MSF to UN Security Council: The promise of Resolution 2286 lies in ruins

Excellencies, colleagues, I would like to thank Denmark, Spain, and New Zealand for convening this meeting.  

Ten years ago, this Council unanimously adopted Resolution 2286 in response to an intolerable reality: hospitals bombed, ambulances attacked, patients killed in their beds, medical workers hunted for carrying out their duty. 

That resolution was born of outrage at the systematic targeting of health care in Syria, and at the bombing and destruction of MSF’s trauma center in Kunduz. It carried a promise to match that outrage: that such attacks would never be accepted as a normal feature of war — and that when they did occur, states would take responsibility for stopping them and ensuring there were consequences.  

Ten years on, that promise lies in ruins. 

What shocked the conscience in 2016 now too often passes without the bare minimum of condemnation — let alone consequence. It has become routine — as if attacking health care were an acceptable cost of war, and the principles meant to prevent it something to set aside when inconvenient. 

In conflict after conflict, we are observing the unmaking of protections you once pledged to defend. In Gaza, the scale and intensity of attacks on health care over the past two and a half years have been staggering. As part of a broader assault on Gaza’s civilian population, the Israeli armed forces have besieged, raided, and gutted hospitals. They have killed, displaced, and detained medical staff — many of whom still languish in jails. 

Since October 2023, 15 of our MSF colleagues have been killed. 

Today, amid a so-called ceasefire, and when humanitarian aid is meant to be flowing freely into the Strip, MSF teams in Gaza are being prevented from restocking essential supplies.

Their ability to care for their patients is being stripped away.  

What makes Gaza distinct is not only the scale of the assault on the health system. It is the way the law itself is being bent to justify it. Israeli forces have repeatedly invoked "loss of protection" under international humanitarian law (IHL): the claim that hospitals had been used for military purposes and therefore forfeited their protected status — claims almost never independently verified.  

But that special protection is not lost by mere allegation. 

It can only be set aside under strict conditions: after a warning has been issued and ignored; where the specific part of the facility concerned qualifies as a military objective; and only when attacks comply with the principles of proportionality and precaution — which remain binding at all times. 

Based on MSF's extensive experience across conflicts, we see no realistic circumstances in which the destruction of a functioning hospital could be lawful — let alone morally justifiable. The military gain is marginal and short-lived. The harm to civilians is predictable and lasting.  

What we have seen in the expansive use of the "loss of protection" argument is the exception swallowing the rule. Suspicion replaces evidence. Protection — granted by default — is treated as something hospitals must prove they still deserve.

In South Sudan, the pattern of attacks has been different, but the consequences are no less devastating. 

In April 2025, armed men stormed our hospital in Ulang, looted the facility, and forced more than 100 patients to flee in the middle of treatment.  

Weeks later, in Old Fangak, government forces bombed the MSF hospital despite its location having been communicated to all parties to the conflict. It was the only hospital serving more than 100,000 people. 

In February of this year, in Lankien, government forces struck again, bombing the hospital compound and destroying critical medical supplies in the only secondary-level facility serving nearly 250,000 people. What followed was looting and deliberate destruction — nothing left to sustain services. 

As a result of these attacks, entire communities have been cut off from medical care — for trauma, for childbirth, for conditions caused or compounded by conflict. 

The impact of individual attacks reverberates well beyond the moment.  

Again, when hospitals are struck, the consequences are immediate, long-lasting, and entirely predictable. In many areas, care does not adapt and shift. It disappears — and those launching these attacks know exactly what deprivation they are inflicting.  

Over the past 10 years, similar attacks have been carried out across practically every major conflict — from Syria to Sudan, from Ukraine to Afghanistan, from Ethiopia to Lebanon.

Violations have piled up while Resolution 2286 is invoked in annual debates, commemorated in side events, but left undefended where it matters most. 

Some states have directly contributed to this erosion — and in many cases, the perpetrators are states themselves. Others have enabled it through silence, selectivity, or political cover.

Attacks on health care are today a standard feature of war. That normalization was not inevitable. It was permitted — incident by incident, year after year — under your watch as custodians of this resolution. 

If Resolution 2286 is to retain any meaning, it cannot remain a ritual invocation while hospitals burn. It must become the basis of a more robust protective framework. That responsibility rests here, with this Council — but it does not stop here. It extends to every member state.

Each of you has an obligation not only to comply with IHL, but to ensure respect for it. That means adopting military practices that protect health care, investigating violations and making the findings public, and holding those responsible to account.  

It also means looking outward. States that provide military support, intelligence, or political backing to parties to conflict cannot treat attacks on health care as a secondary concern. That support must be conditioned on respect for IHL. 

An actionable blueprint already exists. 

Through the Global Initiative’s workstream on the protection of hospitals, over 100 states are already working to advance practical measures to protect medical facilities in conflict — measures grounded in operational reality and consistent with the existing legal framework.  

They show how wars can be waged while still protecting hospitals — through responsible choices in targeting and the deliberate preservation of essential services. They are not aspirational standards. They represent the bare minimum required — and they apply equally to the protection of medical workers and transport.  

What is needed now is implementation — in good faith.  

As for this Council, it has not meaningfully attempted to enforce Resolution 2286. It has failed to use the tools already at its disposal to track and respond to these attacks. 

That must change. 

The Council should address the protection of health care regularly — through briefings, reporting, and concrete follow-up. Where serious violations occur, it should support independent investigations and accountability mechanisms. 

The Secretary-General has a role to play as well. Reporting must go beyond general trends mentioned in the annual Protection of Civilians Report. It should identify patterns, name perpetrators, and trigger Council action when health care is attacked or obstructed.

Today’s discussion centers, in part, on emerging threats to the medical mission — the risks posed by AI-driven targeting systems, by the proliferation of drones, and by the increasing automation of warfare. These developments matter. We are already seeing their effects in our wards. But we should be clear about where the real danger lies. It is not only in the weapons being developed. It is in the responsibility you are failing to uphold.

If there is no will to stop the bombing of our hospitals, the targeting of our colleagues, and the killing of our patients today, what chance do we stand when warfare becomes faster, more automated, and further removed from human judgment? 

For our patients trapped in conflict, and for our colleagues who continue risking their lives to provide care under fire, what happens next will be shaped by the actions you take — or those you chose not to.  

Thank you.