Targeting Healthcare Workers and Facilities

COVID-19 Health Care
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            Pearl River     As the pandemic continues, the service and sacrifices of health care workers continues to be front-page news, although with a different twist.  Rather than reading about pot banging and applause, we’re reading about their vaccination rates.  Where mandates apply in places like New York, we know 95% have had a least one shot, and 85% of home health aides have shots.

            That’s not the whole story in the US though.  We also read about attacks on women’s health centers and the doctors who provide abortions.  Now, healthcare workers could have litigation and fines in Texas.

            These are products of our division.  Talking to Professor Leonard Rubenstein of John Hopkins University, the former director of Physicians for Human Rights on Wade’s World , was even more disturbing.  His focus is how the violence of war is directed at healthcare workers and their institutions, which he detailed in a new book, Perilous Medicine. 

            This depressing story starts around the Civil War in the US and conflicts in Europe that targeted attacks on prisoners, the wounded, and military field hospitals.  An American, Francis Lieber, argued at that time that there needed to be rules of war to protect soldiers in such situations, but he also rationalized that total war might be acceptable if justified in an effort to more quickly end war.  The Lieber Code, often revised, is still part of the handbook for the US military.  Unfortunately, this has been used as cover for everything from Hiroshima to attacks on civilians.  At the same time, the Swiss, Henri Dunant, argued independently, that human rights needed to be guaranteed even in war.  Not only did this philosophy argue for the protection of medical workers and hospitals, but also to not target civilians.

            The so-called winners of wars leaned towards Lieber in justifying the WWII bombings in Germany and elsewhere, not wanting to be guilty of war crimes.  Similarly, the US bombed and destroyed 1000 hospitals in North Korea in that conflict.  The napalming and other total war displays in the Vietnam War, where people all over the world could see the conflict and not ignore the destruction, finally led to revisions to the rules of war, more in line with Dunant’s position.

            As we now are reminded in the pandemic, hospitals that are overcrowded and inaccessible, mean a higher death count.  Rubenstein notes that “Over the last thirty years, an estimated 29 million civilians have died in armed conflict from communicable, maternal, neonatal, and nutritional diseases, as well as non-communicable diseases and injuries.”  That’s a big number.  It may not all come from the destruction of facilities as the lack of access and peril that comes with seeking care during war.

            We haven’t solved this problem by a long shot.  Updating the Geneva Conventions in protecting civilians and health workers has proven difficult. Measures that would punish countries ignoring the conventions have been elusive, as has the creation of safe and no-fly zones, which often are blocked at the United Nations in the Security Council.  Our “better angels” seem to go into the bunkers during wars, but we need to force them out to stop these conflicts and needless, innocent deaths.  For now, we have a long way to go.