healthcare services; supporting local healthcare organisations to maintain basic services; improving legal protections for medical ethics and addressing violations robustly; and targeted training related to the protection of medical personnel and facilities.

Medical humanitarianism stands at a crossroads today. States have an all-important role to play in ensuring that health facilities and healthcare providers are protected during conflict and other humanitarian situations. MSF made the right call on this emerging policy issue, and the call must be heeded urgently.

The writer is a consultant and policy analyst.

Twitter: @arifazad5

Published in Dawn, September 27th, 2016