Over the past three years, attacks on healthcare in conflict settings have increased alarmingly, both in frequency and severity, with a record number of violent incidents against healthcare in 2024, 3,623 incidents, representing an increase of 15% compared to 2023 and 62% compared to 2022. These attacks took place in 36 countries and territories, with the Gaza Strip and the West Bank being the most affected, followed by Ukraine, Myanmar, Sudan and Lebanon. In all of them, there were systematic attacks on hospitals, health centres, ambulances and healthcare personnel.
These attacks occur precisely when healthcare needs are most urgent, depriving communities of access to essential services. The protection of healthcare in conflicts is enshrined in international humanitarian law, which establishes fundamental principles such as the distinction between civilians and combatants, the proportionality of harm and respect for medical ethics. However, these principles are regularly violated, posing a serious threat to human rights and public health.
According to the Safeguarding Health in Conflict coalition, attacks included aerial bombardments, missiles, drones, shootings, fires, looting, occupation of medical facilities and detention of healthcare personnel. Gaza was the epicentre of the violence, with more than 1,300 attacks, the highest number recorded in a single conflict in one year.
Globally, more than 1,100 facilities—hospitals, health centres, pharmacies and other services—were damaged or destroyed, almost double the number in 2023. Attacks on healthcare personnel also intensified: more than 900 professionals, mostly local, were killed in 27 countries, representing a 21% increase over the previous year. In addition, 470 workers were arrested or detained in 15 countries.
The highest number of deaths in 2024 was reported in Lebanon, with 408 deaths, mainly during the Israeli army's ‘Northern Arrow’ operation, while 226 deaths were recorded in the Occupied Palestinian Territory (218 in Gaza and 8 in the West Bank). Significant increases were also reported in Ethiopia, Pakistan, Syria, Ukraine, Myanmar and Sudan.
As for detained health workers, these occurred in various contexts. In Gaza, the Israeli army detained medical personnel during raids, at checkpoints and following evacuation orders.
Although Gaza is the territory hardest hit by attacks on healthcare infrastructure, with 20 of its 36 hospitals out of service and only 40% of health centres functioning, countries such as Sudan, Ukraine, Lebanon and Mozambique have also been severely affected. Sudan and Mozambique, both with very precarious and fragile health systems, are in an extreme situation. In Sudan, less than 25% of health facilities remain operational, while in Mozambique, only one in seven health centres remains active. In Lebanon, more than 100 centres have had to close, and Ukraine is finding it increasingly difficult to keep hospitals operational due to power cuts caused by attacks on the electricity grid. These attacks endanger patients' health by interrupting or delaying surgeries, forcing operations to be performed in the dark or lit only by headlamps, and rendering diagnostic and treatment equipment unusable.
These attacks have devastating consequences for the population, not only causing direct deaths and injuries among patients and healthcare personnel but also disrupting the ability of health systems to respond to emergencies, treat chronic diseases and maintain basic services such as vaccinations and maternal health.
In addition, violence and deliberate attacks prevent patients from accessing the health services they need. In countries such as Syria and Nigeria, people avoid going to health centres out of fear, while in the West Bank, curfews, increased checkpoints, road closures and the destruction of infrastructure make it difficult to access essential health services.
In contexts where humanitarian access is also hindered or prevented, the consequences can be even more serious, as those problems are compounded by a lack of medical supplies and products, including medicines. This can lead, as in the case of Gaza, to extreme situations in which it is necessary to operate without anaesthesia and reuse equipment that would normally be discarded, which becomes commonplace. Patient evacuations may also be affected. Again, in Gaza, only 121 patient evacuations were possible, compared to the 11,000 urgent evacuations that were required. The impact on the health of these patients is unimaginable.
Although the protection of healthcare is enshrined in international humanitarian law, attacks and violence against healthcare systems are carried out with total impunity.
The 1949 Geneva Conventions and their 1977 Additional Protocols, which oblige all parties to a conflict to respect and protect medical care, and UN Security Council Resolutions 2573 and 2286 on respect for IHL and the protection of healthcare in armed conflicts, are systematically ignored.
Resolution 2286, which focuses on protecting medical missions, establishes specific measures to protect healthcare in armed conflicts, requiring States to incorporate protective measures into the military sphere, develop national legal frameworks, collect data on attacks and threats, and share best practices. It also stresses the need to end impunity and to conduct independent, thorough and effective investigations into violations of international humanitarian law related to healthcare.
However, almost 10 years after its adoption, these commitments remain unfulfilled. The international community must therefore be called upon to take all necessary measures to ensure effective compliance with both the Geneva Conventions and the two UN resolutions.
The WHO has proposed a series of recommendations to improve the protection of health systems in armed conflict situations which, if implemented, could represent a significant step forward in protecting medical missions.
However, little progress can be made without the necessary political will on the part of governments, which, despite the seriousness of the violations of human rights and IHL, continue to resist taking action. That is why we must remind them once again that, under Article 1 of the Fourth Geneva Convention, third States have a legal obligation not only to respect but also to ensure respect for the provisions of the Convention. At a time and in a context where international norms are being systematically violated, third States cannot limit themselves to reiterating public statements expressing concern about violations of IHL, including attacks on the medical mission, but must take concrete and proactive measures to enforce IHL. Otherwise, we will enter a spiral of impunity for violations of IHL and the rules-based international system, which could lead to the collapse of the humanitarian system.