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Attacks on health care

Doctors Without Borders staff are seen during a surgery after a US airstrike on MSF hospital in Kunduz Afghanistan on October 03 2015

Widespread shock and condemnation followed news of a recent military attack on a hospital in Kunduz, Afghanistan. Use these activities to explore the humanitarian impulse to protect civilians, and others not participating in armed conflict, as well as the moral revulsion to such attacks.

Help young people understand that the protection of humanity in war requires commitment to firm principles and can pose challenging dilemmas. Groups can try out an actual question posed in the training of humanitarian staff and volunteers.


Learning objectives


By the end of this activity young people will be able to:

  • Describe what they understand by the term humanity - particularly in the context of caring for sick and wounded people during an armed conflict.
  • Identify some of the consequences of attacks on health-care staff and facilities during an armed conflict.

An attack on a hospital


Look at the photograph.

Doctors Without Borders staff are seen during a surgery after a US airstrike on MSF hospital in Kunduz Afghanistan on October 03 2015

Read out the caption supplied by the photo agency on 3 October 2015:

"Doctors Without Borders (MSF) staff are seen during a surgery after a US airstrike on MSF hospital in Kunduz, Afghanistan on October 03, 2015. An Afghan health official has said a US air strike early Saturday morning in the northern city of Kunduz has killed 9 people and wounded 37 people, including 19 MSF staff."

Discuss what the group knows of the attack on the hospital in Kunduz.

Later reports said at least 12 Doctors Without Borders/Médecins Sans Frontières (MSF) staff members and ten patients were killed. The US government has apologised. Such attacks have been condemned by humanitarian groups.


Even wars have limits


General John F Campbell, commander of US forces in Afghanistan, told a Senate committee that striking the hospital was a mistake. "We would never intentionally target a protected medical facility," he said.

Discuss what the General means by the word "protected".

There are rules of war which seek to limit the impact of armed conflict. These rules of war are known as international humanitarian law (IHL).

Under international humanitarian law all parties to a conflict must protect medical facilities and health care workers from attack.


Discussion and debate questions


  • Why do young people think it is important that medical facilities and health-care workers are protected during armed conflict?
  • Do young people think that armed conflict should and can have limits?
  • What is, and isn't acceptable during a conflict?

Rules of war


To learn more about the rules of war, watch our video: Rules of war in a nutshell.



Our dedicated rules of war resource can help you explore this subject in more depth with young people.


Humanity during armed conflict


Discuss what young people think humanity is. Which of the following do the group think best describes it:

  • reducing suffering
  • showing kindness and compassion for strangers
  • treating people as you would like them to treat you.

Can young people think of any other descriptions? Why have they chosen one description over the other?

Invite young people to identify elements of humanity in the photograph

  • Who is reducing suffering? Who is showing kindness and compassion?
  • How could their actions be described as humanitarian?
  • Look at the two men not in surgical robes at the top left of the scene. What can young people guess about who they are and what they are thinking?
  • Might the person on the operating table be known to them? [In this case they are operating on one of the MSF doctors who died later.]

Consequences of conflict


The immediate impact of attacks on health workers and facilities can be devastating.

But the damage done often doesn't stop there. Explore some of the consequences with the following matching exercise.

Match up each action with a likely consequence. [Note: a single action may have more than one consequence. Once young people have their sentences matched up, compare and discuss answers.]

  1. Fighting near a hospital
  2. Threats of violence or direct attacks against health-care personnel
  3. Looting of medical facilities
  4. Direct attacks against health care facilities
  5. Checkpoint delays and transport obstruction
  1. can cause hospitals and clinics where medical treatment could be carried out to close.
  2. prevent patients accessing health care and medical supplies being re-stocked.
  3. can cause medical staff to fear for their safety and flee from the conflict, reducing medical services available for those who stay.
  4. creates shortages of medical supplies needed to treat patients and can lower staff and community morale.
  5. delays patients' access to medical treatment.

Suggested answers: 1a, 2c, 3d, 4a, 5b/e.


Spend a few moments after the exercise discussing these consequences.

  • How many people would be affected by them?
  • What are the long-term impacts of attacks on health care professionals and facilities?
  • Who suffers as a result?

Young people could create a ‘consequences web’ to map the impact further.

For example, if fighting near a hospital causes it to close, what impact will the closure have on individuals and the local community?


Care for the wounded


Health workers in conflict zones are trained to make sure they follow the principles of international humanitarian law.

One of the training modules used by the International Committee of the Red Cross invites responses to a situation that occurred during the Iraq war eight years ago:


Three helicopters arrive at a US camp carrying four badly injured Iraqis. Two of the men were seen placing a roadside bomb. Two others were bystanders. A US helicopter had opened fire on those with the bomb. The bystanders were caught in the fire-fight. 


What would you do if you were one of the US medical staff?

  1. All the wounded would be immediately transferred to the military hospital and taken care of.
  2. The two Iraqi bystanders would be immediately transferred to the military hospital, while the other two Iraqis would be taken into custody for questioning.

Invite the group to choose the answer they think is correct.

The correct answer is A.

The wounded should be cared for without adverse distinction and treatment should be given first to those with the highest medical needs.


Loss of protected status


Health workers and facilities risk losing protection if they commit, or are used to commit, acts which are harmful to a party to the conflict.

Any of the following might lose a medical facility or health worker the protection under the law.

  • Storing arms or ammunition in a medical facility
  • Using a medical facility as a military observation post
  • Carrying weapons for non-defensive purposes.
  • Transporting healthy troops, arms or munitions
  • Allowing armed combatants to enter a medical facility other than for medical reasons.

Encourage discussion around some of the challenges there might be to upholding humanitarian principles in practice.

Ask young people:

  • How would you react as an ambulance driver if armed troops asked for a lift?
  • What if a hospital administrator was told that soldiers were intending to set up observation from the hospital roof?

Role-play a discussion between the characters. Reflect and discuss what they’ve learned.


Credits


This resource was written by PJ White of Alt62 and published in October 2015.

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