Eight Steps MEmber States Can Take to Protect Health Care


Statement of Leonard Rubenstein, chair of the Safeguarding Health in Conflict Coalition, gave the following statement at the UNGA 2017 side event, Protection of Health Care in Armed Conflict, on September 22, 2017.

I am honored to be here today representing the Safeguarding Health in Conflict Coalition. The coalition consists of more than three dozen humanitarian, human rights, and health organizations working together to protect health workers and services threatened by war or civil unrest.

I would like to thank Canada, Spain, UK, and the Netherlands for their leadership, including the specific and concrete actions they are taking to put their commitments into action. I would like to single out one of these actions, pending now: Netherlands’ sponsorship of a proposed resolution for a commission on inquiry in Yemen at the Human Rights Council, which Canada is also supporting. This is the kind of leadership we need to end impunity.

My colleagues have justifiably spoken about the vast scope of attacks in Syria and Yemen that bring catastrophic human suffering. But we need to remember that attacks on health care are a global problem, well-illustrated by violence inflicted on health services during the past two months alone. I will provide just a handful of examples. In July, an armed group bombed a hospital in Kabul, killing at least 50 people. Last month, in the battle for Raqqa, the Syrian Observatory for Human Rights reported that on consecutive days, coalition forces bombed hospitals. Also in August, in the Central Africa Republic, MSF had to pull staff out its hospital in Zemio after armed groups shot a baby in her mother’s arms inside a hospital.

The horrors never seem to cease. But we are at a different place than we were five years ago, where global attention to the attacks on health care was almost nonexistent. Where there was once invisibility and apparent indifference to attention, now we see condemnation, resolutions, and some concrete actions such as the World Health Organization’s launch of an initiative to collect and disseminate data on attacks on health care. But now, unfortunately, at the Security Council, instead of forward movement after the adoption of resolution 2286, the next step has been virtual paralysis. As you know, the council has not even adopted the extensive and sensible recommendations of the Secretary General to member states to reform their laws, improve their military practice, strengthen their investigations, and ensure accountability—and report on all of these actions. And the failure to follow through reinforces impunity.

That paralysis, though, should not impede action by the many member states that deeply believe in the norms of civilian protection and the sanctity of health care. I would like to outline eight concrete steps states can take now, on their own and through UN bodies.

First, the General Assembly should ask for a report by the Secretary General on its 2014 resolution on Global Health and Foreign Policy, which called on states to take preventive measures to promote the safety and protection of health personnel. The report should identity actions taken—and not taken—including steps to strengthen investigations and promote accountability.

Second, member states should publicly commit to implement the recommendations of the Secretary General to fulfill the objectives of Security Council resolution 2286. The commitment should include annual reporting on steps they have taken to carry out the recommendations.

Third, states need to be accountable for actions they have committed in resolution 2286. To do this, leadership states like those here today should support independent reporting on whether states are acting in accordance with resolution 2286 regarding their own laws, practices, investigations, and accountability procedures. In this connection, I note that the Special Rapporteur on the Right to the Highest Attainable Standard of Health is planning to report on laws and practices that criminalize the provision of impartial health care services to people deemed enemies. Similar reporting is needed to assess whether they are taking actions called for by resolution 2286.

Fourth, resolution 2286 calls on the Secretary General to provide country-specific briefings to the Security Council. But they are not taking place, and they must to bring pressure on the perpetrators to cease attacks. These briefings should be provided not just by OCHA, but by the Office of the High Commissioner for Human Rights and the Special Representative on Children in Armed Conflict, both of whose mandates embrace the naming of perpetrators of attacks.

Fifth, states should urge the Secretary General to confirm that his annual report on Children in Armed Conflict will include an appendix containing an accurate, credible and complete listing of perpetrators of grave violations against children’s rights in conflict, including attacks on hospitals and health workers.

Sixth, states need to take seriously their responsibility to ensure respect for international humanitarian law as set in the very first article of each Geneva Convention. To that end, they should initiate investigations of instances where partner military forces as well as their own may have attacks hospitals and other health facilities.

Seventh, consistent with the Secretary General’s recommendations to implement resolution 2286, member states should assess the likelihood that arms they sell may be used to commit serious violations and cease arms sales if there is a substantial risk of such violations.

Eighth, and finally, with respect to Syria in particular, as a follow up the General Assembly’s authorization of an independent mechanism to collect evidence of war crimes in Syria, the General Assembly should consider the establishment of a tribunal to hold perpetrators accountable for targeted or indiscriminate attacks on health facilities and personnel, and the arrest, torture and killing of health workers, as well as for other crimes.

We must go beyond admonitions and hand-wringing about attacks on health care as the so-called new normal. None of the steps I outlined are beyond reach. They are in fact quite modest. It is important to get started. Thank you.