Health workers should not be a casualty of war — they need protections, now 

The world watched as Israeli forces last week attacked Al-Shifa Hospital, the largest health facility in Gaza, where at least 90 people have been killed. Two days before, first responders, including a paramedic, were targeted and killed in Odessa as they were responding to a Russian missile attack on civilian homes.  

In conflicts around the globe, health systems face ongoing threats. 

 In 2023, there were nearly 2,000 attacks on health facilities and health workers, a record since the Safeguarding Health in Conflict Coalition began its reporting a decade ago. So far this year, hundreds of health workers have already died. This trend will only continue until countries like the U.S demand that health workers everywhere are protected.  

During war, health workers are the backbone of any remaining health system. In Gaza, doctors and nurses have worked nonstop — and unpaid— for six months with the constant backdrop of airstrikes. They have had to care for their own family members who have been killed or had limbs amputated. Project HOPE’s medical staff working in Al Aqsa Hospital in Deir al Balah reported that dozens of health workers all slept in one small room, eating only canned food.  

Outside of hospitals, health professionals utilize mobile medical units or pop-up medical tents to provide displaced and isolated communities with essential services, including prenatal care, routine immunizations for children, and treatment for noncommunicable diseases. Without health workers, the death toll in every conflict would certainly be exponentially higher.    

Yet, despite their heroism, they live and work in fear and insecurity every day.    

Since violence erupted in Gaza six months ago, there have been more than 300 attacks on hospitals, primary care facilities, ambulances, and health workers. Sadly, this is hardly unique. We have seen this happen repeatedly in recent and ongoing conflicts.  

In Ukraine, Russia has launched more than 1,000 attacks on hospitals, clinics and health workers. Over 13 years of war in Syria, nearly 950 health workers have been killed. In Tigray, Ethiopia, just 3 percent of all health facilities are fully functioning due to destruction and looting by combatants, relentless violence and mass displacement. In Sudan, over 60 attacks on health facilities, 200 violations against medical staff, and 38 deaths of health workers have been reported since the beginning of the civil war April of last year.  

Repeated acts of violence and assault toward health workers have led to concerns over their safety, contributing to even greater staff shortages in barely functioning health facilities.    

Attacks coupled with the weaponization of fuel, clean water and food increase the risk of morbidity and mortality. Along with shortages of basic goods necessary for human life, lack of access to protected health services exacerbates the risk for potential disease outbreaks, such as cholera.     

As a global community, we cannot risk becoming unmoved and unaffected by attacks on health workers — regardless of the situation. Health workers must be afforded a high level of protection in times of conflict.  

International Humanitarian Law (IHL) recognizes both the humanity and the practicality of protecting health care from attacks. The IHL rule requires combatants not to attack or obstruct hospitals, primary care centers, ambulances, and the wounded and sick themselves. This is true even if the facility is treating wounded combatants. Facilities can lose their protection, but only in exceptional circumstances, such as the confirmed use of a hospital as a base to launch an attack. Actors violating humanitarian law must be held accountable for the laws to retain effect and value. 

In recent years, as violence against health care has gained traction on the global agenda, resolutions, commitments, and declarations of the unacceptability of violence against health care have proliferated. But despite grand promises, there has been little action. Impunity and lack of accountability has enabled these attacks to continue.    

The United States can be a leader in protecting health systems during war by forbidding the provision of arms to perpetrators of attacks on health care, assisting prosecutions at the International Criminal Court for attacks on health care, modeling good practices to protect health care through military doctrine and training, and changing laws that criminalize the provision of health assistance to alleged terrorists. Efforts such as bipartisan House Resolution 389, introduced by Reps. Ami Bera (D-Calif.) and Jen Kiggans (R-Va.), which links the need to protect health workers as part of establishing a resilient health system, is one first step.   

Health workers will continue to die, and entire health systems will collapse if the U.S sits idly. Health workers everywhere deserve support and protection to do their jobs for the civilians caught in conflict.   

Rabih Torbay is president and CEO of Project HOPE, a health and humanitarian assistance organization supporting health services in approximately 30 countries, including conflict-affected areas such as Gaza, Ukraine and Sudan.  

Leonard Rubenstein is a professor at The Johns Hopkins Bloomberg School of Public Health with the Center for Public Health and Human Rights and chairs the Safeguarding Health in Conflict Coalition.