World: Health care under fire: Ten years after Resolution 2286

Country: World Source: International Committee of the Red Cross Scared, but doing it anyway – health care workers on saving lives when their own are at risk Every time Ashraf Al-Khatib, a paramedic with the Palestine Red Crescent Society, leaves for work, his family says goodbye as though they may not see him again. “Every time we return home,” he says, “our families welcome us as if we had returned from the dead.” That sentence – quietly devastating, delivered without ceremony – captures something that no policy document can fully express. Across conflict zones around the world, health workers are making that same calculation every day: the danger is real, and they are going to work anyway. On 3 May 2016, the United Nations Security Council adopted Resolution 2286, condemning attacks on medical facilities, personnel and transport in armed conflict. It reaffirmed what international humanitarian law already makes clear: hospitals, patients, doctors and ambulances must never be targets. Ten years later, that principle is still being violated – and with devastating consequences. Providing care should not need to be an act of bravery Ashraf has thought carefully about fear – what it means, what it costs, and what it demands of him. “The chances of us returning home and the chances of us not returning are equal,” he says. “Every time we go out to work we say goodbye to our families.” While the weight of this is clear, he also refuses to let it be the final word. “Feeling fear is not a flaw. Everyone feels fear. But courage is overcoming your fear and controlling it. Our courage lies in not letting fear control us.” This is a reality that Resolution 2286 was meant to address, and that persists a decade on. Ten years on, health facilities continue to be damaged or destroyed. Ten years on, medical staff are threatened, injured and killed. Ten years on, ambulances are blocked or attacked and patients are prevented from reaching care. The costs are not only immediate. When health care is systematically unsafe, essential services collapse – not just for those caught in a single incident, but for entire communities. The lives behind the statistics Dr Mohammed Shaaban works as an ICRC doctor at a Red Cross field hospital. He has witnessed what that collapse looks like from the inside. “We lost a fellow paramedic while transferring a patient between hospitals,” he says. “He was hit by a stray bullet.” He pauses on what that loss means beyond the grief of it. “The inability of medical or emergency crews to go out and rescue the injured and sick foreshadows a real disaster – in addition to the danger faced by the paramedics themselves.” Behind every statistic is a person. A patient who cannot be reached, family left without care, a community cut off from services that were already stretched thin. In Colombia, Danilo Torrado coordinates medical missions in Norte de Santander, navigating checkpoints, road closures, and the constant calculation of where it is and is not safe to send staff. “We say goodbye to our families and we just don’t know to what extent the conflict is going to affect us,” he says. “We trust that the parties to the conflict won’t attack us or endanger our lives, and that they’ll respect international humanitarian law – but even so, there’s still uncertainty.” That uncertainty has a direct human cost. When staff cannot safely travel to remote rural areas, vaccines don’t reach children. Prenatal care doesn’t happen. Treatable conditions go untreated. Zuheir Ramiyeh, a Palestinian Red Crescent Paramedic in Ramallah, West Bank, experienced this acutely during an emergency call to a Palestinian village for a woman in labour. His ambulance was held at a checkpoint for nearly an hour. “The only way to deal with the situation was to have the patient and her companion walk to the checkpoint on foot,” he says. “Because of the war, response times have become longer. This affects the lives of those seeking medical care.” Miguel Peña, a pharmacist working with the ICRC in Venezuela, describes the wider systemic effect: “When an ambulance or a hospital is targeted, it is not only the physical infrastructure that is lost, but also access to care for hundreds of patients. Fear takes hold of both patients and health-care professionals. When health care loses its protection, the system collapses.” Not a failure of law, but of implementation The protection of health care in armed conflict is not a grey area. It is a legal obligation under international humanitarian law, and Resolution 2286 reinforces it – calling on all parties to conflict to respect and protect medical missions, and on States to take concrete steps: strengthening domestic legal frameworks, integrating protective measures into military operations, investigating violations, and holding perpetrators accountable. Ten years on, violations continue. This is not because the rules are unclear. It is because they are not being fully implemented. Sita Zouri Épouse Traore is an ICRC midwife working in Fada N’Gourma, Burkina Faso. She articulates something that sits at the heart of this gap – not as a policy point, but as a personal one. “What motivates me to continue to go to work when health care is under threat is the impact my work has on vulnerable communities,” she says. “For me, every life matters. When faced with a risk, we feel afraid. But behind that fear, we’re even more committed, because what we’re setting out to do is even more important to us than that fear. So, to save lives, I’ll have to overcome my fear and go out there.” That commitment – from health care workers in Burkina Faso, Nigeria, Palestine, Colombia, Venezuela, and everywhere else – cannot be taken for granted. It is extraordinary. And it cannot be a substitute for protection. From commitments to action This anniversary of Resolution 2286 must mark a turning point. States have the tools to better protect health care. The practical measures are well established: integrating protections into military doctrine and operations, strengthening national laws, training armed forces, investigating incidents, and ensuring accountability. States also have a responsibility not only to respect international humanitarian law themselves, but to ensure respect by others – including those they support. The ICRC works with states to translate these obligations into concrete action, including through the Global Initiative on IHL, supported by more than 100 countries. That initiative provides a practical roadmap. But a roadmap is only useful when someone is willing to follow it. Progress depends on political will. A call to protect those who save lives Danilo Torrado, when asked what it means to do this work, returns to something fundamental: “You do say goodbye to your family and you just don’t know to what extent the conflict is going to affect us.” No one should have to carry that weight. No one should have to choose between saving lives and risking their own. Salamatu Dauda, a medical laboratory technician in Madagali, Nigeria, says it plainly. “Sometimes attacks happen at night, but we still come into work in the morning,” she says. “We are part of the community – we cannot abandon people without medical care.” She knows what is at stake and still, she comes to work. Health care should never be a casualty of war. The health workers quoted here have chosen, again and again, to go back despite the danger. Salamatu, who comes in the morning regardless. Zuheir, who says goodbye to his family and goes. Sita, Danilo, Miguel, Dr Shaaban, and the thousands of others whose names we do not know. Their courage is real. Ten years after Resolution 2286, the international community must match it – not with words, but with action. Protecting health care is not only a legal duty. It is a test of our collective humanity.

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