Image courtesy of the Safeguarding Health in Conflict Coalition.

A new report published by the Safeguarding Health in Conflict Coalition (SHCC) documents 1,989 attacks and threats against health care facilities and personnel across 32 countries and territories in armed conflict and situations of political violence throughout 2022. The reported figure represents the most severe year of attacks against health care in the last decade globally. Over half of all attacks were reported in just two countries, Ukraine and Myanmar. The report identifies more than 750 attacks perpetrated by the Russian Federation on health care in Ukraine alone–the most committed in a single year in one country. 

"Health workers have been systematically targeted with violence, killed, arrested, and kidnapped."

“Over the last year, we identified a 45% increase in reported incidents of violence against or obstruction of health care in conflict zones as compared to 2021,” said Christina Wille, director of Insecurity Insight, which led the data collection and analysis for the report. “Health workers have been systematically targeted with violence, killed, arrested, and kidnapped while health facilities have been destroyed with explosive weapons and robbed of essential medicine and equipment.” 

Of these violent incidents, the report identifies: 

• 1,989 total reported incidents of violence against health facilities and health workers
• 704 incidents where health facilities were destroyed or damaged
• 232 health workers killed
• 298 health workers kidnapped
• 294 health workers arrested.

Despite the alarmingly high global rates of reported attacks on health, the number of violent incidents documented in the report is likely an undercount due to difficulties of data collection given insecurity, communication blockages, and fear of retaliation for reporting. 

“Some of these assaults are well-known and frequently reported, especially the bombing and shelling of hospitals and clinics,” said Leonard Rubenstein, chair of the SHCC and professor at the Johns Hopkins Bloomberg School of Public Health, “But less visible acts, like attacks on vaccinators in seven countries, deprive millions of children protection from measles, polio, and other diseases, as vaccination campaigns have to be suspended.” 

"Attacks on vaccinators in seven countries deprive millions of children protection from measles, polio, and other diseases."

Following Russia’s invasion of Ukraine in February 2022, the report documents 782 violent incidents against health throughout the first 10 months of the conflict alone, many attributed to the destruction of the health infrastructure, shooting at ambulances, and deaths of health workers. In Myanmar, at least 271 violent incidents have been reported since the February 2021 coup d’état by Myanmar’s junta, in which health workers were arrested or brutally killed for caring for wounded and bombing of health facilities. 

“The assaults have a devastating impact on the availability of health care to people already suffering from war. As health systems are destroyed, health workers flee, and essential supplies and medication are looted, severing access to health for years after attacks take place,” added Wille. “The far-reaching impacts of attacks on health are as disturbing as their frequency. Health workers were arrested and killed in countries where political instability has endured, including Iran, Myanmar and Sudan."

In protracted conflicts in Afghanistan, the Democratic Republic of the Congo, Nigeria, South Sudan, the occupied Palestinian territory, and Yemen, the report found severely high rates of attacks on health. Across the wider Sahel, the report also reveals how insecurity for health care providers has been growing as the humanitarian space has been shrinking. 

“The suffering patients and health workers endure from these war crimes cannot be undone, but accountability for the attacks can bring them a measure of justice. Global attention to Russia’s atrocities in Ukraine must become an inflection point in prosecuting the perpetrators of these crimes there and everywhere,” added Rubenstein. 

"When one doctor is killed or a hospital bombed, thousands of patients are deprived of health care."

The report makes a series of pointed recommendations to the UN Security Council; the International Criminal Court (ICC); UN Secretary General; legislators of UN member states; the World Health Organization (WHO); and medical, nursing, and public health organizations. Specifically, the Safeguarding Health in Confict Coalition calls on these entities to:

• End impunity through prioritizing prosecutions of war crimes and attacks on health.
• Strengthen prevention against the obstruction of the delivery of health care through reform of law and military doctrine and training and restrictions on arms transfers.
• Reform the World Health Organization’s system for collecting and disseminating data on attacks on health care. 
• Strengthen global, regional, and domestic leadership on the protection of health care across states and UN bodies.
• Support health workers through ministries of health, UN member states, donors, and health organizations.

“When one doctor is killed or a hospital bombed, thousands of patients are deprived of health care,” said Erika Dailey, director of advocacy and policy at Physicians for Human Rights. “The way to protect the right to health is to ensure that these critical civilian resources are fully protected under the law. If these devastating, cascading harms are to be stopped, perpetrators must be held criminally accountable.” 

Information on the Safeguarding Health in Conflict Coalition:

The Safeguarding Health in Conflict Coalition is a group of more than 40 organizations working to protect health workers and services threatened by war or civil unrest. We have raised awareness of global attacks on health and pressed United Nations agencies for greater global action to protect the security of health care. We monitor attacks, strengthen universal norms of respect for the right to health, and demand accountability for perpetrators.

Prepared by Insecurity Insight with support from MapAction and the SHCC, the interactive health map shows incidents of violence and threats against health care, which includes incidents documented in this year’s report. Insecurity Insight collated data from multiple public sources, confidential contributions from aid agencies and professional bodies to inform the map.
To be connected with expert members of SHCC to discuss the report’s findings, please contact Alexa Lamanna Clark at phr@westendstrategy.com or 202-320-2766.
Tim Bishop at tim.bishop@insecurityinsight.org or +44 (0)7428013134 in the UK and Europe.

IntraHealth International is a founding member of the Safeguarding Health in Conflict Coalition and currently serves on the Steering Committee.