A young patient was among those wounded in a Russian missile strike on a Ukrainian children’s hospital in Kyiv on July 8, 2024. Two people were killed and at least 16 wounded in the strike on Okhmatdyt Hospital.
[ZelenskyyUa/X]

Attacks on clinics, hospitals and health-care workers in conflict zones numbered more than 3,600 in 2024, a 62 per cent increase in two years, says a new report.

More than a third of the attacks targeted Gaza or the West Bank; hundreds more were recorded in Ukraine, Lebanon, Myanmar and Sudan.

The report “Epidemic of Violence: Violence Against Health Care in Conflict 2024,” by the Safeguarding Health in Conflict Coalition, says the attacks consisted of air, missile and drone strikes; shelling; tank fire; shootings; arson; the looting and takeover of health facilities; and the arrest and detention of health-care workers.

“By far the largest number of attacks on health care—more than 1,300—took place in Gaza and the West Bank, far more than we have ever reported in one conflict in one year, including more than double the number of health workers killed,” wrote coalition chair Len Rubenstein.

“But we must also reckon with the more than 2,300 attacks in other conflicts,” he added.

The report profiled 23 countries and territories where multiple acts of violence against health care took place.

New wars have accounted for thousands of incidents in the past three years alone, including:

• more than 1,500 attacks in Myanmar since a military coup in 2021;
• nearly 2,000 in Ukraine since Russia invaded the country in 2022;
• and more than 500 since the outbreak of war in Sudan in 2023.

“Attacks on health care undermine the ability to care for people when it is needed most, in war.”
—Len Rubenstein, chair of the Safeguarding Health in Conflict Coalition

“On average, in 2024, health care came under attack 10 times a day across the world’s war zones,” said Rubenstein. “Each of these assaults brings terror, trauma, and in too many cases, injury, destruction and death.

“Attacks on health care undermine the ability to care for people when it is needed most, in war.”

The report says the numbers are likely lower than they should be because collecting data on violence is impeded by “insecurity, communications blockages and the reluctance of some entities to share data on violence.

“In many countries,” it says, “the looting of health care facilities, threats to health personnel, and the obstruction of access to health care are so common that they are often not reported on a case by-case basis, especially in West and Central Africa.”

A satellite image shows the Gaza Strip’s biggest and most advanced medical complex, Al-Shifa, after a two-week siege by Israeli commandos in March-April 2024.
[Maxar Technologies]

With the onslaught have come attempts by perpetrators to limit legal protections for health care and civilians in war. The International Committee of the Red Cross has described the measures as efforts to create more “leeway to kill and detain.”

Rubenstein explains that Israel has sought to dilute legal requirements of precaution and proportionality during conflict, while U.S. defense secretary Pete Hegseth has called for “a law of war for winners.”

Meanwhile, several countries, led by the U.S. under President Donald Trump, have launched campaigns to delegitimize the International Criminal Court (ICC).

The Americans, who aren’t members of the ICC, have imposed sanctions on court staff and even their families after it charged Israelis (and Hamas) with war crimes. In 2023, Russia’s Duma criminalized co-operation with the ICC or any foreign court or ad hoc tribunal that seeks to hold Russians to account. Hungary announced plans to withdraw from the ICC, alleging political bias.

Rubenstein says the developments “threaten to make a mockery” of next year’s 10th anniversary of UN Security Council Resolution 2286, in which the 15-member council and more than 80 sponsoring UN member states condemned attacks on medical facilities, demanded an end to impunity for those responsible, and insisted warring parties respect international law.

“There has been a complete erosion in the respect for international humanitarian law and the responsibility to protect health care in conflict.” Christina Wille, Insecurity Insight director

The 50th anniversary of the Additional Protocols of the Geneva Conventions is slated for 2027. These laws are supposed to protect health-care workers and civilians during armed conflict.

“If this resolution and law are to be more than words, the current approach to protection, amounting to mere admonitions, must be replaced by centering accountability, accompanied by the political will to drive it,” Rubenstein writes.

The Safeguarding Health in Conflict Coalition is a group of international non-governmental organizations working to protect health-care workers, services, and infrastructure.

Its report states there were 3,623 recorded incidents in 2024. The toll: 1,111 health-care facilities damaged or destroyed, 927 health-care workers killed, 473 health-care workers arrested, and 140 health-care workers kidnapped.

The vast majority of the incidents—about 81 per cent—were perpetrated by state actors.

More than 55 per cent of health-care workers’ arrests in 2024 were made by the Israel Defense Forces in Gaza, the West Bank and East Jerusalem.

The World Health Organization has said access to health care in Sudan has been severely constrained due to attacks and shortages of medicines, medical supplies, health personnel and cash. It says critical services, including maternal and child health care, have been discontinued.
[Anadolu Agency (AA)]

Military ordnance—explosive weaponry, especially the growing use of drones—account for an increasing proportion of the attacks against health care, said the report, rising from 36 per cent of incidents in 2023 to 48 per cent in 2024.

“Never before has the Safeguarding Health in Conflict Coalition (SHCC) recorded such a high number of reported incidents of violence against or obstruction of health care in conflict as in 2024,” said the report.

The report says the number of health-care facilities damaged or destroyed in 2024 was nearly double the 2023 total.

The increase was driven by large numbers of incidents in Lebanon, Myanmar, the Gaza Strip and West Bank, Sudan, Syria and Ukraine. Children’s hospitals, dental clinics, field hospitals, health clinics, hospitals, medical storage facilities, pharmacies and women’s health centres were targeted.

More than half of Gaza’s hospitals—20 of 36—were rendered non-operational due to direct attacks, damage or lack of supplies in 2024. The remaining hospitals operated at partial capacity, often under siege conditions, says the report.

The number of health-care workers killed worldwide rose 21 per cent since 2023, and they died in 27 countries and territories. Thirty-four worked as local employees of the internationally supported humanitarian system, but the vast majority provided care under a national health ministry or de facto authorities. Eight had come from a foreign country to support health care in conflict-affected areas.

They represented virtually all health-care trades and professions, including ambulance drivers, doctors, dentists, gynecologists, hospital staff, laboratory technicians, medical students, nurses, opticians, paramedics, pharmacists, surgeons, vaccinators and volunteers from local humanitarian relief groups.

They died treating patients in hospitals, travelling to remote areas in need, during intercommunal violence, in their homes, and while caring for the sick or injured. They were killed by aircraft, missile and drone strikes, shelling, during hospital raids, and in shootings.

Others were killed during recovery and rescue efforts or in “double tap” strikes (in which second attacks are triggered once first responders show up), while some were tortured and killed in detention or killed after they were kidnapped.

Conflict is exacting a heavy psychological toll on health-care workers says the report.

And even after the violence subsides, it adds, damage to health-care systems can last years. Recovery is impeded by a lack of investment, workforce shortages and lack of co-ordination in countries with already-weakened health-care systems.

“There has been a complete erosion in the respect for international humanitarian law and the responsibility to protect health care in conflict,” said Insecurity Insight director Christina Wille, who led the report’s data collection.

There were 3,623 recorded incidents in 2024; 1,111 health-care facilities damaged or destroyed, 927 health-care workers killed, 473 health-care workers arrested.
—“Epidemic of Violence: Violence Against Health Care in Conflict 2024” report

“As documentation becomes more systematic, the mounting evidence of attacks on health care demands a decisive response: international humanitarian law that protects health care in conflict must be better enforced. Yet many states continue to disrespect their obligations and the international community observes without acting.”

The report calls on UN member states to “collectively reject efforts to reinterpret international humanitarian law that undermine their purpose of protecting health care in armed conflict” and “end impunity by encouraging investigations, data sharing, prosecutions through the ICC and empowering monitoring bodies.”

It also urges support for declarations and treaties that would better protect civilians in armed conflicts, and a review of military doctrines and protocols to put greater emphasis on safety for the health-care sector.