The last pediatrician in Aleppo, Syria was killed and the emergency room and pediatric unit destroyed when a government air strike hit Al-Quds Hospital on April 28, 2016. Since then, shelling and airstrikes targeting civilian areas in Aleppo have continued. Where have people injured during the attacks, particularly children, gone for life-saving treatment? And what steps have been taken to protect Al-Quds and other hospitals from attack?
One step was already taken five years ago, on July 12, 2011, when the United Nations Security Council adopted Resolution 1998. Specifically focused on children and armed conflict, Resolution 1998 made state and armed non-state actors that carry out attacks against schools and hospitals eligible for inclusion in the Secretary General's list of shame published in the annual report on children and armed conflict. Since then, 12 parties from 7 countries have been listed for attacks on schools and hospitals and there has been a widespread increase in awareness amongst practitioners and the public of the prevalence and scale of targeted attacks. However, attention has predominately focused on attacks on education and actions that can be taken to protect education from attack. Comparatively much less is known about attacks on hospitals and health care and the impact of these attacks on children.
Why is this so? First, the Global Coalition to Protect Education from Attack (GCPEA), a network of UN agencies and INGOs, has, since it was founded in 2010, continued to highlight the incidence and impact of attacks on education through research and advocacy. Education under Attack 2014, a global study published by GCPEA, found that education had been attacked in 70 countries throughout the world from 2009 to 2013, with a pattern of such attacks occurring in 30 countries. Malala Yousafzai, who survived an attack by Taliban gunmen on her way home from school on October 9, 2012, has also been an outspoken and inspiring advocate for education and the importance of protecting education from attack. These and other efforts have led to action. Fifty-four states have to date endorsed the Safe Schools Declaration, a non-binding political commitment to adopt a comprehensive approach to protecting education from attack, including implementing into military doctrine and national law the Guidelines to Protect Education from Attack and Schools from Military Use.
Similar efforts should be undertaken to research incidences and the impact on children of attacks on hospitals and health care and to advocate for the implementation of protective measures and accountability for parties that have perpetrated attacks. Reports published in recent years by a number of organizations have documented that hospitals and health care have been systematically attacked as objects of war. A report released in May of this year by Safeguarding Health in Conflict documented that targeted attacks against hospitals and health care had been carried out in at least 19 countries throughout the world between January 2015 and March 2016. The Secretary General's annual report on children and armed conflict released in June reported significant increases in attacks on hospitals and health care in 2015 in a wide range of countries, including Afghanistan, Yemen, and the State of Palestine. According to Leonard Rubenstein, founder and director of Safeguarding Health in Conflict, "while we are getting a better picture of the frequency and types of incidents, we need much more of an understanding of the impact."
Some of the impacts are already known. These include loss of access to health facilities and emergent and preventive care, flight of health workers, and increased mortality. For example, Physicians for Human Rights estimates that more than half of Syria's doctors have fled the country since the conflict began, resulting in entire communities' complete lack of access to medical care.
However, attacks on hospitals and health care have a differential impact on children, including lack of access to vaccinations that have resulted in the recurrence of preventable childhood diseases in countries such as Afghanistan, Syria, and Yemen, and lifelong disabilities resultant from lack of access to health care that might limit or prevent altogether access to education or future employment opportunities. These are but two examples of the devastating consequences to children of attacks on hospitals and health care that are just beginning to be traced by organizations such as Watchlist on Children and Armed Conflict.
When Resolution 1998 was passed on July 12, 2011, so much less was then known about attacks on education. However, sustained research and advocacy have put a spotlight on this issue and helped lead to efforts to protect education from attack. Let us commemorate the five-year anniversary of Resolution 1998 by widening the spotlight to include attacks on hospitals. As with schools, hospitals are protective spaces for children and vital to ensuring children's future. However, for schools and hospitals to be protective, they must be protected. Simply stated, more efforts need to be undertaken to document attacks on hospitals and analyze the immediate as well as long-term effects of attacks on children. Doing so is critical to raising awareness of the prevalence and scale of the problem, so that action can be undertaken.