Bioethics Forum Essay

Health Workers as Pawns of Warfare

Last week, NPR reported a major humanitarian group’s decision to stop treating patients from detention centers in Misrata, Libya. According tothe report,“torture was so rampant that some detainees were brought for care only to make them fit for further interrogation.”

While it must have been heart-wrenching to walk away from the detention centers, knowing some detainees would die without care. There was really no other option. These health workers were being used as pawns of warfare.

In a press release last week,Doctors Without Borders/Médecins Sans Frontières (MSF)stated that MSF workers had treated at least 115 people with torture-related injuries and reported these cases to relevant local and national authorities, but, in case anyone doubted the human capacity for violence or cruelty, their pleas to stop the abuses went unaddressed. Instead, they received four more patients with torture-related injuries.Christopher Stokes, general director of the Brussels branch of MSF called the situation an obstruction and exploitation of the organization’s work.

Using torture in detention centers is a direct violation of theGeneva Conventions. Enlisting health professionals to inadvertently aid or abet these crimes puts them in violation of the most basic tenet of medical practice and ethics: do no harm. More specifically, there are strict, internationally recognized prohibitions against medical professionals participating in torture — covenants and declarations predicated on the desire to prevent the atrocities of World War II from being repeated.

The health professionals working with MSF are among the world’s most committed and courageous — people who work in conflict zones offering nondiscriminatory care to the wounded. The attempts to manipulate these health professionals into unwittingly contributing to ongoing torture are deplorable and criminal.

And what’s worse is that despite the numerous international conventions aimed at protecting health workers in these conflict zones, increasingly they are finding themselves and their clinics under attack — pawnsand targetsof warfare.

Last year, the International Committee for the Red Cross released two reports that highlight this reality as ”one of the most crucial yet overlooked humanitarian issues of today: violence against health care.”


These publications document the death or injury of more than 1,800 people in over 600 cases of violent attacks on health professionals, clinics, patients, or the patients’ families across 16 countries in fewer than three years. These are disturbing but clearly not comprehensive numbers. Headlines documenting this problem are appearing everywhere. For example:


Many groups are calling for immediate action to protect health professional and health facilities. One group of international nongovernmental organizations, including IntraHealth International, is advocating for better documentation of these attacks on health professionals and health facilities as a first step toward stopping these violations.

Last month, the World Health Organization’s (WHO’s) executive board moved to  protect the livesof health workers and patients in conflict zones by passing a resolution that calls on the WHO director general for leadership in documenting these attacks. The resolution shows some concrete progress in an ongoing advocacy campaign that included a consortium of organizationsurgingthe WHO to act in response to assaults on health workers and facilities last year.

The Center for Strategic and International Studies released a new report,Protection of Health Care in Armed and Civil ConflictbyLeonard S. Rubensteincalling for “the mere handwringing that has largely greeted attack on the health care in the past” to “be replaced by concerted international action and a system on documentation, protection, and accountability.” The international community owes at least this much to these health workers, who give so much and put themselves at risk to care for others.

Susanna Smith is the editorial manager at IntraHealth International ( She writes on global health, international development, and medical ethics. An earlier version of this commentary appeared on theGlobal Health blog. Follow her on Twitter@susannajsmith.

Posted by Susan Gilbert at 02/03/2012 02:01:54 PM |

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