Volume 92, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



During armed conflicts over the past several years, attacks on humanitarian workers and patients have increased, including the most recent overt killing of patients in their hospital beds in South Sudan and Central African Republic, and bombardments of hospitals in Iraq, Syria, and other countries. Direct attacks on patients inside hospitals, as well as social structural dynamics that undermine patient safety and security, are met with apparent indifference by international and medical communities. How can the medical profession remain silent and stand by while these factors render its core mission futile? In this article, I aim to shed light on this issue, and its implications for the future of the neutral and impartial provision of medical care; provide an analysis of underlying and contributing factors; discuss current international strategies; reflect on the responsibility of health providers; explore ways to strengthen our roles as physician advocates; and call for the medical profession to do more to protect medicine's core values.


Article metrics loading...

Loading full text...

Full text loading...



  1. Doctors without Borders, 2014. Medical Care under Fire in South Sudan. MSF Details the Killing of Patients and Vandalism and Destruction of Hospitals. Available at: http://www.doctorswithoutborders.org/article/medical-care-under-fire-south-sudan. Accessed February 26, 2014.
  2. International Committee of the Red Cross, 1977. Protocol Additional to the Geneva Conventions of 12 August 1949, and Relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II). Available at: http://www.icrc.org/ihl.nsf/full/475?opendocument. Accessed March 1, 2014.
  3. International Committee of the Red Cross, 2013. Health Care in Danger: First Steps at London Symposium. Available at: http://www.icrc.org/eng/resources/documents/feature/2012/health-care-in-danger-feature-2012-04-25.htm. Accessed February 28, 2014.
  4. United Nations News Center, 2014. South Sudan: UN Humanitarian Official Describes “Shocking” Scenes at Malakal Hospital. Available at: http://www.un.org/apps/news/story.asp?NewsID=47240&Cr=south+sudan&Cr1=#.UyTiso6v1W4UN. Accessed March 1, 2014.
  5. Inter-Agency Standing Committee (IASC), 2013. The Centrality of Protection in Humanitarian Action. Available at: http://www.humanitarianinfo.org/iasc/pageloader.aspx?page=content-about-default and http://www.globalprotectioncluster.org/_assets/files/tools_and_guidance/IASC%20Guidance%20and%20Tools/IASC_Principals_Statement_Centrality_Protection_Humanitarian_Action_December2013_EN.pdf. Accessed March 1, 2014.
  6. Mills K, , 2005. Neo-humanitarianism: the role of international humanitarian norms and organizations in contemporary conflict. Glob Gov 11: 190204.
  7. Wheeler V, Harmer A, , 2006. Humanitarian Policy Group at Overseas Development Institute, Resetting the Rules of Engagement: Trends and Issues in Military-Humanitarian Relations. Available at: http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion-files/273.pdf. Accessed March 1, 2014.
  8. Donini A, Minear L, Walker P, , 2004. The future of humanitarian action: mapping the implications of Iraq and other recent crises. Disasters 28: 190204.[Crossref]
  9. Slim H, , 1998. Not Philanthropy But Rights; The Proper Politicisation of Humanitarian Philosophy. Available at: http://www.tandfonline.com/doi/pdf/10.1080/714003759. Accessed March 1, 2014.
  10. Hersh S, , 2004. Torture at Abu Ghraib. Annals of National Security. The New Yorker. Available at: http://www.newyorker.com/archive/2004/05/10/040510fa_fact. Accessed March 1, 2014.
  11. Lifton RJ, , 2004. Doctors and torture. N Engl J Med 351: 415416.[Crossref]
  12. Annas GJ, , 2005. Unspeakably cruel—torture, medical ethics, and the law. N Engl J Med 352: 21272132.[Crossref]
  13. Rubenstein L, Pross C, Davidoff F, Iacopino V, , 2005. Coercive US interrogation policies: a challenge to medical ethics. JAMA 294: 15441549.[Crossref]
  14. Reis C, Ahmed AT, Amowitz LL, Kushner AL, Elahi M, Iacopino V, , 2004. Physician participation in human rights abuses in southern Iraq. JAMA 291: 14801486.[Crossref]
  15. Rubenstein LS, Bittle MD, , 2010. Responsibility for protection of medical workers and facilities in armed conflict. Lancet 375: 329340.[Crossref]
  16. Rubenstein LS, , 2012. Protection of Health Care in Armed and Civil Conflict: Opportunities for Breakthroughs. Center for Strategic and International Studies. Available at: http://csis.org/files/publication/120125_Rubenstein_ProtectionOfHealth_Web.pdf. Accessed March 1, 2014.
  17. Allie M, Abu-Sada C, Binet L, Bradol J, Brauman R, Crombe X, Doyon S, Hofman M, Lacharite MO, Leduc B, La Page M, Magone C, Neuman M, Rieff D, Terry F, Vidal C, Weissman F, Whittall J, , 2013. Humanitarian Negotiations Revealed. The Centre de reflexion sur l'action et les savoirs humanitaires (CRASH/Foundation MSF). Available at: http://www.msf-crash.org/livres/en/humanitarian-negotiations-revealed. Accessed March 1, 2014.
  18. International Committee of the Red Cross, 2012. Health Care in Danger: The Responsibilities of Health-Care Personnel Working in Armed Conflicts and Other Emergencies. Available at: http://www.icrc.org/eng/resources/documents/publication/p4104.htm. Accessed March 1, 2014.
  19. Medecins Sans Frontieres (MSF) Access Campaign, 1999. Medicine Should Not be a Luxury. Available at: http://www.msfaccess.org/content/medicines-shouldnt-be-luxury. Accessed March 1, 2014.
  20. Drugs for Neglected Disease initiative (DNDi), 2003. Available at: http://www.dndi.org/. Accessed March 1, 2014.
  • Received : 11 Jun 2014
  • Accepted : 31 Dec 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error