Vector Volume 11 Issue 1 - 2017

Healthcare in Conflict Zones
[Feature Article]
Michael Wu
Michael Wu graduated with a B.Pharm from the University of Sydney in 2012 with a major
from the Clinical Excellence Commission focusing on IV to Oral Switch Therapy. Since then, my
passions have grown from Infectious Diseases to just about everything. It’s a problem. I’d like to
work all over the world at some stage, whether in Trauma or Ophthalmology.
Introduction
Medical neutrality in war-ravaged areas
is the cornerstone of healthcare provision in
conflict zones. However, weaponisation of
healthcare – the deliberate destruction or
removal of access to healthcare as a means
of hamstringing opponents – has emerged as
a concerning and common practice in modern
military engagements. Medical neutrality was
formalised in 1864 with the inception of the First
Geneva Convention, which sought to establish
a permanent ‘neutral’ agency that would deliver
medical aid and services to sick and wounded
combatants.[1] There was consensus amongst
governments that armed conflict, no matter
how violent, must maintain some semblance
of compassion and humanity. This recognition
was at the core of the message the Geneva
Convention sent; that a line must be drawn
in war and conflict. Recent years have seen
military forces and governments ignore this
sentiment, with clear violations of the Geneva
Convention, from deliberate bombings and
executions of doctors, nurses, pharmacists,
medical students, and pharmacy students
in Syria and Somalia, for example. Indeed, it
would appear that many countries are either
implicated in, or turn a blind eye to, atrocities
resulting from violations of the Geneva
Convention.
Dr Kathleen Thomas has experienced
this degeneration in the standard of warfare
first-hand. Her story has become a landmark
in this field. As an Australian doctor, she was
responsible for an Intensive Care Unit at a
Medecins Sans Frontieres (MSF) hospital in
Kunduz, Afghanistan, when it was bombed by
an American AC130 gunship in October, 2015.
MSF had released the GPS coordinates of their
hospital to American forces in the region days
prior; their location was known. Repeated air
strikes resulted in 42 fatalities, including 12
staff, 24 patients and 4 caretakers, with dozens
more wounded. MSF maintains that the attack
was deliberate and has called for independent
investigations by multiple bodies.[2] One must
question why American forces, or indeed
any government, would condone the attack
of healthcare facilities. Similarly, however,
it is important to realise that from a military
perspective, this weaponisation of healthcare
makes sense: it removes a valuable resource
to guerrilla forces, that of neutral healthcare.
Healthcare and conflict in Syria
Syria is now the most dangerous nation in
the world according to the Global Peace Index.
[3] The Syrian civil war has left much of the
country’s population displaced since beginning
in 2011. As early as March that year, the country
saw its first documented execution of a doctor.
Subsequently, the attrition of healthcare in
Syria has been the result of direct and violent
attacks on health workers, as well as a mass
exodus of health workers fleeing persecution.
These direct attacks are mostly carried out by
pro-government forces, and have manifested
as “attacks on health facilities, executions,
imprisonment or threat of imprisonment,
unlawful disappearance (i.e. kidnapping),
abduction, and torture sometimes leading to
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