Following the bombing of an MSF hospital, PourquoiDocteur revisits the principles that protect medical structures during a conflict.
At least 22 people were killed in the bombing of the hospital in Doctors Without Borders in Kunduz, on the night of October 3 to 4. After more than a decade of conflict in Afghanistan, the Taliban seized this city in the northeast of the country at the end of September. If the forces of the Afghan and American army quickly regained the upper hand, the destruction of the hospital severely damaged their image.
Despite the scale of the tragedy, attacks on medical facilities, patients or doctors are not new in war zones, despite the legal protections they enjoy. But in the case of Kunduz hospital, the attack should not be without consequences.
Four investigations were launched in parallel, in particular by the United States and by NATO. MSF has called for an international investigation, asking the international community to seize the International Humanitarian Fact-Finding Commission, established in 1991.
Possible “war crime”
Professor Eric David, who is a member of this commission, believes that a violation of international law has clearly been committed by the US military. Since the first Geneva Convention of 1864, the status of health establishments has been framed and protected by the principles of international law.
Four other conventions signed in 1949 complete the picture, granting each time more rights to civilians and medical structures. the International Committee of the Red Cross also published in 2005 a list of customary humanitarian law rules, in particular that which consists in notifying a hospital in the event of an attack.
In complete opposition to these principles, the bombing of Kunduz could even qualify as a “war crime”, if the army is ultimately found guilty of criminal intent.
Eric David, professor of international law and member of the international humanitarian fact-finding commission: “The real problem that arises in the case of the MSF hospital is whether it is a violation of international humanitarian law or, more than that, a war crime …”
The consequences could then be very heavy for the United States. Those responsible for the bombing will already have to pay civil reparations to MSF for the damage suffered, but they could also be held criminally responsible.
1222 violence against hospitals
Beyond the politico-legal conflict, the MSF case underlines that efforts must be continued in order to better protect civilians and health facilities.
The bombing of Kunduz is indeed not an isolated case. A report of the International Committee of the Red Cross (ICRC) even reveals that between 2012 and 2014, 1,222 incidents of violence against hospitals or medical structures were reported, in 11 of the countries in which the organization operates. 700 ambulances and nearly 600 doctors and nurses were also reportedly attacked.
ICRC infographic on victims of violence
Collected by doctors and volunteers in the field, this data warns of the extent of the risks incurred even in particularly protected buildings. Among the 1222 events reported, 403 correspond to bombings or the burning of these structures. More worryingly, perhaps, responsibility for the attacks has been blamed on state forces, the police or the army, in almost 839 of the cases.
The report also notes that these attacks more often affect local health centers. Incidents involving hospitals run by international organizations, such as that of MSF, are rarer, especially as the NGO is used to dialoguing with all the belligerents, to ensure that its missions are respected.
For Mathilde Berthelot, MSF program manager in Afghanistan, international medical staff are therefore less subject to pressure from the various parties to the conflict.
Mathilde Berthelot, responsible for MSF programs in Afghanistan: “When we actually look at the number of attacks, the local staff affected is much more important (…) In rural areas, they will be more exposed to pressure from their community, from the Taliban …”
Necessary support
This feeling of insecurity, within buildings that are supposed to be protected, has serious consequences. It can lead to a dramatic drop in their workforce, in regions which are already sorely understaffed. In addition, for fear of suffering an attack, patients and injured are less likely to go to these structures, while they sometimes need vital care. Finally, damage to buildings, drug stocks and equipment exacerbates failures in the health system.
“The incident in Kunduz forced MSF and ICRC staff to evacuate from the city. As a result, the catastrophic state of health services for Afghans stuck in this conflict will only worsen. In the past, other attacks on clinics and health centers in the region have reduced the ability of local staff and aid workers to help Afghans. In the long term, this will be disastrous, ”emphasizes Olivier. Moeckli, on mission in Kabul for the ICRC.
It is for this reason that the support and training of doctors who go to war zones is essential. Both MSF and the ICRC plan programs for their staff to explain the context and specific risks of the country they are going to, before and after their arrival.
.
