On November 18 last year, as fighter jets roared overhead, explosions ripped through the Omar bin Abdul Aziz Hospital in Aleppo Syria.
The airstrikes destroyed the last operating hospital in the eastern part of the city. This wasn't a rare event. Three other hospitals in Aleppo were bombed on that day, too.
These bombings occurred despite the fact that attacking a medical clinic is a war crime under international law.
Leonard Rubenstein. a lawyer who directs a program on human rights, health and conflict at the Bloomberg School of Public Health at Johns Hopkins. says there were a staggering number of assaults on health care facilities in 2016.
"The international community says it wants to stop this and then does nothing to implement its own recommendations," he says. "These attacks go on."
Rubenstein is the editor of a new report called "Impunity Must End" about aggression against health facilities and health workers globally last year. Syria is definitely the most dangerous place to practice medicine "in terms of the intensity and impact of the attacks," according to the report. The authors say at least 108 Syrian hospitals were hit in 2016, "most by Syrian government and Russian forces."
But Rubenstein found that health care facilities were under assault last year in many other parts of the world. The report was not able to compile data on the total number of attacks in each country.
"It's quite remarkable how varied the forms of attack are," Rubenstein says. "For example we found in 10 countries hospitals were bombed or shelled, in 11 countries health workers were killed, in about 20 countries there were various forms of intimidation — abductions, kidnapping of health workers."
In August a suicide bomber killed 74 people and wounded 112 others at a hospital in Quetta, Pakistan.
In Yemen, Saudi airstrikes directly struck clearly marked medical facilities. In South Sudan mortar shells landed in the maternity wing of an International Medical Corps hospital in the capital, Juba.
In Libya clinics were hit by car bombs and improvised explosive devices. In Iraq ISIS seized control of several health care facilities in order to prioritize treatment of their own wounded fighters.
In Ukraine, soldiers blocked ambulances, resulting in at least 3 deaths, according to the report. Polio vaccinators were kidnapped in Afghanistan, Pakistan and Nigeria. Some were even killed.
On May 3, 2016 the U.N. Security Council adopted a strongly worded resolution — Resolution 2286 — denouncing attacks on medical personnel and facilities worldwide.
But this new report says combatants continue to shell, bomb and shoot up hospitals with impunity.
"It must be emphasized that in the months since the passing of resolution 2286, attacks on hospitals dramatically escalated in Syria and continued without respite in other parts of the world," the report states.
Rubenstein points out that one Syrian hospital in Aleppo known as the M10 was bombed four times over the course of two weeks.
"The result is people who were suffering traumatic injuries from the bombings had no place to go. And many, many died because they couldn't get medical care," he says. "Unless we really commit to something and hold the perpetrators accountable, they'll continue."
RACHEL MARTIN, HOST:
There are rules in war - at least they're supposed to be. And one of those rules, according to the Geneva Conventions, is that hospitals should be safe from any kind of attack. It still happens though. A new report documents hundreds of attacks on health care facilities and health care workers in 2016. NPR's Jason Beaubien reports.
JASON BEAUBIEN, BYLINE: By far the most dangerous place to be a doctor last year was Syria. According to the new report called Impunity Must End, more than a hundred hospitals and clinics were attacked in Syria in 2016.
LEONARD RUBENSTEIN: It's the worst case in modern history that we could find on attacks on health care.
BEAUBIEN: Leonard Rubenstein from the Bloomberg School of Public Health at Johns Hopkins is the editor of the report. Some of the most destructive assaults came from airstrikes by Syrian government and Russian fighter jets.
RUBENSTEIN: And if you think about the siege of Aleppo back in the summer of 2016, there was a hospital in Aleppo called M10, which was the largest and most important hospital, which was bombed four times in the course of two weeks.
BEAUBIEN: Not only were people killed in the bombings at the hospital but other people who were injured elsewhere died because they couldn't get medical care, Rubenstein adds. He says due to a lack of documentation of hospital attacks in the past, it's impossible to say definitively whether such incidents are increasing or not. But the authors do call the sheer number of attacks they documented in 2016 staggering.
The report found attacks on health care settings and workers in 23 countries around the world. In August, a suicide bomber killed 74 people and wounded 112 others at a hospital in Pakistan. In Yemen, Saudi airstrikes struck clearly marked medical facilities. In Afghanistan, Pakistan and Nigeria, polio vaccinators were kidnapped. Some of them were even killed. In Iraq, ISIS militants seized control of health care facilities at gunpoint, demand treatment of their own colleagues. The Geneva Conventions state explicitly that in a time of war, hospitals must be respected and protected. But as war has changed, that respect for the sanctity of hospitals has crumbled. A year ago, the U.N. Security Council passed a resolution denouncing attacks on medical facilities, and it drew up a new plan to try to combat them.
RUBENSTEIN: But there's been no action on that plan despite a lot of recommendations from the secretary general. So that makes impunity even worse.
BEAUBIEN: Rubenstein says a big part of the problem is that no one is being held accountable for what clearly could be prosecuted as war crimes.
Jason Beaubien, NPR News.
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