Ten years after the United Nations Security Council adopted Resolution 2286, which condemned attacks on health care and called for an end to impunity, attacks on medical care in armed conflicts have reached record levels, according to a new Doctors Without Borders/Médecins Sans Frontières (MSF) report.
Instead of better complying with international humanitarian law, respecting civilian lives, ensuring accountability, and reversing the culture of impunity, warring parties — including states — are increasingly shirking their obligations to protect medical facilities, staff, patients, and vehicles.
MSF’s new report, “Medical Care in the Crosshairs,” draws figures from existing international databases and MSF’s own experience working in areas of armed conflict. In 2025, the World Health Organization's Surveillance System for Attacks on Health Care reported a total of 1,348 attacks on medical facilities, resulting in the deaths of 1,981 people. This marked a significant increase in fatalities among medical workers and patients in conflict zones, which doubled from 944 in 2024.
Sudan was the most affected country, with 1,620 people killed, followed by Myanmar with 148, Palestine with 125, Syria with 41, and Ukraine with 19 people.
Medical care remains under fire
On October 3, 2015, MSF experienced one of the deadliest attacks on our staff, patients, and facilities when a United States AC-130 gunship bombed the Kunduz Trauma Center in Afghanistan. The attack killed 42 people, including 14 MSF staff.
Seven months later, following advocacy from the humanitarian sector, the UN Security Council adopted Resolution 2286 on the protection of medical facilities and staff, which called for an end to impunity for those responsible and to respect international humanitarian law.
It has now been a decade, and medical care and humanitarian action continue to come under fire in armed conflicts — arguably more than ever.
“This resolution was a glimmer of hope, as it was the first time these concerns were addressed in a binding decision,” said Erik Laan, an advocacy expert with MSF. “However, only six of the then-15 Security Council members who adopted Resolution 2286 had ratified all Additional Protocols to the Geneva Conventions, which enhance the protection of victims of armed conflict.”
Attacks leave people without medical services
When health workers are killed and medical facilities are forced to close, people often lose access to the only medical treatment and support available in their communities.
“Violence against medical and humanitarian care leads to the closure of essential medical services and the withdrawal of humanitarian organizations, thereby cutting access to health care for communities that often have no alternatives,” said Raquel González, MSF Spain coordinator. “People living in conflict areas are already affected by violence, and the loss of medical care makes their lives even more unbearable.”
Consequences of attacks on health care in South Sudan
Read moreLocally hired staff from NGOs, who come from the communities they work in, are particularly affected by attacks. They represent 98 percent of the total number of aid workers killed, 96 percent of those injured, and 94 percent of those kidnapped. According to the Aid Worker Security Database, between 2021 and 2025, 1,241 locally hired aid workers were killed, 1,006 were injured, and 604 were kidnapped worldwide.
States are responsible for most attacks in 2024
In 2024, the latest available data from the Safeguarding Health in Conflict Coalition documented 3,623 incidents targeting health care — 15 percent more than in 2023 and 62 percent more than in 2022. In 2024, approximately 81 percent of incidents of violence against health care were attributed to state groups.
“State involvement in armed conflict poses specific challenges to protecting medical care as state groups are more likely than non-state armed groups to carry out air-launched attacks and use explosives, especially in densely populated areas,” González said.
A country’s own laws and legislation, which ultimately incorporate international legal obligations, play a crucial role in this context. National legislation, if not crafted carefully with due consideration of international humanitarian law, can undermine related obligations in practice, particularly the right to medical care for everyone, including those labelled as “enemies” by a warring party.
“States must comply with international law, and all warring parties must ensure proper mechanisms for military engagement to ensure the protection of medical care, prevent the use of medical facilities for military purposes, and integrate the protection of medical missions into military doctrine and decision-making,” Laan said. "States must also be held accountable when they fail to comply with such laws. They must accept independent fact-finding missions, conduct their own investigations, and share findings transparently. These mechanisms are essential to establish the facts and contribute to ensuring accountability and countering the prevailing culture of impunity.”
