Sir, – I have been reading A Woman in Berlin, that searing account of the final weeks of the second World War in 1945. The anonymous author describes a hospital marking its roof with white sheets and painted crosses in a desperate plea for protection. The bombs kept falling. Even then, the staff and wounded were not spared.
The destruction of hospitals in war is not new. It is a deliberate strategy to break morale, hollow out resilience and to turn care into terror. But in today’s conflicts this tactic has been refined, industrialised and, most disturbingly, normalised.
The justification is by now grimly familiar: hospitals are said to be used as “human shields”. Yet across conflicts this claim has hardly been substantiated, certainly not to the standard required to override the protections of international law. And even where misuse is credibly suspected, the law is unambiguous: protection is not simply voided. There must be warning, time, discrimination and proportionality. These principles are being eroded in practice. They are signals that the red line around medical neutrality, never very clear, is fading fast.
The scale is stark. Here are the raw figures: the World Health Organisation (WHO) has reported 2,881 attacks on healthcare facilities in Ukraine, with 233 health workers killed and 930 injured since February 2022. In Gaza 442 health facilities have been damaged and 756 health workers have been killed, research by Insecurity Insight has found. In Lebanon WHO reporting in 2024 cited 158 attacks on health facilities and the deaths of 241 health workers. The Iranian Red Crescent Society has said 307 medical facilities have been damaged in the last six weeks. Given the scale of destruction, it would make no sense for a combatant group to hide its materiel there – anywhere else would be safer, it seems.
RM Block
For those of us responsible for training the next generation of healthcare workers, this raises an intolerable question. Are we now preparing them not only to save lives, but to accept that their workplace may be a target? That their vocation carries an existential risk once confined to the battlefield?
That is not a future we should accept. The systematic erosion of medical neutrality demands more than documentation; it demands outrage, accountability and reversal. If we allow this to become normal, we diminish not only medicine, but our collective humanity. – Yours, etc,
Prof COLIN DOHERTY MD,
Head of School of Medicine,
Trinity College Dublin.
