“In Kunduz, our patients burned in their beds. [Doctors Without Borders] doctors, nurses and other staff were killed as they worked. Our colleagues had to operate on each other. One of our doctors died on an improvised operation table – an office desk – while his colleagues tried to save his life.
Today we pay tribute to those who died in this abhorrent attack. And we pay tribute to those MSF staff who, while watching their colleagues die and with their hospital still on fire, carried on treating the wounded…
Ten patients, including three children, and twelve MSF staff were killed in the attack”
Thus spoke MSF International President Dr. Joanne Liu of the bombing of a Doctors Without Borders (MSF) hospital in Kunduz, Afghanistan by the United States Air Force, at the request of the Afghan government. This brazen atrocity, with one hundred and five patients and more than eighty staff in the building, continued for thirty minutes after MSF informed the US military that they were being bombed. In addition to the twenty-two civilian casualties, another thirty or more were injured. MSF has called for a war crimes investigation to be brought against the United States for the act.
What must it be like, as a patient in a hospital under attack? Being in an ostensible safe zone, a place of healing and sanctuary, rocked by explosions, hit by debris, the substances used to sterilize and keep you clean and safe now a sea of fire, the doctors, gods in white, screaming or bleeding. Fear and helplessness at its most pure, this is true terror. It is an outrage. As it always is.
In nearly every case, the Israeli Defense Force justified the attacks by declaring there were weapons caches within or beneath the hospitals
The MSF attack has been likened to the bombings of hospitals in Gaza, and parallels are certainly clear. Israel began destroying hospitals almost immediately with the start of 2014’s Operation Protective Edge. On the first day, July 9, one of Gaza’s largest health facilities, the European Hospital of Khan Younis, was shelled by Israeli planes. On July 18, the Israeli Defense Force (IDF) evacuated and then “obliterated” El-Wafa Hospital, Gaza’s only rehabilitation hospital, with fifteen direct artillery. Three days later, Al-Aqsa Hospital was struck by a tank shell, killing four and injuring forty. Then, on July 25, Israel hit Beit Hanoun Hospital, wounding two and killing one adult, and the Mohammed Durra Children’s Hospital, killing a toddler. Finally, on July 28, Gaza’s largest referral hospital, Al-Shifa, was attacked by the IDF. In nearly every case, the IDF justified the attacks by declaring there were weapons caches within or beneath the hospitals. MSF has, reasonably, also called these attacks war crimes.
And like Gaza to anti-Zionists, the MSF bombing is being used by anti-US pundits as a symbol of America’s exceptional cruelty in the world. The Intercept, for example, did a thorough if brief history of US bombings of civilian facilities since 1991, a vital piece of reporting, but one that skews the narrative to a single nation and a single timeframe. US and Israeli excesses must be called out, documented, and tried to the fullest extent of international law, but there is nothing exceptional about these situations. Salon writer Ben Norton declares as the headline of his article on the MSF attack “We have committed a war crime,” as though this were the first. But there is a rich military history of hospital bombings, beyond Kunduz and Gaza, from the Communist North Vietnamese to the Serbs at Vukovar to the Russian hospital bombings in Syria that took place just last week.
“In the first six months of 2014, Iraqi government forces repeatedly hit Fallujah General Hospital with mortar shells and other munitions”
Human Rights Watch (HRW) laid out in a twenty-four-page report the past decade of attacks on health care workers and infrastructure, including several on hospitals. Among the most gripping attacks happen, as is to be expected, in Syria and Iraq. However, the complete looting of a hospital in Mobaye, Central African Republic, and the Ukrainian military’s shelling of the Kransny Liman Railway Hospital, which “killed the hospital’s surgeon and resulted in severe infrastructural damage to the surgery, gynecology, and pharmacy wings of the hospital” are certainly still noteworthy. Additionally, in South Sudan, “during a period of extreme violence in Bentiu in April 2014, opposition forces targeted people sheltering for safety in Bentiu State Hospital, killing at least 19.” As well, “[f]rom December 15, 2013, to June 15, 2014, MSF recorded at least 58 people killed on hospital grounds, 17 cases of destroyed or stolen medical vehicles, and six incidents of hospitals looted or destroyed” Hundreds more healthcare attacks in South Sudan have been documented by MSF.
In Iraq, the situation is gruesome. According to HRW:
“[I]n the first six months of 2014, Iraqi government forces repeatedly hit Fallujah General Hospital with mortar shells and other munitions while battling armed groups in Anbar province. The hospital sustained structural damage and at least seven health workers and an unknown number of patients were injured in the attacks. In September, the same hospital was attacked again, seriously injuring at least one heath worker. The hospital is now believed to be under the control of ISIS. In June, a Médecins Sans Frontières (MSF) clinic and the main hospital in Tikrit were targeted. Shelling severely damaged the clinic, and two weeks later a targeted airstrike hit the main hospital. A helicopter dropped a bomb that destroyed the emergency room and ground floor of the hospital. One person was killed, and another injured, causing medical workers to flee. One month later, on July 20, Shirqat hospital was bombed and health workers were forced to evacuate and transfer patients to facilities in other towns. On September 7, the Iraqi Air Force struck an ISIS-controlled hospital near Kirkuk, killing seven patients and wounding 22, including children. Despite Prime Minister Haider al-Abadi’s orders to the Iraqi army to cease attacks in ISIS-controlled civilian areas, shelling hit another hospital in Fallujah a day later, seriously injuring a medical staff member. British aerial bombings in the Iraqi border town of Rabia on October 1 struck another ISIS-controlled hospital.”
And in Syria:
“The UN Independent International Commission on the Syrian Arab Republic has reported that Syrian security forces have systematically targeted hospitals in opposition-controlled areas. … [A] government air strike with targeted missiles destroyed al-Rodwan Hospital in Jassem, Dara’a governorate on May 15, 2014. … a doctor, nurse, radiologist, lab technician, and two children were killed in the attack. … A doctor with the Aleppo City Medical Council, an independent nonprofit organization, told Human Rights Watch that government forces began repeatedly bombing the city’s hospitals around January 2014 and struck hospitals that were not being used for military purposes in Hanano, al-Sukari, al-Sakhour, and alShaar neighborhoods. The doctor also said that barrel bombs hit two well-marked hospitals in al-Shaar and Hanano neighborhoods of Aleppo on April 13 and 21, 2014 respectively. According to Physicians for Human Rights data, government forces aerially bombarded eight medical facilities in 15 separate attacks in eastern Aleppo city between January and July 2014. Thirteen of the attacks were with barrel bombs, the other two with guided rockets and missiles. None of the facilities were on the front line. In November 2014, an ISIS suicide truck bomb reportedly struck and damaged a field hospital in Kobani, a Syrian city on the Turkish border.”
A comprehensive study of such attacks would fill a book
As Russia begins their own bombing campaign in Syria, we must be reminded of their own record in the field of hospital attacks. In fact, a mere two days after the US bombing of the MSF hospital in Afghanistan, it seems the Russian air force bombed another hospital in the Syrian city of Hama. As Russian airstrikes intensify, Syrians can expect an increase in such horrors, not a decrease.
But this is not a modern phenomenon. Hospital attacks as a form of state warfare have been going on throughout history. What follows is a far-from-complete study of attacks on hospitals by state military forces. A comprehensive study of such attacks, without even adding the thousands of acts of terrorism or attacks by local militias, or expanding to attacks on other medical facilities or personnel, would fill a book. The following examples, however, should provide sufficient evidence to show that military attacks on hospitals are not the exception but the rule.
World War Two seems, from our understanding, an exceptionally prolific period for attacks on hospitals. Japan, for example, was particularly vicious during the battle for Singapore:
“Japanese soldiers stormed Alexandra Military Hospital and slaughtered its occupants, including the medical staff and patients. Even those undergoing surgery were not spared. Following the massacre, the Japanese forced those left to clean up the mess and then herded them into cramped rooms. When morning came, the Japanese rounded up the 200 survivors (some died during the night) and bayoneted them in the courtyard. Only five survived the second massacre—by hiding in a storm drain.”
Similar hospital massacres occurred in Hong Kong during the Japanese occupation, such as the St. Johns College massacre, in which over one hundred doctors, nurses and injured patients were butchered. And of course it surprises no one that the German military in both world wars had a similar record of hospital attacks starting in the First World War and continuing into the Second.
It was attacks like this that allowed the US military to excuse the annihilation of entire cities, with nineteen hospitals destroyed in the firebombing of Dresden, and the eighteen hospitals wiped off the map in the nuclear holocaust of Hiroshima, even more appalling records than Germany’s destruction of the Spanish town of Guernica, which destroyed at least two hospitals. This history is worth remembering as Japan revises its constitution to use its armed forces for any purpose other than defense for the first time since that fateful war, a move that opponents declare will lead to involvement in US-led wars, the kind that result in the bombing of Doctors Without Borders hospitals. And, while in no way comparable to the annihilation of entire cities with fire and nuclear weapons, it is worth mentioning that the British military were no angels either, bombing the Bethel Hospital in Bielefeld, Germany in 194o and nine hospitals in the bombing of Cologne in 1942, as well as San Loreto Hospital (the RAF and USAF working together) in Naples in 1942. Russia joined in as well, with such acts as the slaughter of forty-two doctors and patients in a Polish hospital in 1939.
The 1949 Geneva Convention stated that civilian hospitals “may in no circumstances be the object of attack”
While World War Two may have ended in 1945, the world remained at war. In Mandatory Palestine, today’s Israel, in 1948, a Jewish medical convoy on its way to Hadassah Hospital was ambushed by Arab forces, some in Iraqi military uniform. Seventy-nine Jewish patients, doctors, nurses, students and soldiers were killed. This attack is still remembered in Israel, and used as further justification for more modern atrocities such as the Gaza hospital bombing. Interestingly (and embarrassingly), while Israel justifies attacks on Gaza hospitals by citing weapons caches being stored within, the Hadassah Hospital convoy was also carrying weapons, ostensibly to fortify the hospital from attack, making the ambush justifiable by IDF logic.
After the second Great War, international attempts were made to forbid atrocities against civilian populations in future. The 1949 Geneva Convention stated that civilian hospitals “may in no circumstances be the object of attack”. Following the most recent spate of bombings, MSF President Liu said in her speech:
“This was not just an attack on our hospital – it was an attack on the Geneva Conventions. This cannot be tolerated. These conventions govern the rules of war and were established to protect civilians in conflicts – including patients, medical workers and facilities. They bring some humanity into what is otherwise an inhumane situation.”
But, despite lovely intent and pretty promises, such attacks did not end with Geneva, and have been regularly tolerated since.
Hospital bombings heed no geographical bounds. In 1950, during the first battle of Seoul, North Korean forces massacred between seven hundred and nine hundred doctors, nurses, patients, and injured soldiers in the Seoul National University Hospital, the building for which the massacre is named.
In August 1967, a Communist North Vietnamese attack on a hospital in Vietnam killed forty-six and wounded two hundred twenty two people.
In April 1977, the Zaire military bombed a hospital at the Zambian border during the war between the two countries.
Of course, Kunduz is far from the first of these hospital bombings by the American military
Perhaps the most famous hospital attack of modern times is the Vukovar Hospital Massacre at the early stages of the breakup of Yugoslavia. When it took place in November 1991, it was considered the worst war crime in Europe since the end of World War Two, though it was shortly thereafter surpassed. Nearly three hundred people, including both civilians wounded in the civil war and injured soldiers, were taken by Serb forces from the hospital in the Croatian city of Vukovar to a farm six miles away, where they were shot or beaten to death and buried in a mass grave. The hospital itself was additionally bombed in an airstrike a month and a half before the massacre.
And of course, Kunduz is far from the first of these hospital bombings by the American military. During the invasion of Grenada in 1983, the US Air Force destroyed a mental hospital, killing twelve, while in the initial 2003 invasion of Iraq, they bombed a Red Crescent maternity hospital along with many other civilian targets.
In 1999, during the seemingly eternal civil war in Colombia between the western-supported regime and the notorious guerrilla group FARC, it is reported that:
“The Colombian military took advantage of U.S.-supplied aircraft, logistical support and equipment to open fire on the civilian population of Puerto Lleras… During the heat of battle, the Colombian Air Force swooped from the sky to bomb and strafe dozens of buildings, including houses, a hospital, a church and a convent killing three civilians and wounding several others… Extremely troubling was that the Colombian Air Force strafed a hospital with a red cross painted on its roof and with a Red Cross flag posted outside. The hospital was providing shelter for 400 civilians trying to escape the combat. The air force also fired on a clearly marked ambulance carrying wounded civilians for evacuation. Witnesses… said they identified American flags on the tail fins of some of the aircraft.”
In May 1999, NATO twice bombed hospitals in Serbia, first when “a cluster bomb aimed at an airfield in the Yugoslav city of Nis hit a hospital and a market, killing 15 civilians,” and then two weeks later when “a Nato bombing attack led to the deaths of at least three patients in a Belgrade hospital. Parts of the Dragisa Misovic hospital, near a barracks in the Dedinje district, were reduced to rubble. State television reported that emergency services evacuated infants and pregnant women. One woman was in labour when the bombs hit, the report said.” In both cases, NATO’s top brass denied targeting civilians or medical centers.
From the Pacific Rim to the Middle East to Europe to Africa to the Americas, the phenomenon of attacks on hospitals in war is rampant
In Sri Lanka’s endless war on its Tamil citizens, hospital attacks have been a common strategy. As recently as 2009, Human Rights Watch accused the Sri Lankan military of shelling at least nine hospitals in the country’s safe zones. Primary among these is the Mullivaikal Hospital, which was shelled by government forces between April 23 and May 12, 2009, killing more than one hundred, and injuring a similar number.
From the Pacific Rim to the Middle East to Europe to Africa to the Americas, the phenomenon of attacks on hospitals in war is rampant. As far as a century back, the data is easy to compile, yet looking back further one can see that, in eras when the utter annihilation of entire cities was not uncommon in war, something as small as the destruction of a hospital would not have seemed necessarily noteworthy to historians at Carthage, Schechem, Tenochtitlan, or any of the other razed cities of ancient history. To document every wartime attack on a hospital, while an important task, would take years. And that’s the point.
In her speech, MSF President Liu declared “Today we say: Enough. Even war has rules.” But sadly, despite this deeply held conviction by nearly every international player that war is somehow a just act, the reality of war is the atrocity. We want so badly to pretend that war is a civilized practice, that civilians can be protected from state violence and that there can be rules and they can be followed, that war can be as innocent as it is portrayed on film or in games. But those laws that allow us to play this game of make believe have been consistently ignored since their conception, and no major military has yet been convinced to take them seriously. The truth of war is the hospital bombing. The truth of war is the massacre and the war rape and the child soldier. War is not defense but legalized violence against a vaguely defined “Other”. The horror is the truth of war, not the exception.
Hospital Attacks In Wartime Are Not The Exception, They Are The Rule by Zachary Gallant is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
