‘Healthocide': experts warn of rise in targeting of health services in conflict
Health services are increasingly deliberately under attack and medics are facing violence and abuse in conflict zones around the world – in particular in Gaza, but also in Lebanon, Ukraine, Sudan, Syria and El Salvador.
This is despite the longstanding principle under international humanitarian law of medical neutrality, which protects healthcare workers and facilities during armed conflict and civil unrest, enabling them to provide medical care to those in need.
In a commentary published in the British Medical Journal, Dr Joelle Abi-Rached and colleagues of the American University of Beirut, Lebanon wrote: 'Both in Gaza and Lebanon, healthcare facilities have not only been directly targeted, but access to care has also been obstructed, including incidents where ambulances have been prevented from reaching the injured, or deliberately attacked.
'What is becoming clear is that healthcare workers and facilities are no longer afforded the protection guaranteed by international humanitarian law.'
The authors cite data from Israel's full-scale invasion of Gaza, which has resulted in at least 986 medical workers' deaths. Recent figures from the Healthcare Workers Watch show that 28 doctors from Gaza are being held inside Israeli prisons without any charge, eight them senior consultants in surgery, orthopaedics, intensive care, cardiology and paediatrics.
The World Health Organization's representative for the West Bank and Gaza stated at the UN security council in January that hospitals in Gaza had 'turned into battlegrounds', while the healthcare system was being 'systematically dismantled and driven to the brink of collapse'.
Healthcare workers in Gaza who were among the hundreds detained by the Israeli military who spoke to the Guardian for the Doctors in Detention project in early 2025 believed they were targeted because they were doctors.
They shared harrowing testimonies of torture, beatings, starvation and humiliation, including being constantly beaten and kept in stress positions for hours at a time, and having loud music played nonstop to prevent them from sleeping. They were also denied food, water, showers and changes of clothes.
Lebanon's ministry of public health has found that between 8 October 2023 and 27 January 2025, 217 healthcare workers were killed by the Israel Defense Forces, 177 ambulances were damaged, and 68 attacks on hospitals were recorded.
Figures from the Safeguarding Health in Conflict Coalition recorded 3,623 attacks on or obstruction of healthcare in 2024, the highest number ever documented.
These attacks included doctors, nurses and allied healthcare professionals who were beaten, arbitrarily arrested, kidnapped, tortured and killed; patients shot in their beds or dragged to detention centres; and hospitals that were deliberately bombed and raided.
The authors of the BMJ article are calling on doctors to 'forsake the principle of medical neutrality' and speak out against 'healthocide' or face emboldening future violators. This might include advocating for enforcement of justice and international humanitarian law, and documenting and exposing abuses of medical neutrality.
Writing in the Guardian, Maarten van der Heijden, a global health lawyer and researcher at the London School of Hygiene & Tropical Medicine, noted that the international humanitarian laws, the Geneva conventions, leave 'considerable room for interpretation and forgoes accountability', allowing hospitals to be bombed if it is considered 'harmful to the enemy'.
The British Medical Association's medical ethics committee chair, Dr Andrew Green, said: 'In recent years, doctors have been devastated to see the appalling increase in attacks on healthcare, patients and staff in conflict zones, and the disregard for medical neutrality and international humanitarian law.'
He noted that although there were examples around the world, Gaza was the most severe given that 'the population is both at risk of imminent famine, while health systems necessary to look after the starving have been systematically obliterated and health workers killed and arbitrarily detained.'
He urged international medical associations, NGOs, governments and the UN to 'call out when we see human and health rights abused, and hold those breaking international humanitarian law accountable'.
'Those with power must use all levers at their disposal to ensure the provision of humanitarian aid and urgent healthcare to the world's most vulnerable. One clear step would be the establishment of a UN special rapporteur on the protection of health in armed conflict,' he added.
The Foreign, Commonwealth and Development Office minister Hamish Falconer has previously said that the UK government is urging the Israeli authorities to ensure that 'incidents are investigated transparently and that those responsible are held to account and lessons learned'.
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The Guardian
5 hours ago
- The Guardian
‘Healthocide': experts warn of rise in targeting of health services in conflict
Targeting medics and hospitals in acts of war should be called 'healthocide', academics have urged, amid an increase in such attacks in recent years. Health services are increasingly deliberately under attack and medics are facing violence and abuse in conflict zones around the world – in particular in Gaza, but also in Lebanon, Ukraine, Sudan, Syria and El Salvador. This is despite the longstanding principle under international humanitarian law of medical neutrality, which protects healthcare workers and facilities during armed conflict and civil unrest, enabling them to provide medical care to those in need. In a commentary published in the British Medical Journal, Dr Joelle Abi-Rached and colleagues of the American University of Beirut, Lebanon wrote: 'Both in Gaza and Lebanon, healthcare facilities have not only been directly targeted, but access to care has also been obstructed, including incidents where ambulances have been prevented from reaching the injured, or deliberately attacked. 'What is becoming clear is that healthcare workers and facilities are no longer afforded the protection guaranteed by international humanitarian law.' The authors cite data from Israel's full-scale invasion of Gaza, which has resulted in at least 986 medical workers' deaths. Recent figures from the Healthcare Workers Watch show that 28 doctors from Gaza are being held inside Israeli prisons without any charge, eight them senior consultants in surgery, orthopaedics, intensive care, cardiology and paediatrics. The World Health Organization's representative for the West Bank and Gaza stated at the UN security council in January that hospitals in Gaza had 'turned into battlegrounds', while the healthcare system was being 'systematically dismantled and driven to the brink of collapse'. Healthcare workers in Gaza who were among the hundreds detained by the Israeli military who spoke to the Guardian for the Doctors in Detention project in early 2025 believed they were targeted because they were doctors. They shared harrowing testimonies of torture, beatings, starvation and humiliation, including being constantly beaten and kept in stress positions for hours at a time, and having loud music played nonstop to prevent them from sleeping. They were also denied food, water, showers and changes of clothes. Lebanon's ministry of public health has found that between 8 October 2023 and 27 January 2025, 217 healthcare workers were killed by the Israel Defense Forces, 177 ambulances were damaged, and 68 attacks on hospitals were recorded. Figures from the Safeguarding Health in Conflict Coalition recorded 3,623 attacks on or obstruction of healthcare in 2024, the highest number ever documented. These attacks included doctors, nurses and allied healthcare professionals who were beaten, arbitrarily arrested, kidnapped, tortured and killed; patients shot in their beds or dragged to detention centres; and hospitals that were deliberately bombed and raided. The authors of the BMJ article are calling on doctors to 'forsake the principle of medical neutrality' and speak out against 'healthocide' or face emboldening future violators. This might include advocating for enforcement of justice and international humanitarian law, and documenting and exposing abuses of medical neutrality. Writing in the Guardian, Maarten van der Heijden, a global health lawyer and researcher at the London School of Hygiene & Tropical Medicine, noted that the international humanitarian laws, the Geneva conventions, leave 'considerable room for interpretation and forgoes accountability', allowing hospitals to be bombed if it is considered 'harmful to the enemy'. The British Medical Association's medical ethics committee chair, Dr Andrew Green, said: 'In recent years, doctors have been devastated to see the appalling increase in attacks on healthcare, patients and staff in conflict zones, and the disregard for medical neutrality and international humanitarian law.' He noted that although there were examples around the world, Gaza was the most severe given that 'the population is both at risk of imminent famine, while health systems necessary to look after the starving have been systematically obliterated and health workers killed and arbitrarily detained.' He urged international medical associations, NGOs, governments and the UN to 'call out when we see human and health rights abused, and hold those breaking international humanitarian law accountable'. 'Those with power must use all levers at their disposal to ensure the provision of humanitarian aid and urgent healthcare to the world's most vulnerable. One clear step would be the establishment of a UN special rapporteur on the protection of health in armed conflict,' he added. The Foreign, Commonwealth and Development Office minister Hamish Falconer has previously said that the UK government is urging the Israeli authorities to ensure that 'incidents are investigated transparently and that those responsible are held to account and lessons learned'.
The Guardian
19 hours ago
- The Guardian
‘Heartbreaking': a London surgeon on the trials of operating in a Gaza hospital
Every day between 4am and 6am, Graeme Groom, an orthopaedic surgeon from London, would be woken by a dawn chorus of bombs and missiles. And so began another 24 hours at the Nasser hospital in Gaza, the largest functioning hospital in the territory. Shortly after 8am, the first patients would be wheeled into the operating theatres. Groom and his orthopaedic and plastic surgery colleagues saw on average 20 patients a day: one-third children, one-third women, then men of all ages, their limbs mangled by bombs and guns. Groom, a co-founder of the charity Ideals that provides health services in places affected by conflict, has been to Gaza about 40 times, including four visits since Hamas militants attacked Israel on 7 October 2023. One evening on his most recent trip, just as the 12-hour-plus shift was ending, another emergency was wheeled in. It was an 11-year boy who had lost his nine siblings in an Israeli strike on their family home in Khan Younis. His father, a doctor, was in a critical condition, and later died of his injuries. That night Groom and his team managed to save the boy's arm, rather than amputate it. The boy's name was Adam al-Najjar. As Adam got better, the NHS doctor found that Adam spoke good English and had 'the most angelic smile', which could be prompted by a bar of chocolate from the surgeon's pocket. A few weeks later Adam and his mother were evacuated to Italy. Physically, he was much better by the time he left, Groom said, although it was too early to assess the long-term impact of the explosion on his brain, or the mental scars. 'We could not begin to get a mental health assessment of the effects of losing almost all his family in one bomb.' For every Palestinian child whose trauma captures headlines, there are thousands more whose stories go untold. The UN agency for children reported on 16 July that more than 17,000 children have been killed and 33,000 injured in the 21-month conflict. The NHS doctor recalls seven-year-old Yakub, who, with his older brother, was the only survivor of a bomb attack. Yakub's legs had been broken above and below the knees, the skin and much soft tissue flayed by bombs. 'While I was writing up the operation note … it was just heartbreaking to hear him calling for the mother who was dead.' He recalls two other patients: a mother who was cradling her three-year-old daughter when the bombs exploded. The child lost both legs, the mother's elbows were damaged, depriving her of the use of her arms. She is now regaining the use of one arm. Patients are usually discharged to tents, or improvised shelters in the sand, without rehabilitation. They are malnourished, so wounds heal less well. Infection rates are high and it is hard to keep track of them for follow-up. But it is happening. 'Amazing Palestinian colleagues are doing their very best … [and] without it, the mortality and the long-term disability rate would be much, much higher,' Groom said. The Ideals charity has been sending medical teams to the occupied Palestinian territories since 2009. But never before has it been so hard to bring in supplies. In the past Groom alone brought five large cases. On the most recent visit, his team was banned 'under pain of exclusion, confiscation and possible penalty' from bringing desperately needed equipment such as delicate plastic surgery tools for repairing vein and tissue or orthopaedic frames that allow broken bones to heal. Since the Ideals team first went to Gaza there have always been damaged buildings, but 'absolutely nothing to compare with the apocalyptic destruction that is everywhere' now. All his Palestinian colleagues have been forced to move, some many times. Many have lost close relatives, or most of their extended families. They live in tents near the hospitals with self-dug latrines for toilets. One woman slept in her hijab each night, 'so that if she was killed, she would be presentable', he recalled. 'What was astonishing was how many of them would turn up for work each day from their tents … clean, well-dressed and smiling.' Several appeared to shrug off unimaginable personal suffering. 'When they talked about the loss of family members … they would say 'this is our lives'. I probably have heard that a dozen times,' Groom said of his Palestinian colleagues. Several have also told him they do not want to be known as resilient. They just want the bombing to stop, said Groom. At his most recent visit, from 13 May to 4 June, market stalls had almost disappeared. Unrwa, the UN agency for Palestinian refugees, reported on Tuesday that doctors and nurses were among people 'fainting from hunger and exhaustion', having previously said Israeli authorities were 'starving civilians'. On 20 July, an anaesthetist, who was also a parent to six children, told Groom that he and his family were starving. His children ranging from two to 13 are suffering from fatigue, weakness, cramps and amnesia. They were confused, they were crying, the anaesthetist said in messages to Groom seen by the Guardian. The anaesthetist could only give them salt to lick and water. Groom has relayed what he has witnessed in Gaza to policymakers in Brussels, Berlin and Paris, urging greater western pressure on Israel. 'Everywhere we were met with empathy, very often with tears, but with a sense of impotence.' After he spoke to the Guardian, the European Commission proposed a partial suspension of Israel's participation in the EU research programme, the first possible punitive measure against the Israeli government, which must be agreed by a majority of member states to take effect. Groom had been 'hugely disappointed' when earlier this month EU foreign ministers took no action following a review into the bloc's relations with Israel, 'but I don't think the fight is over'.
The Guardian
a day ago
- The Guardian
100 Gaza children hope to be evacuated to UK for urgent medical care
More than 100 critically ill and injured children in Gaza hope to come to the UK as soon as possible after the government announced a scheme to provide those in severe need with NHS care. The government announced on Sunday that it would evacuate children from Gaza to the UK for treatment under a scheme to be announced within weeks. While campaigners welcomed the announcement, they urged ministers to move quickly, saying children awaiting urgent medical care in the UK had died waiting, or were forced to be medically evacuated to other countries. 'We have previously had children on the list but because approval takes so long, some of those children have ended up dying,' said Omar Din, a co-founder of Project Pure Hope (PPH) and a healthcare executive in NHS primary care. 'The government needs to move at pace.' Through a private scheme, the charity has brought three children to the UK this year. Now, its efforts will provide a blueprint for the new taxpayer-funded scheme, which will operate in parallel. 'It's not too late in the sense that there are people who can still be helped, there are many children,' Din said. But he added: 'We should have done this much sooner.' The UK's decision to offer itself as a receiving state comes as starvation and famine from Israel's aid blockade take hold in Gaza, where more than 50,000 Palestinians have been killed since 7 October. The World Health Organization (WHO) has estimated as many as 12,500 patients in Gaza require medical evacuation, and humanitarian organisations have called on more countries to assist. Last month, a charity launched legal action against the government's decision not to provide medical evacuations against historical precedent, and ministers faced increased pressure from more than 100 MPs to act. Charities hope that about 100 children on their existing lists will be permitted to come to the UK, along with a guardian and possibly siblings. PPH has told the government it has between 30 and 50 children who should come to the UK, and the charity Children Not Numbers (CNN) has 60 children in critical need of medical evacuation from Gaza. Charities said there were many people – working in healthcare and other sectors – who were willing to donate their time and money to help. 'We have a thriving private healthcare system in addition to our NHS system, and combined with the government behind them, I think services can be expanded to support a greater number of children,' said Din. Looking to counterparts in Europe and the US, and the neighbouring countries Egypt, Qatar and the UAE, which had evacuated more than 7,000 patients as of April, according to the WHO, Din said the UK government should assist children 'relative to our counterparts'. One child the charity was assisting had fourth-degree burns to 40% of his body. However, discussions with the government over bringing the child to the UK moved too slowly, the charity said, and the child ended up being taken to Italy in June, along with a one-year-old boy with a congenital disease. The charity has also assisted medical evacuations to the UAE and Jordan. 'We've now developed a blueprint, we've got all the resources [and] learning. The whole pathway is there now for you to take and use the full force of government to scale [up] urgently,' said Din. Sign up to First Edition Our morning email breaks down the key stories of the day, telling you what's happening and why it matters after newsletter promotion Last month, CNN took legal action against the Home Office and Foreign Office over their decision not to provide medical evacuations. Welcoming the government's announcement, a spokesperson said 71 children they were assisting had died due to insufficient treatment, medicine and delays to medical evacuations, since they first called on the prime minister to consider such a scheme in November last year. 'This is absolutely disheartening,' said a CNN spokesperson. 'We had to wait around 10 months for it to happen.' The charity said the 60 children it had in critical need of evacuation had their paperwork and medical records ready for final review from Israel's coordinator of government activities in the territories (Cogat). Médecins Sans Frontières has previously called on the Israeli government to allow more patients to leave Gaza, and be more flexible, saying cases faced a lot of Cogat rejections. 'We are ready to go as long as we have the green light from the government,' said the CNN spokesperson. A Foreign Office spokesperson said a cross-government taskforce had been created to pull the new scheme together as quickly as possible. 'We are taking forward plans to evacuate more children from Gaza who require urgent medical care, including bringing them to the UK for specialist treatment where that is the best option for their care,' they said.
