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Hospitals are meant to be our safest places, even in war zones

02 Jun 2016

When I read about the recent attack on a Medecins Sans Frontieres-supported hospital in Aleppo, Syria, that resulted in 14 people being killed, including the city's last remaining paediatrician, my heart sank.

It immediately conjured up visions of the horror that had enveloped me in Medecins Sans Frontieres' Kunduz Trauma Centre eight months earlier; being ripped from sleep by the eardrum-rupturing first explosion; my thudding heart, my shaking hands, dry retching while helplessly staring into the terrified eyes of my friend who was bleeding to death in front of me. It reminded me of my overwhelming grief as another and another and another of my friends, colleagues, patients were confirmed dead, while I tried to focus on saving the lives of countless others brutally injured - limbs ripped off, shrapnel rocketed through their bodies, pressure injuries to the eyes, ears, lungs.

I had seen them just two hours earlier and my reassurances to them that the hospital was the safest place was replaced with the horror of knowing that my intensive care patients, incapacitated, were burning to death in their beds.

On October 3 last year, a US military AC130 gunship bombed our hospital, killing 42 people, including 14 of our own staff. I was inside.

The bombing of our hospital in Kunduz was a high-profile international case that helped to build public awareness about the alarming trend of attacks on medical facilities in conflict zones and the apparent growing disregard for International Humanitarian Law (IHL). In 2015 alone, 75 Medecins Sans Frontieres hospitals were attacked around the world. And these were just the Medecins Sans Frontieres and Medecins Sans Frontieres-supported hospitals – only the tip of the iceberg.

Four of the five permanent members of the UN Security Council have, to varying degrees, been associated with coalitions responsible for attacks on health structures over the past year. These include the NATO-led coalition in Afghanistan, the Saudi-led coalition in Yemen, the Russia-backed Syrian-led coalition. I have no doubt that the international community has allowed these attacks to happen by standing by with their mouths closed and backs turned.

On May 3 the UN Security Council passed Resolution 2286 reaffirming the protection of medical personnel in conflicts, and demanded that states and armed groups comply with IHL. "When so-called surgical strikes are hitting surgical wards, something is deeply wrong," UN Secretary-General Ban Ki-moon said. The resolution is a small but important step forward. However, it is not enough to simply pay lip service to this issue. Resolution 2286 needs to be enforced.

"By not advocating for the protection of patients, and care givers in war zones Australia tacitly accepts a world where war – especially war against "terrorist" groups has no rules."

While there are already several institutions in place to investigate and punish those who break international humanitarian law, without a robust system of enforcement, this resolution is doomed to be ineffective. The US military's attack on the Kunduz hospital demonstrates the problems with enforcing such a resolution. Although the International Humanitarian Fact-Finding Commission – which is mandated under the Geneva Conventions to investigate potential violations of international humanitarian law – was ready to carry out an independent investigation into the attack, the US and Afghan governments refused to consent. Instead, we were left with only a heavily redacted US military investigation. The US said the attack did not amount to a war crime. But how could we ever possibly know the facts, when there is so little transparency? If the US refuses to even allow for an independent investigation what sort of example are they setting for the rest of the world?

The only way the resolution can be successful is for all the UN member states to speak out and demand that the rules of war protecting medical personnel and facilities are actually applied and insist that when the rules are broken, the perpetrators accept the systems of reporting, investigation and accountability. Australia must play a proactive part in all of this. After the Kunduz attack, in a letter to my father, Malcolm Turnbull wrote: "I agree with Kathleen that there must be accountability for violations of international humanitarian law. Australia is and will continue to be, a strong advocate for these rules." In another letter Julie Bishop wrote: "The government supports a thorough, effective and transparent investigation into this incident." Despite these statements of commitment, the Australian government never made any public condemnation of the attack and did not push the US to accept an independent investigation.

"I know I can never forget the nightmarish horror of being bombed while working inside a hospital and feel an obligation to help prevent such an atrocity in the future."

Australia can and must do better than this. We must push our allies to comply with the resolution. We should also work with New Zealand, which is currently uniquely positioned to play a leadership role because of their seat on the Security Council, to further our commitment. If we don't stand strong on this, then who will? By not advocating for the protection of patients, and care givers in war zones Australia tacitly accepts a world where war – especially war against "terrorist" groups has no rules. I know I can never forget the nightmarish horror of being bombed while working inside a hospital and feel an obligation to help prevent such an atrocity in the future. But I sincerely hope that as Australians, who live in the luxury of peace, we can see that it is part of our global responsibly to help protect the lives of patients and their brave medical staff, who have the misfortune of being caught up in a war zone.

 

 

Originally published in the Sydney Morning Herald on May 31 2016

Watch Foreign Correspondent's episode, Surgical Strike, for more about the attack