Hospitals and healthcare workers are increasingly becoming direct targets in conflicts worldwide, with documented incidents more than doubling since 2021. This alarming trend, fuelled by wars in Ukraine, Gaza, and other regions, saw over 2,500 attacks last year across 33 countries, according to the Safeguarding Health in Conflict Coalition. These figures represent a historic high, challenging the fundamental principles of international law designed to protect medical facilities and personnel during wartime.
The dangers faced by frontline medical staff are starkly illustrated by accounts from Ukraine. Liubov Martynenko, a midwife in Kherson, narrowly escaped death in June when an ambulance she was travelling in was hit by a drone. The vehicle, clearly marked with 'ambulanza' and a red cross – an internationally recognised symbol of protection – was targeted on hospital grounds. Both Martynenko and the driver survived with minor injuries, but she described the incident as a deliberate attack by Russian operators, not an isolated event.
Similar patterns of aggression against healthcare have been observed globally. In Lebanon, a recent offensive has led to 247 incidents affecting healthcare and 148 health workers killed since March, even amidst repeated ceasefire attempts. Three hospitals in southern Lebanon were struck in a single week last month, with medical personnel accounting for the majority of the 150 wounded. This widespread disregard for medical neutrality is also evident in Sudan, Myanmar, the Democratic Republic of Congo, and Afghanistan.
International law, a cornerstone of humanitarian protection established by the first Geneva Convention in 1864 and reaffirmed by the UN Security Council, explicitly grants special protection to hospitals, healthcare workers, and the wounded. However, these protections are being steadily eroded. Experts like Rohini Haar, an emergency doctor and human rights lecturer, suggest that state actors are now routinely employing healthcare attacks as a weapon of war. Major offenders, including Russia and Israel, frequently invoke 'dual-use' claims, alleging that hospitals serve military purposes, yet often provide little public evidence to substantiate these assertions.
Legal experts contend that the 'dual-use' loophole does not legitimise such attacks. International law mandates that any target must be verified as a military objective, that harm must be proportionate, and that advance evacuation warnings must be issued. The increasing frequency of these attacks, particularly by state actors, raises serious concerns about the stability of international humanitarian law. If the most basic humanitarian protections, such as those for hospitals, cannot be upheld, it risks a broader collapse of global legal frameworks and a significant increase in civilian suffering in conflict zones.