US leadership needed to stop atrocities against doctors and patients abroad

Photo of People Pulling a Man Out From an Airstrike Site in Syria
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Earlier this month, eight airstrikes on hospitals in Syria, likely launched by the regime of Bashar Assad, killed more than 20 people. It was the latest of more than 350 attacks on hospitals in Syria since the war began, as reported by Physicians for Human Rights, most of them by the regime and its ally, Russia. The targets this time included a pediatric center supported by the United Nations. The vulnerability of hospitals has become so intense and the results of attacks so lethal that our colleagues there have told us that people in need of healthcare often refuse to go to hospitals.

The latest assaults on Syrian hospitals came just weeks after the U.N. Security Council's first-ever resolution designed to stop such assaults wherever they happen. The resolution demands that governments and armed groups adhere to longstanding norms in international human rights and humanitarian law against interference with healthcare in conflict. It calls on governments to develop effective measures to prevent attacks, reform their laws to prohibit punishing those who provide healthcare to their enemies, and train their militaries to respect and protect medical facilities. And it stresses the centrality of accountability for perpetrators.

The resolution comes against the background of widespread disrespect for norms against attacking health facilities. Last month, the Safeguarding Health in Conflict Coalition released a sobering report on attacks on healthcare in 19 countries in 2015 and early 2016. In four countries — Afghanistan, Iraq, Libya and Yemen — hospitals were subjected to aerial bombing. In four countries — Afghanistan, Nigeria, Pakistan and Somalia — polio vaccinators and their guards were abducted, killed or both. Brutal and sometimes lethal attacks on medical staff and patients inside hospitals were committed in more than a half-dozen countries. Health systems in Yemen, South Sudan, Syria and elsewhere have been decimated.

The Security Council resolution was one of a number of steps the Obama administration has supported to end violence inflicted on doctors, nurses and patients. At the recent World Humanitarian Summit, the administration joined the condemnations against attacks on hospitals and health workers and successfully lobbied for expanded World Health Organization actions to prevent attacks and monitor those that do occur. But the real question is whether political will exists to stop the worst atrocities when these steps are insufficient.

The evidence so far is not encouraging. The U.S. and its allies responded to the latest hospital bombing with the usual condemnations, along with tepid calls for Russia, which has bombed hospitals in Syria before and after passage of the Security Council resolution, to restrain its ally. Not surprisingly, these words had no effect. Shortly thereafter, 51 current U.S. diplomats protested the Obama administration's passivity in the face of atrocities in Syria. They pointed to the human costs of refusing to intervene — civilians dead or unable to get basic medical, food, water or shelter — as well as the price the world and the Syrian people pay as prospects for a political settlement become ever dimmer. The diplomats' letter called for, among other policies, the establishment of no-fly zones in Syria to provide protection to civilians, hospitals and schools. Secretary of State John Kerry met members of the group, but U.S. policy remains unchanged.

Elsewhere, too, the administration's record of taking action needed to stop carnage against healthcare is equivocal at best. At home, the Pentagon conducted a lengthy investigation of a bombing attack on a Doctors Without Borders hospital in Kunduz, Afghanistan, that led to the deaths of 43 civilians and medical personnel. It found gross negligence by U.S. military personnel but declined to press criminal charges against commanders and soldiers responsible for the deaths.

Meanwhile, the administration dithered over systematic atrocities against patients and health workers in Yemen. For more than a year, Saudi Arabia bombed urban areas there with U.S.-supplied weapons, destroying and damaging dozens of health facilities and killing many, including children. But it wasn't until last month, after pressure from human rights organizations, that the White House suspended the sales of cluster munitions to Saudi Arabia, which the kingdom had used previously in bombings of hospitals in Yemen.

The good work of building institutions and mechanisms to prevent attacks on healthcare is undermined by refusing to take strong action when needed to protect doctors, nurses and patients in Syria and other parts of the world from bombing, torture and execution. The cost to U.S. leadership on human rights is enormous; the cost in lives lost is even higher.

Rubenstein is the director of the Program on Human Rights, Health and Conflict at the Center for Public Health and Human Rights at the Bloomberg School of Public Health at Johns Hopkins University. Sahloul is a critical care specialist in Chicago and former president of the Syrian American Medical Society. He is also a member of the advisory committee of the Center for Public Health and Human Rights.

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