Breaking the Silence: Advocacy and Accountability for Attacks on Hospitals in Armed Conflict

Key Takeaways

• There is a critical lack of accountability and investigation for attacks on hospitals in armed conflicts, despite robust legal protections under international humanitarian law. It highlights that as of 2019, there were over 1,203 documented incidents of violence against medical facilities and personnel across twenty countries, with many cases not being systematically documented or prosecuted.
• Four case studies—Vietnam, Bosnia and Herzegovina, Palestine, and Afghanistan—illustrate how inadequate investigations and prosecutions have contributed to this ongoing issue. These cases show varying degrees of investigation and response, often influenced by international pressure, yet consistently fall short of achieving full accountability for attacks on medical facilities.
• The discussion explores the challenges of enforcing legal protections due to the complexities of modern armed conflicts, where medical facilities are often located near military targets, making them more vulnerable to attacks. This complexity often leads to justifications for attacks based on claims of hospital misuse or operational necessity.
• The article calls for stronger independent, robust, and transparent investigations into violations of international humanitarian law, coupled with greater civil society engagement and advocacy. It suggests that current legal mechanisms need strengthening, including the need for States and international bodies to actively pursue criminal prosecutions for those responsible for targeting hospitals in conflicts.
• Legal frameworks need adaptation to modern warfare realities, where conflicts often occur in urban settings, increasing risks to healthcare facilities. The paper calls for a reevaluation of the intentionality standards required to prosecute war crimes, advocating for a focus on recklessness as a potential criterion.
• Civil society’s role is crucial in driving awareness, advocacy, and accountability for attacks on healthcare facilities. Public campaigns and independent investigations serve as critical avenues to ensure that violations do not go unnoticed, often pushing international bodies and States towards action.
• Despite existing protections, the lack of enforcement and systematic investigation frameworks in place undercuts the efficacy of international humanitarian law, warranting more robust international legal and advocacy efforts to protect healthcare in conflict settings.