Policy Tag: Attacks

Adopted by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

PREAMBLE

 The WMA is deeply concerned at the increasing rate of violence against health professionals and facilities in Nepal. The Nepal Medical Association, a WMA member, documented at least seven incidents of misbehaviors and physical assault on medical personnel in the last 15 days, as well as vandalism in health institutions.

 

RECOMMENDATIONS

1. Recalling its policies on Workplace Violence in the Health Sector and on the Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence, the WMA and its members condemn in the strongest terms any form of violence against health personnel and facilities, and express its solidarity with its Nepalese colleagues.

2. The WMA and its members urge the Nepalese authorities to commit to preventing and ending violence against health personnel through the implementation of robust and coordinated policies, in particular:

  • immediate security measures to guarantee a safe environment for health personnel and facilities in the country;
  • an appropriate funding dedicated to the protection of health personnel and facilities;
  • adequate accountability mechanism, with rapid responses from the authorities against perpetrators of attacks on health personnel.

 

Adopted by the 66th General Assembly, Moscow, Russia, October 2015
and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024

After the events of October 3 in Kunduz (Afghanistan), the WMA:

  • Extends its deepest condolences to families, colleagues and friends of doctors, healthcare workers and patients killed in the bombing
  • Deeply regrets and condemns the bombing of the Hospital of MSF , considering it a violation of human rights.
  • Reaffirms its positional statements on “Healthcare in Danger” and calls on all countries to respect healthcare personnel in conflict situations
  • Demands an immediate enquiry into the attack by an independent body and the assumption of responsibilities.

Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013
And reaffirmed with minor revisions by the 215th Council session (online), Cordoba, Spain, October 2020

PREAMBLE

During wars and armed conflicts, hospitals and other medical facilities have often been attacked and misused and patients and medical personnel have been killed or wounded. Such attacks are a violation of the Geneva Conventions (1949), Additional Protocols to the Geneva Conventions (1977) and WMA policies, in particular, the WMA Statement on the Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence (Montevideo 2011) as well as WMA Regulations in Times of Armed Conflicts and Other Situations of Violence (Bangkok 2012).

The World Medical Association (WMA) has been active in condemning documented attacks on medical personnel and facilities in armed conflicts, including civil wars. The Geneva Conventions and their Additional Protocols are designed to protect medical personnel, medical facilities and their patients in international and non-international armed conflicts. The parties on both sides of the conflict have legal and moral duties not to interfere with medical care for wounded or sick combatants and civilians, and to not attack, threaten or impede medical functions. Physicians and other health care personnel must act as and be considered neutral and must not be prevented from fulfilling their duties.

RECOMMENDATIONS

  1. The WMA recalls the United Nations Security Council Resolution 2286 adopted in 2016 condemning attacks and threats against medical personnel and facilities in conflict situations and demanding an end to impunity for those responsible.
  2. The WMA calls upon all parties in the Syrian conflict to ensure the safety of healthcare personnel and their patients, as well as medical facilities and medical transport, and to respect the ethical obligation of health personnel to treat all patients, irrespective of who they are in line with the Ethical Principles of Health Care in Times of Armed Conflict and other Emergencies endorsed by civilian and military health-care organizations in 2015.
  3. The WMA calls upon its members to approach local governments in order to facilitate international cooperation in the United Nations, the European Union or other international body with the aim of ensuring the safe provision of health care to the Syrian people.

 

Adopted by the 191st WMA Council Session, Prague, April 2012

The WMA recognises that attacks on health care facilities, health care workers and patients are an increasingly common problem and the WMA Council denounces all such attacks in any country.

These often occur during armed conflict and also in other situations of violence, including protests against the state.  Patients, including those injured during protests, often come from the poorest and most marginalised parts of the community and suffer a higher proportion of serious health problems than those from wealthier backgrounds.

Governments have an obligation to ensure that health care facilities and those working in them can operate in safety and without interference either from state or non-state actors, and to protect those receiving care.

Where services are not available to patients due to government action or inaction, the government, not the health practitioners, should be held responsible.

Noting that recent and ongoing conflicts in Bahrain and Syria have seen physicians, other health care personnel and their patients attacked while in health care facilities, the WMA demands:

That states fulfill their obligations to all their citizens and residents, including political protestors, patients and health care workers, and protect health care facilities and their occupants from interference, intimidation or attack.
That governments enter into meaningful negotiations wherever such attacks are possible, likely or already occurring to stop the attacks and protect the institutions and their occupants, and
That governments consider how they can contribute positively to the work of the International Committee of the Red Cross on promoting the safety of health care provision through awareness of the concepts within their project Health Care in Danger.

Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
and revised by the 73rd WMA General Assembly, Berlin, Germany, October 2022

PREAMBLE

The right to health and medical assistance is a basic human right that should be guaranteed at all times; ethical principles of healthcare remain the same in times of emergencies and in times of peace. Healthcare personnel must be duly protected.

Various international agreements, including the Geneva Conventions (1949), Additional Protocols to the Geneva Conventions (1977, 2005) and the Basic Principles on the Use of Force and Firearms by Law Enforcement Officials of the United Nations, must guarantee safe access to medical assistance as well as the protection of healthcare personnel.

The United Nations Security Council Resolution 2286 (2016) condemns attacks and threats against health care personnel, demands an end to impunity for those responsible, and that all parties to armed conflict comply fully with their obligations under international law.

Despite recognized international standards and the mobilization of humanitarian and human rights stakeholders over the last years denouncing the surge of violence against healthcare worldwide, the WMA notes with great concerns persistent attacks and misuses of hospitals and other medical facilities, as well as threats, killings and other violence against patients and healthcare personnel in emergency contexts.

The WMA condemns in the strongest terms this scourge of violence against healthcare personnel and facilities, which has disastrous humanitarian implications with critical impacts on the capacity of the health system to provide the care needed, resulting in unjustifiable suffering and death. Violence against healthcare personnel constitutes an international emergency, requiring urgent actions.

Recalling its Statement on Armed Conflicts, the WMA reaffirms that armed conflicts should always be a last resort and that States and other authorities who enter into armed conflict must accept responsibility for the consequences of their actions.

The safety and personal security of physicians and other healthcare personnel are essential in enabling them to provide care and save lives in situations of conflicts. They must always be respected as neutral and should never be prevented from fulfilling their duties. Healthcare personnel and facilities should never be instrumentalised as means of war.

Recalling its Regulations in Times of Armed Conflict and Other Situations of Violence, the WMA reaffirms that the primary obligation of physicians and other healthcare personnel is always to their patients; they have the same ethical responsibilities in situation of violence or armed conflicts as in peacetime, the same duty of preserving health and saving lives; they shall at all times act in accordance with the ethical principles of the profession, relevant international and national law, and their conscience.

 

RECOMMENDATIONS

The WMA calls upon all parties involved in situations of violence to:

1.Fully comply with their obligations under international law, including human rights law and international humanitarian law, in particular with their obligations under the Geneva Conventions of 1949 and the obligations applicable to them under the Additional Protocols of 1977 and 2005;

2. Ensure the safety, independence and personal security of healthcare personnel at all times, including during armed conflicts and other situations of violence, in accordance with the Geneva Conventions and their additional protocols;

3. Respect and promote the principles of international humanitarian and human rights law which safeguard medical neutrality in situations of conflict;

4. Protect medical facilities, medical transport and the people being treated in them, provide the safest possible working environment for healthcare personnel, and protect them from threats, interference and attack;

5. Never misuse hospitals and other health facilities for military purposes and dedicate them exclusively to health care;

6. Enable healthcare personnel to treat injured and sick patients, regardless of their role in a conflict, and to carry out their medical duties freely, independently and in accordance with the principles of their profession without fear of punishment or intimidation;

7. Ensure that safe access to adequate medical facilities for the injured and others in need of medical aid is not unduly impeded;

8. Ensure that the equipment, including personal protection equipment, necessary for the safety of healthcare workers, is available to them as needed, and that the staffing is adequate;

9. Support and strictly respect the ethical rules of the medical profession as defined, among other documents, in the Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies and in the WMA Regulations in Times of Armed Conflict and Other Situations of Violence, and to never require from physicians or force them to breach or renounce these rules, in particular:

  • privileges and facilities afforded to physicians and other health care professionals in times of armed conflict and other situations of violence must never be used for purposes other than health care;
  • physicians must at all times show appropriate respect for medical confidentiality;
  • physicians must never accept acts of torture or any other form of cruel, inhuman or degrading treatment under any circumstances; they must never be present at nor take part in such acts;
  • physicians have a duty to recognize and support vulnerable populations, including women, children, refugees, the disabled and displaced persons;
  • physicians and WMA constituent members should alert governments and non-state actors of the human consequences of warfare;
  • where conflict appears to be imminent and inevitable, physicians should ensure that authorities are planning for the protection of the public health infrastructure and for any necessary repair in the immediate post-conflict period.

The WMA calls upon governments to:

10. Establish efficient, secure and unbiased reporting mechanisms with sufficient resources to collect and disseminate data regarding assaults on physicians, other healthcare personnel and medical facilities;

11. Provide to the WHO the necessary support to fulfil its leadership role in documenting attacks on healthcare personnel and facilities[1];

12. Foster the mechanisms of investigating and bringing to justice those responsible for reported violations of the international agreements pertaining to the protection of healthcare personnel in armed conflicts and other situations of violence, and of enforcing the sanctions when such have been decided;

13. Develop and implement more efficient legal protection for medical and other healthcare personnel, so that whoever attacks a nurse, physician or another healthcare personnel knows that such actions will be severely penalised.

The WMA calls upon governments, its member organisations and the appropriate international bodies to:

14. Raise awareness of international norms on the protection of healthcare personnel and cooperate with different actors to identify strategies to tackle threats to healthcare and strengthen the mechanism of investigating the reported violations;

15. Raise awareness at both national and local level of the fundamental importance of protecting the healthcare personnel and of upholding their neutrality in times of conflict;

16. Support the development of pregraduate, postgraduate and continuous education for the healthcare personnel to ensure their competencies and their security and to minimize the psychological toll when confronted with armed conflicts and other situations of violence.

 

[1] The WMA recognizes that in some circumstances, documenting and denouncing acts of torture or other violence may put the physician, and those close to him or her, at great risk. Doing so may have excessive personal consequences. Physicians must avoid putting individuals in danger while assessing, documenting or reporting signs of torture and cruel, inhuman and degrading treatment and punishments.