As the National Academies’ Committee on Human Rights (CHR) marks its 50th anniversary, NAM and emeritus CHR member Robert S. Lawrence and health and human rights scholar Leonard Rubenstein reflect on the promise of an international effort to protect health workers and facilities in armed conflict, the accountability gap that has limited its impact, and why safeguarding health care in conflict remains urgent.”
On May 3, 2016, the United Nations Security Council unanimously adopted Resolution 2286, condemning attacks on medical facilities and personnel in conflict and calling on states to strengthen protections for health care under international law.
Tragically, however, attacks on hospitals, health workers, ambulances, and patients continue to be rampant in conflicts around the world, raising urgent questions about implementation, accountability, and the role of the health community in responding.
To mark both anniversaries, we spoke with Robert S. Lawrence, co-founder of Physicians for Human Rights, and Leonard Rubenstein, co-founder of the Safeguarding Health in Conflict Coalition, about why Resolution 2286 mattered when it was adopted, what the past 10 years have revealed, and what stronger implementation could look like in the decade ahead. They also discuss how the National Academies and broader health communities can help address this global problem.
Both Lawrence and Rubenstein have long engaged with the National Academies on health and human rights issues, particularly through the CHR. For decades, the Committee has worked at the intersection of human rights and science, engineering, and medicine, including examining how conflict, repression, and attacks on health professionals and infrastructure affect societal health and safety.
This interview has been edited for length and clarity.
For readers who may be new to this issue, what is Resolution 2286, and why did it matter when it was adopted?
Leonard Rubenstein: The resolution came about after there had been a great deal of attention to some dramatic attacks on health care in different contexts, including the 2015 bombing of a Doctors Without Borders hospital in Afghanistan and the widespread targeting of hospitals during the war in Syria. In response to those attacks, and to growing attention to the problem globally, the UN Security Council decided to act and passed its first-ever resolution on the protection of health care in war.
At the time, it seemed like a landmark resolution. It required governments to reform military doctrine and practice, incorporate international law into domestic law and train their soldiers in it, conduct investigations, hold perpetrators into account, and take a number of other measures that were thought to make a serious difference in protecting hospitals, wounded and sick people, health workers, and ambulances. It passed unanimously. There was a great deal of hope at the time that because this was the highest body of the UN, it could really change behavior in a serious way.
Robert S. Lawrence: I would add a little historic note. The resolution seemed like the logical progression of a series of international agreements that began with the Geneva Conventions and evolved over time toward greater attention to civilian casualties, health workers, and health institutions. But none of those efforts had ever risen to the level of a Security Council resolution. So, this really was a historic moment.
Ten years later, has the resolution made a meaningful difference?
Rubenstein: Unfortunately, it has made no difference at all. The requirements the resolution laid out have not been implemented. There has been virtually no compliance, no enforcement, and no accountability for governments failing to take the promised actions.
At the same time, we have had terrible wars since 2016, and the situation has gotten much, much worse on the ground. There has been complete disrespect both for the Geneva Conventions and for the requirements of the resolution. The result is a lack of accountability and a lack of political commitment to complying with the obligations in the resolution.
Lawrence: The last 10 years have also shown how much the conduct of major powers matters. When the countries with the greatest influence show disregard for these norms, it weakens any hope that others will provide leadership in addressing attacks on health care. That has deeply undermined the promise of the resolution.
What have the past 10 years taught us about what it takes to better protect health care in conflict settings?
Rubenstein: One thing we have not talked about enough is the accountability gap, or the impunity gap. The resolution did call for accountability, starting with domestic accountability and then international accountability if domestic systems fail. But if there are no consequences for violations, impunity becomes an enabler of further violence.
There has not been justice for victims. There have not been serious political, economic, or diplomatic consequences for perpetrators of attacks. And when those who commit these acts continue to face no real costs, there is no incentive to stop. That impunity, as much as anything else, has led to the endless and routine violence against health care around the world.
Lawrence: Failure at the local and state level has an unintended consequence. It raises the threshold for getting action at the international level. There is no stepwise building of authority and accountability that begins closer to where the violations happen. The absence of that discipline sends a signal to others that there will be no consequences. That is extremely disturbing.
What role can health leaders, academic institutions, and international organizations play in moving this work forward?
Rubenstein: Before the resolution, or at least before the war in Syria, academic institutions did almost no research on the nature of these attacks, their dynamics, or their impacts on health systems. In the last 15 years, that has changed. There has been an outpouring of research, and we know much more now than we once did.
But what is still missing is serious engagement from the medical and public health communities globally. In any serious human rights crisis, it takes a constituency to push for compliance and accountability. You would think the medical community would be vocal in demanding protection for their colleagues from violence and showing solidarity with the people who face this violence every day. But that has been missing.
Lawrence: Bioethics and human rights are often considered as two sides of the same coin but attacks on health care have still not been made central enough in the way these issues are taught and discussed. Attacks on hospitals and health workers are among the clearest violations of respect for the individual and human dignity.
This is also where the National Academies can help. There is an opportunity to bring together people with expertise in psychology, sociology, law, medicine, engineering, and other fields to better understand the vulnerability of health workers and health systems in conflict, and to deepen the research on why these attacks happen and how to prevent them.
What does stronger implementation look like in practice over the next decade?
Rubenstein: First, we have to recognize that there is a crisis in human rights and a crisis in international humanitarian law globally, and this is one aspect of it. There has to be a major shift in commitment to these laws. And to make that happen, there has to be demand from constituencies of all kinds.
There are still steps that can be taken. Governments can be pressured not to sell arms to perpetrators of atrocities. Political and economic relationships can be made more difficult if these acts continue. The International Criminal Court can be pushed to bring cases. Domestic authorities can use the powers they have to prosecute perpetrators. The fact that these things have not happened does not mean they cannot happen. What is needed is commitment.
Lawrence: I would link this issue to broader challenges of the current day, including climate change, widening inequality, and the weakening of international support systems. These pressures all contribute to failures to protect basic human needs. If we are going to get back on the right path, we have to understand that this is part of a much larger system that is putting populations at risk.
On this anniversary, what do you most want readers to understand about why safeguarding health care in conflict is so important?
Lawrence: It goes to the core of preserving human dignity. When you have somebody who is sick and suffering, wounded, and in need of care, the ability to protect that person, and the people trying to help, is fundamental. Preserving respect for health care workers, health care institutions, and protective medical emblems calls upon the most basic principles that human rights law and the rules of war were built to defend.
Rubenstein: Over the last couple of generations, the medical community has increasingly recognized that its responsibility is not only devotion to individual patients, but also to the health of populations. This issue belongs within that responsibility. The effects of attacks on health care are so overwhelming, so obvious, and so long-lasting that it is important to get over the reluctance to think of the violence as something happening somewhere else. It is something to care about and extending that commitment could make a huge difference.
Solidarity with colleagues who face these harms every day matters. They go back to work with diminished supplies, with risks to their own lives and their families’ lives, and they persevere. They deserve support, and we owe them that support.
More about the CHR
Half a century ago, the Committee on Human Rights (CHR) – a standing committee of the National Academy of Sciences, National Academy of Engineering, and National Academy of Medicine – was founded to defend the rights of colleagues under threat around the world, while raising awareness of the importance of human-rights based approaches to science, engineering, and medicine.
Promoting and protecting the right to health for all people is a core part of the CHR’s work. The Committee has conducted behind-the-scenes advocacy for hundreds of health professionals subjected to unjust trials, arbitrary detention, and other forms of severe ill-treatment. It has also convened events, developed resources, and built communities of health professionals to address urgent health and human rights concerns. The latter includes the CHR’s Forum to Address Attacks on Health Professionals, which brings together domestic and international health care associations to help address violence against health professionals and health care, in the United States and around the world.
The CHR relies on the generosity of its supporters. As it marks its 50th anniversary this year, please help expand the program by making a gift and learn more about the CHR’s legacy and future by visiting its anniversary website.
