MSF Blasts U.S., Russia, Syria, and Saudi for Hospital Strikes

After another attack on one of its hospitals, Medecins Sans Frontieres takes to the United Nations to settle scores.

By Colum Lynch, a senior staff writer at Foreign Policy, and John Hudson
The United Nations Security Council votes during a meeting on non-proliferation in North Korea on March 4, 2015 at the United Nations in New York. AFP PHOTO/Don Emmert        (Photo credit should read DON EMMERT/AFP/Getty Images)
The United Nations Security Council votes during a meeting on non-proliferation in North Korea on March 4, 2015 at the United Nations in New York. AFP PHOTO/Don Emmert (Photo credit should read DON EMMERT/AFP/Getty Images)

In a stinging rebuke, the president of French medical relief agency Medecins Sans Frontieres on Tuesday accused several governments, including the United States, Russia, Saudi Arabia, and Syria, of either directly attacking medical workers or participating in coalitions that have done so.

Speaking in a special session of the U.N. Security Council on the protection of health care workers, MSF leader Joanne Liu said four of the council’s five permanent members — Britain, France, Russia, and the United States — “have, to varying degrees, been associated with coalitions responsible for attacks on health structures over the last year.”

Those coalitions, Liu said, were responsible for strikes on medical targets in Afghanistan, Yemen, and Syria. But the attacks on medical workers reach far beyond those countries, endangering health workers in Iraq, South Sudan, and Somalia. The world, Liu warned, is “facing an epidemic of attacks on health facilities, impeding our ability to do our core work.”

“Stop these attacks!” she urged the council’s big powers. “You … must live up to your extraordinary responsibilities and set an example for all states.”

The council’s meeting took place as medical workers have come under renewed attack in Syria, where government aircraft last week bombed a hospital in Aleppo, killing 20 people, including three children and one of the city’s few remaining pediatricians. On Tuesday, rebel rocket fire again struck a hospital and maternity clinic, killing three women, according to the official Syrian Arab News Agency.

It also follows a Pentagon investigation into last year’s U.S. attack on a MSF hospital in Kunduz, Afghanistan.

On Tuesday, the United States offered its “profound condolences” to the French medical relief agency for killing more than 40 doctors, nurses, and patients during the Oct. 3, 2015, attack in Kunduz. Michele Sison, the second-highest ranking U.S. ambassador at the United Nations, said American forces are prohibited from targeting protected medical facilities and “deeply regrets the tragic and mistaken attack.”

But Liu expressed dissatisfaction with the outcome of the Pentagon inquiry, which concluded that U.S. forces committed no war crimes because they were unaware they were striking a hospital. Sixteen U.S. military personnel were disciplined with suspensions, removal of command, or letters of reprimand.

“Perpetrators cannot be investigators, judges, and juries,” Liu told the council. “Accountability begins with independent and impartial fact-finding. And today, our calls for an independent investigations have gone unheeded.”

Violence in Aleppo has peaked in recent days following the collapse of a Feb. 27 cease-fire established by the United States and Russia. U.N. special envoy to Syria Staffan de Mistura met Tuesday with Russian Foreign Minister Sergei Lavrov in Moscow in an effort to revive the cease-fire.

In Washington, Secretary of State John Kerry told reporters that negotiators may be hours away from completing a new cessation of hostilities agreement to help protect Aleppo.

“We are working urgently right now to reaffirm the cessation of hostilities nationwide,” he said.

Without an agreement, humanitarian and monitoring groups have reported a surge of attacks on civilians and medical workers from armed rebels and government air strikes — a pattern MSF wants world powers help curb. Doctors in Iraq have also complained of increasingly hostile work environments that expose them to attacks from militia leaders and even victims’ families.

The Security Council was meeting to adopt a resolution — drafted by Egypt, Japan, New Zealand, Spain, and Uruguay — condemning attacks on the sick and war-wounded, as well as the nurses and doctors who tend to them. The resolution “strongly urges states to conduct in an independent manner full, prompt, impartial, and effective investigations” into such attacks, which amount to war crimes.

The resolution’s main drafters — all non-permanent members of the council — intentionally dissuaded the big powers from leading negotiations on the text because some have been implicated in attacks on medical facilities and feared the discussions could quickly descend into a politically divisive game of tit-for-tat.

The session opened with U.N. Secretary-General Ban Ki-moon and International Committee of the Red Cross President Peter Maurer presenting a grim tally of the scale of violence against the medical community in conflict zones.

In the past three years alone, the Red Cross has documented 2,400 attacks against patients, health personnel, facilities, and ambulances in 11 countries at war.

“That’s more than two attacks per day, every day, for three years,” Maurer told the council. Last year in Afghanistan, he said, attacks against health staff and facilities increased by 50 percent from 2014, according to the ICRC. “That means one incident every three days,” he said.

But he said the attacks on medical workers has a knock-on effect on the health of those who are not in the line of fire, undermining a country’s entire health system. “Today, the reality in too many war-torn countries is that if you don’t die of shelling or fighting, you die because there is no dialysis equipment, no diabetes medicine, no antibiotics, and no heart disease treatment,” Maurer said.

In Syria, more than 730 medical personnel have been killed since the conflict began in 2011, Ban said, citing figures compiled by Physicians for Human Rights. He accused Russian-backed government forces of “systematically” removing medical supplies from humanitarian convoys.

“In Syria and elsewhere, governments impose cumbersome procedures that restrict access to health care,” Ban said. “This is strangulation by red tape.”

In Yemen, more than 600 medical facilities have been closed because they sustained damage during the ongoing war, now in its 13th month, between a Saudi-led coalition that supports President Abd Rabbuh Mansur Hadi and Houthi rebels. The United Nations has confirmed 59 attacks against 34 hospitals. One of them, in January, hit the Shiara Hospital in Yemen’s Saada governorate, which Ban said served about 120,000 people.

“Following the attack, women were reportedly forced to give birth in caves rather than risk traveling to the hospital,” Ban said.

He cited a similar pattern of attacks against medical workers in Iraq and South Sudan. Additionally, he singled out the U.S. bombing of the MSF hospital in Kunduz, noting that the attack “killed dozens, as patients were burned alive in their beds.”

“Such attacks must end,” the U.N. chief said. “When so-called surgical strikes end up hitting surgical wards, something is deeply wrong. Explanations ring hollow to parents burying their children and communities pushed closer to collapse.”

Humanitarian experts differ on the cause of the uptick in attacks on hospitals. But many agree that the longer conflicts in Syria, Yemen, Afghanistan, and Iraq persist, the more likely that gross human rights violations will occur.

“The longer the war, the more bitter it becomes, and the more humanitarian principles and norms are trampled upon,” Jan Egeland, a special advisor to de Mistura and secretary-general of the Norwegian Refugee Council, told Foreign Policy.

In Syria, where a boiling hatred persists between the regime of President Bashar al-Assad and Sunni rebels, Egeland noted a growing “notion that the doctor of my enemy is my enemy.”

Humanitarian organizations have tried to push back against that mentality, arguing that all wounded individuals have a right to safe and secure medical care — regardless of whether they are civilians or enemy combatants.

During Tuesday’s council session, U.N. delegates eulogized Dr. Mohammad Wassim Maaz, a pediatrician who was killed by Syrian government airstrikes against the Aleppo hospital where he worked. “His devotion to treating the war’s youngest victims was unparalleled,” said British U.N. ambassador Matthew Rycroft. “By day he worked in the children’s hospital, at night he responded to emergencies at Al Quds hospital.”

MSF’s Liu, meanwhile, said her ability to assure her own doctors and nurses of their safety in the field has been shaken. She recalled a conversation with a nurse whose left arm was blown off in the U.S. attack on MSF’s hospital in Kunduz. The nurse reminded her that MSF had assured its staff at the trauma center that they would be safe.

“We believed you,” Liu recalled the nurse telling her. “I told him that until Oct. 3, I truly believed that the hospital was a safe place. I cannot say that anymore about any medical facilities on the front lines today.”

Photo credit: Getty Images

Colum Lynch is a senior staff writer at Foreign Policy. Twitter: @columlynch