Dr. Joanne Liu Address to United Nations Security Council Regarding Hospital Attacks

MSF/Paulo Filgueiras

Speech by Dr. Joanne Liu

International President

Doctors Without Borders/Médecins Sans Frontières (MSF)

United Nations Security Council

September 28, 2016, New York, USA


Excellencies, Ladies and Gentlemen:

Last week the world witnessed a savage attack on a United Nations and Syrian Red Crescent humanitarian convoy, and on a hospital near Aleppo. Secretary General Ban Ki Moon said: “Just when we think it cannot get any worse, the bar of depravity sinks lower.”

Indeed, it does.

The conduct of war today is ever boundless. It is a race to the bottom.  The unremitting assault on Aleppo by Russian and Syrian forces over recent days is certainly testament to that.

On the third of May, this council unanimously passed Resolution 2286.

You, the Council Members, pledged to protect civilians and the medical services they need to survive.

But the reality you preside over has only become worse.

You passed the resolution in the wake of the obliteration of Al Quds Hospital in Aleppo by the Syrian government and its allies. It was the latest in a staggering number of such attacks.

On May 3rd, you pledged to protect the medical mission.

Five months later, the resolution has plainly failed to produce any effect on the ground.

This endeavor has failed due to a lack of political will—among member states fighting in coalitions, and those who enable them.

There can be no more waiting.

Make your pledges operational.

Since this resolution passed, MSF alone has experienced more horrific attacks.

In early August, our hospital in Abs, Yemen was destroyed in an airstrike carried out by the Saudi-led coalition. Nineteen people were killed, among them patients and health workers.

The GPS coordinates of the structure—a fully functioning hospital—had been shared with belligerents, including the Saudi military.

It did not matter.

Imagine the patients in beds and the doctors and nurses treating them, mercilessly snuffed out in an instant, or sentenced to a slow, agonizing demise.  A hospital—a place of life—horrifically transformed into a place of death.

It was the fourth such attack against MSF facilities in Yemen in less than a year, which together killed 32 people and injured 51.  And it was as unsparing and illegitimate as those before it. Our team had to withdraw from the north of the country, leaving scores with reduced medical care.  Saudi carpet bombing in the area has further reduced health services.

One week after the attack in Abs, an MSF-supported hospital in Idlib, Syria was destroyed in repeated air strikes.  Four hospital staff and nine patients were killed. And from one minute to the next, lifesaving assistance for 70,000 people was cut.

In Syria, the government and its allies relentlessly—deliberately—attack hospitals, doctors, first responders, and patients.  Doctors in Aleppo tell us that the remaining intensive care wards are completely full.  People are being taken off life support so that the multitude of wounded can be treated.

With the bombs continuing to fall, the doctors tell us they await their own deaths.

Such attacks are clearly part of their war strategy. Opposition groups also demonstrate little respect for medical services.

In Yemen, attacks on protected medical facilities, patients and personnel are “business as usual” in an all-out war. The Saudi-led coalition and its opponents are so negligent, their rules of engagement so loose, that this war truly stands apart.

It’s not just hospitals that are hit.

Schools, markets, roads, and bridges in Yemen are routinely destroyed.  The catastrophic domino effect on civilians—on ordinary people—is beyond measure.

The failure of Resolution 2286 is plain to see, because the bottom line has not changed - before or after its passage:  Hospitals are still attacked and civilians in war have less—if any—access to lifesaving medical care.

Many attacks are said to be non-intentional.  They are brushed off as mistakes, committed in the fog of war.

We reject the word “mistake.”

In Syria, the attacks never stop. Doctors in Aleppo pull their weakest patients off ventilators, so someone else gets a chance. But ventilators are made for the weakest cases. This is desperate, desperate medicine. Just this morning, two more hospitals in eastern Aleppo were struck, leading to their temporary shutdown. In one, the intensive care unit was severely damaged.  The Associated Press reports that patients died because they couldn’t be kept alive following the attack.

Besieged, our Syrian colleagues are there for the duration. They will die there, they tell us, with their patients. When it’s their turn.

We denounce the deliberate and systemic failure of states to avoid attacking hospitals and to appropriately control their conduct of hostilities.

We deplore the lack of control over how hostilities are carried out. This free-for-all is a choice. There is a method in the madness.

In both Yemen and Syria, four of the five permanent members of this council are implicated in some way in these attacks.

In an age when counter-terrorism shapes war, a license to kill has been issued.

We call on you all—again—to revoke this license.

And we call on you to immediately enact the absolute prohibition of attacks on medical facilities. even if those you see as enemies are being treated in them.

Because throwing medical impartiality to the wind may also become a new norm of warfare, if states do not balance military and humanitarian necessities.

To reverse this devastating trend, Security Council members must live up to the obligations and responsibilities bestowed upon them. Obligations and responsibilities that civilians in war, patients, and our medical colleagues need them to uphold.

Attacking hospitals and medical workers is a non-negotiable red line. Non-negotiable. As such, it must be set out—in clear and simple terms—in all military manuals, rules of engagement and standard operating procedures.

The legal bar for determining the loss of protection is very high, and for good reason: healthcare is the last line of humanity in an otherwise inhumane setting.

But in practice, the bar is low.

Too often, unverified intelligence or mere claims that a hospital has lost its protection is justification enough for attacking it.

Worse, the criteria used to determine the loss of protection are both ill-defined and opaque. For instance, how is a hospital ultimately determined to be hosting a “command and control center?”

Militaries are given great latitude for interpretation, if not abuse, in making these determinations.  And medical providers are left in the dark and ultimately endangered.

Self-defense cannot be casually invoked as an excuse for attacking protected populations and health services.

These ongoing attacks demand accountability if they are to ever stop.

They must be credibly investigated.

But investigations carried out by the perpetrators of attacks, while welcome, are insufficient.

I deliver this message almost one year to the day United States forces destroyed the MSF hospital in Kunduz, Afghanistan—the critical, triggering event for Resolution 2286.  We are still waiting for an independent investigation into how 42 patients, hospital personnel, and caregivers were cut down while simply receiving, and providing, medical care.

We appeal to you to immediately endorse and implement the Secretary General’s recommendations—in particular the call for dedicated mechanisms for independent, prompt, and effective investigations into attacks on civilians and medical care.

We also urgently request that the Secretary General appoint a special representative mandated to document and report attacks on medical facilities, health personnel, and patients protected under international law.

The impunity enjoyed by those who attack civilians and medical services must finally end. It will only end when sufficient political pressure and accountability are applied.

Meanwhile, people trapped in war, alongside with front-line health workers, are losing the safety and care guaranteed under the norms and laws you are obligated to uphold.

These norms and laws are eroding almost beyond repair.

They must be respected and restored.

In short, make your resolution operational.

Stop bombing hospitals.

Stop bombing health workers.

Stop bombing patients.

Thank you.