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UNACCEPTABLE: Health Workers as Pawns of Warfare

This blog was crossposted at the Hastings Center Bioethics Forum.

Last week, NPR ran a story that made me cringe, describing a major humanitarian group’s decision to stop treating patients from detention centers in Misrata, Libya. According to the report, “torture was so rampant that some detainees were brought for care only to make them fit for further interrogation.”1

On the one hand, I thought, it must have been heart-wrenching to walk away from the detention centers, where the organization had been working since last August, knowing some detainees would die without care. But then I thought, there really was no other option; these health workers were being used as pawns of warfare.

In a press release last week, Doctors Without Borders/Médecins Sans Frontières (MSF) stated that MSF workers had treated at least 115 people with torture-related injuries and reported these cases to relevant local and national authorities, but, in case anyone doubted the human capacity for violence or cruelty, their pleas to stop the abuses went unaddressed. Instead, they received four more patients with torture-related injuries. Médecins Sans Frontières General Director Christopher Stokes called the situation an obstruction and exploitation of the organization’s work.

Torture: Flouting International Law and Medical Ethics

Using torture in detention centers is a direct violation of the Geneva Conventions. Enlisting health professionals to inadvertently aid or abet these crimes puts them in violation of the most basic tenet of medical practice and ethics: do no harm. More specifically, there are strict, internationally recognized prohibitions against medical professionals participating in torture—covenants and declarations predicated on the desire to never see the atrocities of WWII repeated.2-5

The health professionals working with MSF are among the world’s most committed and courageous—people who work in conflict zones offering non-discriminatory care to the wounded. The attempts to manipulate these health professionals into unwittingly contributing to ongoing torture are deplorable and criminal.

And what’s worse is that despite the numerous international conventions aimed at protecting health workers in these conflict zones, increasingly they are finding themselves and their clinics under attack—pawns and targets of warfare.

Last year, the International Committee for the Red Cross released two reports that highlight this reality as ”one of the most crucial yet overlooked humanitarian issues of today: violence against health care.”6

These publications document the death or injury of more than 1,800 people in over 600 cases of violent attacks on health professionals, clinics, patients, or the patients’ families across 16 countries in fewer than three years. These are disturbing but clearly not comprehensive numbers. Headlines documenting this problem are appearing everywhere. For example:

Many groups are calling for immediate action to protect health professional and health facilities. One group of international nongovernmental organizations, including IntraHealth International, is advocating for better documentation of these attacks on health professionals and health facilities as a first step toward stopping these violations.

Earlier in the month, the World Health Organization’s (WHO’s) Executive Board took an important step toward protecting the lives of health workers and patients in conflict zones by passing a resolution that calls on the WHO director general for leadership in documenting these attacks. The resolution shows some concrete progress in an ongoing advocacy campaign that included a consortium of organizations urging the WHO to act in response to assaults on health workers and facilities last year.

Just yesterday, the Center for Strategic and International Studies released a new report, “Protection of Health Care in Armed and Civil Conflict” by Leonard S. Rubenstein calling for “the mere handwringing that has largely greeted attack on the health care in the past” to “be replaced by concerted international action and a system on documentation, protection, and accountability.” The international community owes at least this much to these health workers, who give so much and put themselves at risk to care for others.


1. Associated Press. January 26, 2012. Medical Group Halts Work In Libyan City's Prisons. National Public Radio.

2. The World Medical Association. 1948. Declaration of Geneva,

3. The World Medical Association. 1949. International Code of Medical Ethics.

4.  World Medical Assembly. 1975. Declaration of Tokyo, Guidelines for Physicians Concerning Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment.

5. The United Nations. 1982. Principles of Medical Ethics.

6. International Committee of the Red Cross. 2011. Health Care in Danger: Making the Case.