We must limit the impact of war on healthcare and humanity
The impacts of conflict on human health mean we must demand that Russia respects its obligations under the Geneva Conventions and International Humanitarian Law, says Julian Sheather, consultant ethicist and specialist adviser in ethics to the British Medical Association.
On February 24, a Russian ballistic missile carrying a cluster munition struck just outside a hospital in Vuhledar, eastern Ukraine. It killed four civilians and injured six healthcare workers, damaging the hospital, an ambulance and civilian vehicles. Mobile phone footage has emerged of Russian attacks on an oncology centre in Melitopol in south-eastern Ukraine. Once again patients, healthcare facilities and health staff are caught up in the juggernaut of war.
Morality and the law of war
For as long as there has been war there has been disagreement about the morality of it. Some say we must distinguish between a recourse to war that is lawful, and that which is unlawful. Or that law – or morality – must set limits to its fury. The law, it is argued, must restrict the targets of war, distinguish between combatants and innocents and deprive aggressors of weapons of mass and indiscriminate destruction. Others have argued that morality has no place in war; that the urgency and necessity of war pushes it outside the ambit of moral judgment.
International Humanitarian Law … seeks to regulate armed conflict and set limits to its devastating effects
On paper at least, this argument has been decided. International Humanitarian Law (IHL), also called the ‘law of war’, which incorporates the Geneva Conventions and their additional protocols, seeks to regulate armed conflict and set limits to its devastating effects. IHL is universal. Every state in the world, including Russia, is a signatory to the Conventions. Their moral justification is rooted in our common humanity.
The protection of healthcare, of the sick and injured, of health services and personnel is central to IHL. The rules include:
- the wounded and sick must be respected in all circumstances
- the wounded and sick must be treated without discrimination
- medical personnel exclusively undertaking medical duties must be protected at all times
- parties to an armed conflict may not impede the provision of care by preventing the passage of medical personnel; they must facilitate access to the wounded and sick, and provide the necessary assistance and protection to medical personnel
- health personnel must not be punished for carrying out activities compatible with medical ethics, including the provision of impartial care
- medical units, such as hospitals and other facilities used exclusively for medical purposes, must be respected and protected in all circumstances.
Despite the apparent unanimity of support for IHL and medical neutrality enshrined in the edicts listed above, they are under enormous contemporary stress. The conflicts disfiguring the greater Middle East, particularly in Syria and the Yemen, have been characterised by sustained and deliberate targeting of healthcare facilities and health professionals. The health consequences are difficult to exaggerate. Physical trauma goes untreated. Immediate health outcomes for pregnant women and young children plummet. Infectious diseases re-emerge – diphtheria has returned to the Yemen for the first time in 25 years. Psychological trauma can trigger serious and lasting mental disorders including PTSD and psychosis, along with depression, anxiety and a host of stress-related disorders. Substance misuse disorders spike. Those with long-term conditions go untreated.
If war cannot be prevented, its devastating effects must be constrained. Our common humanity demands it
War also displaces people. At the time of writing, 500,000 people have already left the Ukraine and that number could grow exponentially. As we have seen in recent decades, displacement can have serious long-term effects on individual and population health.
It is difficult to believe that a war on this scale has returned to Europe. Although looking at the events in Ukraine can lead to frustration and impotence, the impacts of conflict on human health mean we must demand that Russia respects its obligations under the Geneva Conventions and International Humanitarian Law. If war cannot be prevented, its devastating effects must be constrained. Our common humanity demands it.
Dr Julian Sheather PhD is consultant ethicist and specialist adviser in ethics to the British Medical Association.
You can follow Julian on Twitter @greenparakeet1
