It has been almost a decade since the United Nations Security Council unanimously adopted a resolution condemning attacks on medical personnel and facilities during conflict and demanding compliance with international humanitarian law intended to protect them. Instead, attacks on health facilities, personnel, and patients have become calculated elements of war strategy.
Security Council Resolution 2286, adopted in May 2016, was supported by the United States, Russia, China and other member States. And yet, according to the annual report of the Safeguarding Health in Conflict Coalition (SHCC), 2024 marked another rise in attacks against health care worldwide — a 15 percent increase over the previous year. Never before had such a high number of attacks on health care — 3,623 identified incidents — been recorded as in 2024. This continues a shocking escalation. These attacks include strikes on hospitals and ambulances, as well as abductions and killings of health-care workers. Behind each statistic are families shattered, communities losing vital care, and health workers killed or injured for simply doing their jobs.
Globally, the hybrid nature of these attacks reflects the shift in modern warfare. In settings ranging from Gaza to Sudan to Ukraine, perpetrators increasingly are not only bombing hospitals or threatening medical staff, as if that weren’t horrific enough. Attackers are taking advantage of how interconnected health-care systems are with other critical infrastructure to inflict maximum harm, deliberately severing humanitarian aid, power, heating, water, and supply routes to disrupt the delivery of health care. These tactics show that attacks on health are not isolated events; they are part of a deliberate war strategy.
Ukraine as a Stark Example
Ukraine is one stark example of this shift. Since Russia’s February 2022 full-scale invasion, the organization where I work, Physicians for Human Rights (PHR), has helped document 2,000 incidents of attacks on health care. Over the course of the war, assaults on health care also have become more systemic and multidimensional. In the Russian-occupied areas, for example, hospitals are militarized and care is conditioned on whether the patient has Russian nationality (another way to coerce Ukrainians under occupation to accept Russian citizenship that is being forced on the population).
Other tactics include double-tap strikes, the term for rushing to the scene of a military strike to help, and more indirect maneuvers, such as targeting energy infrastructure vital to the functioning of the health care system. PHR and the Ukrainian human rights organization Truth Hounds have detailed how Russia’s targeting of energy systems led to blackouts in intensive care units, disruptions of medical services, increased burden on staff, and reverberating impacts on health.
The situation has been further exacerbated by the suspension of U.S. government foreign aid funding in Ukraine in early 2025, which by disrupting services for HIV and tuberculosis patients, impeding hospital modernization and rehabilitation efforts, and limiting access to care. Russia’s ongoing attacks combined with these resource constraints are putting additional pressure on an already weakened system.
The dynamics of deliberate obstruction are evident in Gaza, where PHR and partners documented how Israel’s blockade and restrictions on medical supplies have compounded the devastation of the health care system. “We Could Have Saved So Many More,” a recent report from PHR (a separate entity from Physicians for Human Rights –Israel), details how months of denied entry of essential medical supplies, including anesthesia, insulin, and oxygen cylinders, left health-care workers unable to treat the wounded and critically ill.
Fragmented and Weak Enforcement
Despite the existence of robust international legal frameworks, including the Geneva Conventions, enforcement measures for attacks on health care remain fragmented and weak. The continuous and persistent impunity for these attacks has rendered the norms established under U.N. Security Council Resolution 2286 ineffective. The resolution was innovative at the time, marking the first instance when the U.N. Security Council addressed violence against health in armed conflict, with States making commitments to seek accountability among perpetrators. But the measure falls short on specific mandates and mechanisms for oversight, investigation, or follow-up. The responsibility of addressing attacks is placed on States that often are the perpetrators of these tactics, and there is no single body or mechanism focused on health care in conflict at the global level.
As a result, responses have been uneven: occasional condemnations, under-resourced documentation efforts, and a reliance on humanitarian actors with limited capacity and mandate to fill the gap left by political inaction. This leaves victims and health-care workers with no clear avenues for redress and puts them at risk, as perpetrators are emboldened to carry out additional attacks unchecked. The international community has been regrettably slow in moving beyond reaffirmation towards accountability.
That goes some way toward explaining why there still have been no prosecutions for attacks on health. Aside from legal, institutional, and political obstacles, investigators also encounter difficulties with evidence collection and the distinction between legitimate targets and protected objects. Investigative authorities may lack technical expertise or a mandate to focus on health-specific violations. And above all, there is a lack of political will: States are reluctant to challenge perpetrators when doing so could strain relations or implicate allies. Until these systemic barriers are addressed, the cycle of impunity will continue.
Four Critical Lines of Effort
In this year leading up to next May’s 10th anniversary of Resolution 2286, States and international community must take four critical sets of actions to turn the tide on attacks against health and ensure justice for those affected by these serious violations of international law.
- Invest Political Will in Enforcing Protections for Health Care
Efforts to stop violence against health care will not succeed through international norms alone. The core issue is not a lack of frameworks or actors — it is a lack of political will. While coalitions such as the Safeguarding Health in Conflict Coalition, of which PHR is a member, have made critical contributions to documentation and advocacy, meaningful State action must follow. What is needed is a coordinated commitment by States — that goes beyond a U.N. resolution — willing to use their political, diplomatic, economic, and legal leverage, including through the ICC, arms control, and bilateral pressure to hold perpetrators accountable and deter future violations.
This moment also offers an opportunity to link enforcement with broader modernization of international humanitarian law, recognizing the challenges of current legal frameworks in the face of the ever-changing nature of violent conflict. Given the close connection between the attacks on health and the rights to life and health, the U.N. Human Rights Council and other rights-based mechanisms have a critical role to play by grounding attacks on health more firmly within international human rights law.
- Heed the Needs of Affected Health Care Workers
Any efforts to address the growing scale of attacks must also prioritize the voices and needs of health-care workers. Specific steps could involve enhanced security and preparedness protocols, institutional support for documentation efforts, and access to redress, psychosocial, and legal support. In Ukraine, dozens of health-care workers have been detained, tortured, and forcibly disappeared by Russian forces. Others have risked their lives to continue providing care in bombed-out hospitals or during blackouts. Health-care workers are not only victims and survivors of these attacks but also first responders, witnesses, and documenters — roles that require recognition, protection, and support.
- Deliver Reparations and Mechanisms to Prevent Future Attacks
Third, for victims and survivors of attacks on health in Ukraine, accountability must extend beyond criminal justice. Full recovery will require a better understanding of the reverberating harms that attacks on health care cause for communities and for countries in general.
In Ukraine, clear principles for reparations in the health sector should be a key element of the ongoing peace negotiations and transitional justice efforts. Survivors and victims, including health-care workers, must be meaningfully involved in shaping these frameworks.
Reparations for attacks on health — through compensation, restitution, and forward-looking measures to prevent violations — should be embedded into Ukraine’s broader post-war recovery. These measures could include legal and institutional reforms to strengthen protection of health care and improve compliance with international law through targeted pressure. Comprehensive justice also means rebuilding hospitals, compensating families of health-care workers killed or injured, and rebuilding the capacity of the health sector.
- Treat Accountability as Non-Negotiable
With accountability for attacks on health historically neglected, the fast erosion of international humanitarian law should be a turning point. Justice should be prioritized not just as an obligation and moral imperative but also as a necessary deterrent. Thousands of survivors and victims of these attacks deserve to have perpetrators held to account.
In Ukraine, this urgency is amplified by a volatile geopolitical climate in which such violations risk being sidelined — or even denied — at the international level. As the Parliamentary Assembly of the Council of Europe affirmed in April, any peace process in Ukraine must not compromise accountability. To ensure that justice processes are effective and grounded in the national context, the capacity of local investigators and prosecutors should be strengthened, with particular attention to identifying, prioritizing, and building cases related to attacks on health.
Next year’s 10th anniversary of Resolution 2286 must be more than a commemorative moment. It presents a chance to build something concrete to ensure full implementation of the resolution and to pave the way towards sustained and meaningful accountability.
The post Protecting Health Care in Conflict: Lessons from Ukraine for a Global Roadmap appeared first on Just Security.
