I am a doctor, my wife a nurse & midwife, so I have a pretty selfish conflict of interest in sharing this post. I don’t want to be killed during my working life providing care for people who have come for help. In Mackay, that is going to be pretty unlikely. Although, recently a doctor in Nowra faced down a patient with a gun and an Adelaide doctor was bashed during a robbery at home (he later died from his injuries) this is not the usual narrative in Australia.
There are places in the world where a doctor, midwife, nurse or any healthcare profession may well face this narrative on a daily basis.
Although with a bias towards US interest risk, the Centre for Preventive Action hosts a website in which world conflicts are tracked. It aims to “inform the general public about threats to international peace and security by providing a reliable and regularly updated online source of information about ongoing conflicts.”
Today, I counted conflict on every continent bar Australia and Antarctica. For example, there is obviously Gaza and Ukraine which have been in the headlines recently. There has been a rise in conflict in Democratic Republic of Congo as the country went to elections last in 2023. Even though President Tshisekedi was returned there is concern about ongoing violence there. Civil wars affect Syria, Sudan and Yemen, Somalia just to name a few. Another website which lists countries in armed conflict is The Geneva Academy.
In all of those conflicts doctors and nurses are called on to deal with injuries to civilians and in maybe even combatants. Hospitals provide a place to provide that care, open spaces, specialised equipment, medications, an operating room, an emergency department, a place where a team manages the patient. Providing medical, social and humanitarian care and simple things like food, water, blankets, protection from the weather. At the same time hospitals and health care facilities still need to deal with the usual medical care. I see 30 to 40 patients a day- none with bomb fragments or bullet wounds.
And because care may be provided to an opponent (real or perceived), doctors and nurses become a target. Or even if this world of “precision” targeting become collateral damage. Perversely, the destruction of hospital may be factored into some calculus of proportionality. Although difficult to predict the fragmentation pattern and range of a 2,000lb Mk 84 bomb is generally said that this weapon has a ‘lethal radius’ of up to 360m. The blast waves of such a weapon can create a very great concussive effect; affects humans up to 800 metres from the point of impact. Yet these weapons are used multiple times in civilian-dense regions like Gaza. Remember 2 million people live in Gaza; 41 km long up to 12 km wide. I can ride my push bike 41 km in under 2 hours. At ground level you can see almost 5 km.
During the Syrian Civil war, which I read is finally winding down, Amnesty International alleges that hospitals were targeted intentionally by both the Syrian government forces and their Russians supporters. In 2016, Amnesty International noted “The latest string of attacks on health facilities north of Aleppo appears to be part of a pattern of attacks on medics and hospitals, a strategy that has destroyed scores of medical facilities and killed hundreds of doctors and nurses since the start of the conflict.”
In 2015, during the last Afghan war, the US intentionally destroyed a Medicine San Frontier hospital in Kunduz killing 42 people. The US claimed the hospital was occupied by militia, the MSF say it was treating wounded militia along with civilians.
The International Health Law implications of attacking medical facilities are discussed in this paper.
In Yeman, hospitals have been destroyed by the US backed Saudi coalition. August 2016, a hospital supported by Medicine San Frontier was bombed Saudi airstrike in the northern town of Abs, Yemen. By placing themselves in conflict zones, MSF does seem to be dealing with damaged health infrastructure more than others.
During the Rwanda Genocide hospitals and churches did not save victims of violence’s. In fact some would say that in the mistaken belief sanctuary, such institutions made it easy for the orgy of death to continue. For doctors in these hospital a stethoscope draped around a neck was not a free pass to life.
As reported in the BMJ, human right group allege in Destruction and Devastation: One Year of Russia’s Assault on Ukraine’s Health Care System, that there were an average of two attacks every day between 24 February and 31 December 2022. These included hospitals being bombed, medics being tortured, and ambulances being shot at. Russian troops occupied a hospital knowing that under Rule 35, the Ukrainians would not return fire. In this case the hospital is a often a big, expansive sturdy building with many things soldiers need to prosecute a war.
Destroying hospitals is a war crime pure and simple. It is a crime to use a hospital for military purposes, something that Hamas amongst other have been alleged to do. But that does not morally justify another aggressor targeting the hospital. They make that choice to drop that 2000 pound bomb knowing full well the consequences.
Some of the examples mentioned about discuss targeting the infrastructure in which we work. Unfortunately in recent conflicts individuals have also been targeted. For example Dr Tetsu Nakamura from Japan. After qualifying as a doctor he moved to Pakistan in 1984 to treat patients with leprosy, then crossed into Afghanistan, where he opened his first clinic in a remote village in Nangarhar and established a NGO, Peace Japan Medical Services. Honorary Afghan citizenship was his reward for dedication to humanitarian projects. He was killed along with five others during an ambush on the outskirts of Jalalabad in December 2019 at the age of 73. Dr Egil Tynaes, a Norwegian doctor died also in Afghanistan in an ambush in June 2004. There are many more dedicated individuals whose stories can be found by searching Google, and many more whose death goes unnoticed outside of their community.
Killing doctors and nurses means that from that day that highly trained individual no longer is there to help keep their community healthy. I not putting myself on some sort of pedestal here as health also means access to fresh food, water, sanitation protection from the elements. But in the indiscriminate bombing we have seen in Gaza those things have also been taken away.
This confronting article published today by Aljazeera details better than I the impact the Israeli war on Gaza is having on health care. Would I choose to be a doctor there?
https://www.aljazeera.com/features/longform/2024/1/23/how-doctors-in-gaza-persevere-amid-israel-attacks
Mark Raines 