On the second day of informal consultations on the draft political declaration the use of explosive weapons in populated areas, Mines Action Canada took the floor to share our views on Section 4 of the draft text.

Here is the statement: 

Thank you Ambassador.

One strength of a political declaration over a legal document is the increased availability of descriptive and human-centred language. Section 4 of the draft Political Declaration allows states to commit to making real life-saving change using language that puts civilians at the centre of their actions.  We support INEW’s stamen on this section but would like to highlight a few key points.

In particular Paragraph 4.4 should be strengthened significantly to put civilians at the centre. Revising this paragraph with more detail of what victim assistance includes will avoid creating differential obligations towards victims of different weapons. INEW, HRW and HI have all made excellent suggestions so I will put our support behind those.

The reference to urban warfare in paragraph 4.1 should be deleted since not all populated areas can be considered urban. The mention of urban here focuses the paragraph too narrowly on civilians who live in urban areas rather than civilians living in all populated areas.

We welcome the commitment to make data collected public in paragraph 4.2, however, we would like to see the phrase “where possible” deleted as it weakens this paragraph. Data is crucial for understanding how explosive weapons impact civilians and for providing life-saving services as mentioned by MAG therefore that data should be available widely. 

Paragraph 4.3 like others, should refer to all use of explosive weapons, not just that with wide area effects. Our efforts to limit the harm caused by explosive weapons should not exclude some types of these weapons. Additionally, the word “relevant” in qualifying civil society should be removed from this paragraph. We share Chile and Mexico’s questions about this language.

We support the suggestion by the Conflict and Environment Observatory to include language encouraging state signatories to support the work of the United Nations and other international and domestic stakeholders in identifying and implementing best practices in the assessment and environmentally sound management of conflict debris and pollution resulting from the use of explosive weapons.

We also support the inclusion of civil society in section 4.6 as mentioned by New Zealand, Chile, Mexico, Italy, Switzerland and others. We agree with Canada’s suggestion to ensure participatory and gender sensitive inclusion of civil society at all levels.

Finally, we would like to take this opportunity to strongly encourage states to be ambitious as we move towards a final version of this declaration. An ambitious document like the treaties adopted in Oslo in 1997 and Dublin in 2008 will save lives. Please keep people at the centre of your work here today and in the future.

Thank you Ambassador for your able and open chairing of week. We look forward to continuing the process.

On the second day of informal consultations on the draft political declaration the use of explosive weapons in populated areas, Mines Action Canada took the floor to share our views on Section 3 of the draft text.

Here is the statement: 

Thank you Ambassador.  

We support the comments from INEW on this section which will be delivered later.

Like our colleagues at Norwegian People’s Aid, we believe risk education should be added to paragraph 3.5. The Mine Ban Treaty, the Convention on Cluster Munitions and CCW Protocol V have all shown the need for and the value of risk education.

Because our purpose this week is to protect civilians, we note that there is no need to wait for the end of active hostilities to conduct risk education especially because explosive weapons use causes new contamination and during armed conflict civilians are often forced to undertake risky activities or travel to new areas with contamination due to displacement or infrastructure damage.

Finally, I would like to make a general comment. Yes it is important to take into account the views of states with operational experience and of civil society but it is crucial to include the experiences of states and communities living with the long term and extensive impact of explosive weapons use.

Thank you.

On the first day of informal consultations on the draft political declaration the use of explosive weapons in populated areas, Mines Action Canada took the floor to share our views on Section 1 of the draft text.

Here is the statement: 

Thank you Ambassador and thanks to the whole Disarmament Ireland team for their work to keep this process going.  

The purpose of this political declaration is to change behaviour and therefore the text must go beyond merely restating International Humanitarian Law (IHL). The evidence gathered over the past decade has shown that civilian harm continues even when IHL is applied. IHL is the bare minimum and all actors must take additional measures to prevent harm to civilians when using explosive weapons. As a member of INEW, Mines Action Canada has the following suggestions for strengthening section 1. 

As many state and civil society speakers have noted, the word “can” in the title and in paragraphs 1.2, 1.3 and beyond should be removed because there is significant evidence of the harm caused by explosive weapons. We have noted a small number of states have said that explosive weapons use in populated areas do not necessarily result in civilian harm but we have not seen any evidence to that extent, the evidence shows that when explosive weapons are used in populated areas, civilian harm will result. Like others in INEW, we would also recommend removing the qualifier “with wide area affects” throughout the declaration.  

On the title specifically we support INEW’s detailed comments. 

Articulating the harm caused by explosive weapons use in populated areas in paragraph 1.2 is a key part of the political declaration. This paragraph should clearly outline the direct, indirect and reverberating effects of explosive weapons used in populated areas as mentioned by many of my colleagues. Adding a direct mention of the gendered impacts in this paragraph would be beneficial here.  Though we would also support Mexico, Chile and Spain’s suggestion of a specific paragraph on gendered impacts.  

Reference to environmental harm in paragraph 1.3 is welcome. This point could be strengthened by referring to the environment rather than the natural environment. Also, as mentioned by Finland and perhaps others replacing the word urban with populated would strengthen this paragraph by not limiting the declaration to one type of populated area. 

Like Switzerland we believe that in Paragraph 1.4 the term “unexploded ordnance” should be changed back to the appropriate technical term “explosive remnants of war,” which includes both unexploded ordnance and abandoned ordnance since they both cause harm to civilians. This change is also in line with the mention of explosive remnants of war in paragraph 3.5. 

We welcome the reference to the need for additional data on the gendered impacts of explosive weapons made in paragraph 1.8, however, WILPF has said the word “potential” should be removed as there is significant evidence that there are gendered impacts of explosive weapons use.  

In the last three decades there have been numerous additions to IHL in response to the changing nature of conflict and human settlement. These changes have been motivated by preventing death, injury and destruction from different weapon systems. They have been welcome additions to IHL making it more robust. Nevertheless, we should not be afraid to do more than existing IHL requires to protect civilian populations. 

Thank you.  

In 2017, Canada became the one of only five countries to commit to developing an explicitly feminist foreign policy. So far, this effort includes multiple specific directives, including the Feminist International Assistance Policy (FIAP), but an official outline of the feminist approach to Canada’s foreign policy has yet to be published. 

During this period, the world has seen continued conflict in multiple regions, with frequent use of explosive weapons in populated areas (EWIPA). The use of EWIPA poses specific humanitarian threats to civilians. In addition to immediate death and injury, EWIPA causes severe damage to critical infrastructure including roadways, electrical grids, schools, water and sanitation centres and hospitals. Many people are forced to flee from unlivable and dangerous conditions, including women and children.

The international community took notice of this humanitarian problem and has come together for negotiations of a political declaration to protect civilians in populated areas from explosive weapons. This declaration has the potential to set a benchmark for Canada’s feminist foreign policy. The text of the agreement adopts a non-partisan, rights-based, humanitarian centred approach to restricting the use of explosive weapons in populated areas. The political declaration aims to be transformative to those living in conflict affected areas by having states commit to updating military policy to protect civilians in populated areas from explosive weapons.

The draft declaration also supports policy coherence for Canada by reinforcing not only several action areas in FIAP, but also Canada’s commitments to the Women, Peace and Security Agenda and meeting the Sustainable Development Goals generally known as the SDGs. Multiple SGDs are endangered by the use of EWIPA; specifically, goal 4 of good health and well-being and goal 16 of peace, justice and strong institutions. This declaration supports the achievement of these goals. The declaration also reinforces the government’s commitment to the Safe Schools Declaration, which aims to protect education in conflict by restricting schools as military targets. Due to infrastructure loss, education is often disrupted when explosive weapons are used in populated areas.      

The Feminist Foreign Policy Working Group, a team of individuals from multiple civil society and academic organizations, has recently published a set of suggested core policy principles, including adopting a rights-based approach and upholding policy coherence, for Canada’s feminist foreign policy and the text of this declaration is in alignment with those core principles. While being a feminist document, it also promotes feminist outcomes; specifically, non-violence and sustainable development. 

More and more people are moving to and living in populated areas, making them critical locations for sustainable development. The use of EWIPA is catastrophic to this ambition. Not only is infrastructure lost, but the economy grinds to a halt, the health of the population is endangered, and the next generation is forced out of school. This turns back the clock on the economic and social development strides that have been made in the last two decades; but this declaration allows for significant gains in development to be recovered and built upon.   

We know what a future free from the impacts of EWIPA can look like. From the incredible work of humanitarian mine clearance organizations and others, including the Canadian government for their leadership with the Ottawa Treaty, areas that were once uninhabitable from landmine contamination are now thriving cities. Including Huambo, Angola, where Princess Diana made her famous landmine walk in 1997. Fast forward to today and women, men and children are safe, can get an education, can contribute to the economy and can continue to develop in a sustainable way. What was done once with landmines can be done again with explosive weapons in population areas.

Combating humanitarian consequences of the use of EWIPA must be central to Canada’s feminist foreign policy. As a first step, Mines Action Canada calls on Canada to lend its support and leadership to the Draft Political Declaration on Strengthening the Protection of Civilians from the Humanitarian Consequences that can arise from the use of Explosive Weapons with Wide Area Effects in Populated Areas negotiations and to implement the Feminist Foreign Policy Working Groups core policy principles in the official policy. Mines Action Canada has specific suggestions on how Canada and other states can improve the Draft Political Declaration in line with a feminist foreign policy available here.

Blog post by MAC Research Associate, Madison Hitchcock who is a graduate student in globalization and international development at the University of Ottawa.

A Fall recap post by MAC Research Associate, Madison Hitchcock who is a graduate student in globalization and international development at the University of Ottawa.

On September 27^th of this year, conflict broke out between Armenia and Azerbaijan over the region of Nagorno-Karabakh. While it is a self-governing, democratic region that holds independent, free and fair elections, it is a heavily disputed territory internationally recognized as part of Azerbaijan while being home to mostly ethnic Armenians.

There has been confirmed use of explosive weapons and sustained heavy shelling in cities such as Stepanakert and Ganja, as well as multiple other areas. After multiple brief cease fire agreements, a peace seems to be holding. On November 9^th, 2020, the two parties reached an armistice after six weeks of bloody conflict; with Armenia conceding territory to Azerbaijan.

The humanitarian cost of this conflict is heavy. Currently, hundreds of civilians have been confirmed dead and thousands have been displaced from the conflict. The use of explosive weapons in populated areas cause high civilian casualties from their wide area blast effects in densely populated zones, as well as damaging critical infrastructure including hospitals, homes, schools, roadways, electrical grids and sanitation centres. These reverberating effects will cause further death and injury, as well as continued displacement of survivors in the future.

These weapons have been utilized by those on both sides of the conflict. Azerbaijan has refused to allow additional humanitarian aid other than the International Committee of the Red Cross to enter the region which is extending the suffering of many survivors who are unable to access support. This crisis is all happening in the context of COVID-19 which puts civilians at further risk.

Additionally, there have been credible reports of the use of cluster munitions which have been banned by international convention – to which neither Armenia nor Azerbaijan are signatories. These weapons are especially harmful to civilians as they have wide blast areas and it is estimated that between 5-20% of the munitions fail to explode leaving incredibly dangerous situations for civilians long after their initial use[1].    

Under international humanitarian law, Armenia and Azerbaijan have an obligation to minimize harm to civilians. Mines Action Canada strongly condemns the neglect of this duty and calls on all parties to uphold this obligation and refrain from using explosive weapons in populated areas and banned cluster munitions; as well as allowing further humanitarian aid organizations into the region. We also call on Armenia and Azerbaijan to immediately join the Convention on Cluster Munitions and support the draft Political Declaration on Strengthening Protections from Humanitarian Harm arising from the use of Explosive Weapons in Populated Areas. 

[1] Amnesty International https://www.amnesty.org/en/latest/news/2020/10/armenia-azerbaijan-civilians-must-be-protected-from-use-of-banned-cluster-bombs/

The International Network on Explosive Weapons (INEW) has released a new Question and Answer document. This publication tackles such questions as:

- Are some explosive weapons worse than others?

- If we are limiting the use of certain explosive weapons in populated areas, are we encouraging the use of other, more targeted weapons?

- Does international humanitarian law adequately address this problem?

- Won’t some armed actors/explosive weapon users take such a standard more seriously than others?

- What can be done?

For answers to these questions and more, check out INEW's new publication here. 

After years of occupation by the so-called Islamic State (Da’esh) the city of Mosul, Iraq is on the verge of being liberated. The urban battle there has raged for almost nine months leaving a devastating humanitarian disaster in its wake. The weapons which were used during this battle have a direct impact on what comes next for the city and its inhabitants.

Although the Iraqi Prime Minister has declared victory and the city liberated, the humanitarian suffering will continue for years or more likely decades due to the indiscriminate and inhumane weapons used.[1]

The weapons used and their impact

For a number of years, civil society under the International Network on Explosive Weapons and a number of states have been concerned about the use of explosive weapons with wide-area effects in populated areas. During the battle for Mosul, INEW expressed great concern about the weapons being used and encouraged all actors to cease using explosive weapons with wide area effects in the densely populated city. Despite these calls for restraint, populated areas of Mosul and especially west Mosul have seen the use of airdropped munitions, unguided bombs, multiple launch rocket systems, mortars, other shelling, and improvised explosive devices including car bombs for months.

The use of explosive weapons with wide-area effects in a densely populated city results in high levels of civilian casualties. Mosul has seen this assertion to be true over the past nine months. Airwars, a civil society monitoring organization, estimated that as of July 1, 2017 between 900 and 1,200 civilians were killed by Coalition airstrikes or artillery in Mosul. That number does not include civilians killed when there was uncertainty about the user of the explosive weapon (International Coalition, Iraqi security forces or Da’esh) or casualty reports which could not be verified. The casualty toll from Da’esh’s use of explosive weapons and improvised explosive devices is expected to be quite high. The United Nations reports that in a three day period in March 2017, at least 95 civilians were killed in four neighbourhoods of western Mosul alone by Da’esh explosive weapons and snipers.

These numbers of civilians killed only show a small glimpse of the suffering caused by the explosive weapons with wide area effects used in Mosul. For each person killed, many more have been injured. The ICRC reported that their surgical team at Mosul General Hospital has received over 650 cases, many of them children. Hospitals in the area have been overwhelmed with the injured during the battle.

Those who are injured may need ongoing care to deal with their injuries and any resulting impairments.  Rehabilitative services, prosthetics, mobility aids and psychological support will all be needed to ensure that those injured can participate in society fully.

Beyond immediate casualties the use of explosive weapons with wide area effects in Mosul has resulted in extensive destruction of key infrastructure, housing and other buildings greatly compounding the ongoing humanitarian suffering.

The United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) reports that water treatment plants and pumping stations in both eastern and western Mosul were damaged. Of the damaged facilities, nine are under rehabilitation in July 2017, however, ongoing insecurity and a lack of funding has inhibited rehabilitation. Water is currently being trucked into Mosul. Related to the damage done to the water supply is the destruction of sanitation infrastructure. In addition, the electrical grid has been seriously disrupted, waste disposal operations have been halted for months on end and schools, medical facilities and religious or cultural buildings were destroyed. All of these results of explosive weapons use have humanitarian consequences now and will make it much harder and costlier to rebuild a thriving city in the future.

UNOCHA reported that out of west Mosul’s 54 residential neighbourhoods, 38 are heavily to moderately damaged. The damage and fighting combined with the draconian rule of Da’esh has resulted in over half a million people being displaced from in and around Mosul. Studies conducted in similar situations around the region have shown that the use of explosive weapons in populated areas is a key driver of displacement and the ICRC gathered a number of reports from displaced persons from Mosul who stated they fled the city due to explosive weapons use. For many, return will be impossible until rubble has been cleared and reconstruction has been begun.

Not every explosive weapon used in the battle for Mosul functioned properly, especially considering the number of homemade mortars. These explosive remnants of war will need to be cleared before reconstruction and return of displaced persons can begin in earnest.

In addition to the explosive remnants of war, Da’esh has been using improvised landmines, booby traps and other victim activated weapons extensively to continue killing after they have retreated. In one village near Mosul, improvised mines have already killed ten and injured five. High levels of contamination are being reported across the region in areas liberated from Da’esh and Mosul is no exception. The improvised mines left by Da’esh aim to prevent civilian return to Mosul and surrounding villages.

Mines are being found surrounding essential infrastructure, schools and other public buildings further impeding reconstruction and rehabilitation efforts. Booby traps contaminate residential homes waiting in mattresses, kitchen sinks, doorways and other ordinary items for the residents to return. The contamination will take years to clear. Mines Advisory Group calls the situation in areas liberated from Da’esh a new landmine emergency, noting that the improvised mines created by Da’esh are often sensitive enough to be triggered by a child but packed with enough explosive to destroy a tank.

What’s next?

Recovery

There is little doubt that significant work needs to be done to rebuild Mosul after the nine months of conflict and years of Da’esh rule. Iraqi officials estimate that recovery and complete reconstruction will cost billions of dollars.

The weapons used during the conflict in many ways dictate the next steps towards reconstruction. Of prime importance is rehabilitating water and sanitation facilities as well as the electrical grid. In terms of saving lives and limbs, the clearance of mines and ERW must be a priority. The presences of ERW and improvised mines will hamper reconstruction by making clearing rubble and navigating the city a very risky endeavor. Humanitarian demining organizations are on the ground outside the city and armed forces explosive ordnance disposal teams are also working hard to remove the mines and ERW. However, this is a task that will take many months or years. Without clearance, travel, shopping, attending school and other aspects of everyday activities will be life-threatening. Once this work is done, the city and surrounding countryside can return to a thriving community.

In the meantime, risk education will be needed to protect civilians still living in Mosul and those who may return. Risk education can show residents what common dangerous objects look like and warning signs will remind citizens to be on the alert. For communities that have never been contaminated with mines and ERW before risk education is crucially important. Such activities are already underway and will need to be expanded to populations who were recently liberated from Da’esh.

The destruction of buildings through explosive weapons use has resulted in significant amounts of rubble littering neighbourhoods across Mosul which will need to be cleared before reconstruction can begin in earnest. The rubble poses a threat to the health of residents as well as an impediment to reconstruction. Rubble may contain harmful chemicals while the long term inhalation of dust may impact breathing; these impacts will be magnified if industrial areas and infrastructure was targeted. Environmental remediation will have to be included in the recovery plans to ensure that the city remains a healthy place to live.

At the moment, reports indicate that not only is there significant amounts of rubble in West Mosul, but that the bodies of those killed in the bombing and shelling are still buried under the rubble. Collection of human remains and proper burial is needed to be able to start clearing the rubble and to allow family members and friends to grieve.

Once the deceased have been properly cared for and the rubble cleared, basic infrastructure will need to be repaired or rebuilt. Displaced persons will need to have access to water, sanitation and electricity prior to return. The destruction of Mosul is extensive as discussed above. Water, sanitation and electricity infrastructure have been severely damaged, schools and hospitals have been destroyed and roads are clogged with rubble. The rehabilitation of destroyed infrastructure has already begun but the process will be long. Standing buildings will need to be assessed for structural safety, as well as, for improvised mines, booby traps and other ERW. Partially destroyed buildings will need to be repaired following assessments. Destroyed buildings will need to have the rubble cleared away and the buildings rebuilt. In addition to essential infrastructure, houses, schools, hospitals, mosques, churches and markets will need to be rebuilt. Entire neighbourhoods have been destroyed and will need extensive reconstruction to make them thriving communities again. This will be a long and costly process, but the city will need to be rebuilt in order for the citizens to be able to return and begin to re-establish their lives.

Beyond Rebuilding

For those who lived through the conflict, re-establishing their lives will require more than just rebuilding the city and its infrastructure. As mentioned above, ensuring proper support and services to those injured by explosive weapons will be a major undertaking for the foreseeable future. Medical care, rehabilitation, mobility aids, assistance with social and economic reintegration and psychosocial support will all be needed. To provide services to the large number of injured, there will need to be a large increase in the availability of age and gender sensitive services. Under the Ottawa Treaty banning landmines and the Convention on Cluster Munitions, Iraq has an obligation to provide assistance to victims of those weapons. The principle of non-discrimination in victim assistance under those two treaties would likewise require the provision of services to citizens with similar needs regardless of the cause of those injuries. Those who were not injured but have lived under the bombing and shelling for months may require mental health care as well.

One consideration that is not entirely unique to the use of explosive weapons in populated areas, but is greatly exacerbated by their use is the fate of unaccompanied children. Families get separated in armed conflict. The Red Cross/Red Crescent and other organizations have worked to reunite families in conflicts for decades. More than just getting lost in the chaos of fleeing conflict, UNICEF reports that a number of medical facilities have received injured or traumatized children who are alone and remain unclaimed. Often they are the sole survivor of a bombing or airstrike that destroyed their family’s home. The explosive weapons used in Mosul would frequently collapse an entire home or building on those inside, especially in the Old City, killing large numbers of the same family. This family destruction was intensified by the use of civilians as human shields by Da’esh which forced extended families to shelter together.  Some of these unaccompanied children may be in the care of  UNICEF and other humanitarian organizations but that is a temporary solution. These children will need to be reunited with surviving extended family or placed in safe and loving foster or adoptive homes to give them the best possible chance to recover from this trauma and become productive members of society.

All of this reconstruction work requires strong social cohesion and civil society. Years of displacement or occupation coupled with the long battle have weakened social ties as is evident by the extra-judicial retribution currently going on in Mosul. If the goal is to rebuild the city and defeat Da’esh work needs to be done on countering the damage done to the culture of the city, as well as, the buildings and people. Citizens are beginning this work already by bringing back music and cultural activities and that work should be supported. Civil society organizations should also be supported especially networks and peer support groups for survivors of explosive weapons use. We know from work on landmines and cluster munitions that peer support is key to adapting to new impairments caused by weapons injuries in terms of physical, psychological and economic recovery. It will also be crucially important to ensure that women and marginalized communities have a seat at the table while decisions are made about rebuilding the city. Iraqi officials and others must make sure these populations are included in the reconstruction process. In addition to supporting the physical rebuilding of the city, donors such as Canada should be supporting grassroots organizations to build their capacity to provide services in Mosul and to reconstruct society.

Conclusion

Moslawis experienced years of occupation by an inhumane terrorist organization and then suffered immensely during the battle to liberate the city from Da’esh. Much of this suffering was caused by the tactics used during the battle and the behavior of actors in the conflict, but the weapons used will determine what comes next for the city. The city cannot rebuild without dealing with the legacy of the weapons used and the ways in which the weapons have harmed and continue to harm the civilian population.

Last week saw global outrage over the bombing of two hospitals in Aleppo, Syria. Coming soon after the bombing of a civil defense centre, the destruction of al-Quds hospital and Al Marjeh Primary Health Care Centre within days of each other made headlines around the world. Sadly, these horrific and illegal bombings were not isolated incidents.

Over the last few years, Syria, Yemen, Afghanistan, South Sudan and too many other countries, have seen attacks on health care facilities. Although health care facilities and medical personnel are protected under International Humanitarian Law (IHL), making such attacks war crimes, 2015 witnessed an alarming increase in these illegal tactics. To be clear, these are not mistakes or accidental collateral damage but targeted attacks on those providing life-saving medical care in the midst of conflict. As a result, there has also been a rise in the number of unmarked ambulances and covert field hospitals established in conflict zones.  These field hospitals have even become the main source of health care in opposition controlled Syria.

With hospitals, ambulances and medical facilities under attack or destroyed, thousands of civilians are being denied a fundamental human right guaranteed by the 1946 Constitution of the World Health Organization and the 1948 Universal Declaration of Human Rights: the right to health.  This unacceptable war tactic is exacerbating already dire humanitarian crises around the world. The ongoing situation not only undermines the credibility of the international community, but also highlights one of the most damaging long term impacts of the use of explosive weapons in populated areas.  

The unseen impacts of attacks on health care facilities

Attacks against medical facilities impede access to health care and have disastrous impacts on long term health. Beyond the obvious death and injury caused by attacks on health care systems and the lack of emergency treatment for those injured in the conflict, targeting health care has wide-spread humanitarian impacts. The already overwhelmed health care systems of states in conflict are often unable to cope with the influx of patients caused by the destruction of medical facilities.  “Targeting the health system has compounded the crisis, caused many medical personnel to flee, and prevented countless civilians from getting treated’’ said Widney Brown, Physicians for Human Rights’s director of programs.  In addition to war-injured persons, thousands of people are dying of preventable causes because they unable to access proper health care across conflict zones.

Targeting medical facilities has also impeded vaccination campaigns. The outbreak of polio in Syria and Iraq which started in October 2013 was called “the most challenging outbreak in the history of polio eradication.” Before this outbreak, polio was last reported in Syria in 1999 and in Iraq in 2000.  Unusually large outbreaks of malaria and dengue fever were reported in Yemen by the WHO in 2015. Additionally, fighting forced the postponement of a polio and measles vaccination campaign endangering the lives of millions of children in Yemen. 

Case studies

Syria

Attacks on medical facilities and health care providers have been a feature of the conflict in Syria. A report from Physicians for Human Rights (PHR) identified that between March 2011 and December 2015, 346 attacks were conducted on 246 Syrian medical facilities, killing 705 medical personnel. Syrian government and Russian forces were found responsible for 315 attacks according to the NGO.  Hospitals were specifically targeted on at least 211 occasions. 

The scale of attacks on medical care in Syria is overwhelming, we will just look at attacks on hospitals in Aleppo, both the city and governorate. The city of Aleppo, Syria’s most populous city, saw its health care facilities attacked 45 times in the three years prior to October 2015. As a consequence of these attacks, less than a third of its hospitals were functioning in late 2015, and the ratio of doctors to residents is eight times less than before the conflict started, denying access to much needed medical services. “The Syrian government is using attacks on Aleppo’s health care system as a weapon of war” said Dr. Michele Heisler, of PHR.

A late January 2016 Russian air attack destroyed the last major hospital, the Andan Charitable Hospital, in northern Aleppo. The hospital was providing advanced medical services, including surgery, to residents of the Aleppo countryside. Residents are now forced to travel 50 km to clinics along the Turkish border to receive health care. The hospital was directly targeted by Russian airstrikes. A doctor and a 10 year old patient were killed, and 24 others were injured as a result of the attack.

The result of these attacks is most evident in a media story from 1 May 2016:

Amr al-Halaby, 32, said his teenage daughter, whose leg was severed by a government barrel bomb, had only been able to receive limited treatment from a local vet in the family’s home. “Her painkillers have run out and there is nowhere for us to take her,” said Mr Halaby. “She has reached hell and we can only watch her sink deeper.”

Yemen

The already fragile health care system in Yemen is coming under severe strain since the conflict erupted in March 2015. The WHO has estimated that almost a quarter of Yemen’s medical facilities are no longer operational due to the violence. “The health system is on the brink of collapse” declared Dr Ahmed Shadoul, WHO Representative for Yemen.  The situation is so dire that the president of the ICRC, Peter Maurer, said that “Yemen after five months looks like Syria after five years", warning the international community of the growing humanitarian catastrophe as medical facilities continue to be targeted. Two ICRC staff were killed by gunmen in September 2015 and the organization’s office was raided by gunmen in a separate incident.

A UNICEF report stated that at least 63 health facilities have been attacked since the start of fighting in March 2015 and almost 600 facilities have ceased operations due to damage or lack of supplies, electricity and staff. The report goes on to estimate that “nearly 10,000 children under the age of five may have died in the past year from preventable diseases as a result of the decline in key health services such as immunization against vaccine preventable diseases and the treatment of diarrhoea and pneumonia.”

Afghanistan

An attack on a medical facility in Afghanistan in October 2015, brought the issue of attacks on health care to the general public’s attention. The MSF hospital in Kunduz province, the only trauma centre in northern Afghanistan, was repeatedly attacked and eventually destroyed by U.S airstrikes, killing 42, including 14 staff and 24 patients and 4 caretakers.  Now, residents in the Kunduz province have to either go to expensive private clinics, or attempt the long and dangerous journey to Kabul or Pakistan to receive treatment. On 29 April 2016, the United States Department of Defence released their long, jargon filled and partially redacted report on the incident and said the incident was not a war crime.

The hospital in Kunduz has not yet reopened.

Response

In December 2011, during the 31^st International Conference of the International Red Cross and Red Crescent Movement, the international community adopted a resolution mandating the ICRC to initiate consultations with subject matter experts to formulate practical recommendations for improving safe access to health care services.  The “Health Care in Danger” project was created to achieve this objective.  The ICRC published its first recommendations in 2013. 

In conjunction with those 2013 recommendations, the United Nation (UN) adopted four resolutions for the protection of health care services during armed conflict in December 2014.  This reinforced the principles in four Geneva Conventions and two additional Protocols already providing for the protection of health care facilities. These resolutions asserted to warring parties that attacks against medical facilities constitute a war crime. 

However, governments and rebel groups appear to be ignoring the warnings of the international community, as more and more hospitals and medical clinics become the targets of attacks.

Civil society has not been silent in the face of these unacceptable and illegal attacks. MSF launched a social media campaign to raise 

awareness on the fact that its hospitals have been bombed every week in 2015 and 2016 in Syria and have been targeted countless times worldwide. The #NotATarget campaign demands that medical facilities stop being treated as military targets in conflict zones.  The longer these attacks are tolerated by the international community, the more likely they will become a new norm in armed conflicts. The usually reserved ICRC is speaking out more on this issue, most recently in collaboration with MSF, and the ICRC President Peter Maurer has been uncharacteristically blunt.

In our humanitarian disarmament work, we advocate strongly for effective assistance to victims of landmines, cluster munitions, explosive remnants of war and explosive weapons used in populated areas. The targeting of health care facilities and medical personnel prevents victims from getting the emergency and long term care they need.  

The international community has a chance this month to reverse course and reaffirm international prohibitions on attacking medical facilities.  Tomorrow, 3 May 2016, the United Nations Security Council is scheduled to vote on a resolution designed to stop future attacks against hospitals, patients and civilians in war zones. Update: We're pleased to see that Canada will be co-sponsoring this resolution. Later this month, states will gather in Turkey for the World Humanitarian Summit where they will make core commitments in regards to humanitarian issues. One of the High-Level Leaders’ Roundtables is on “Upholding the norms that safeguard humanity” where states will have the opportunity to speak out on the targeting of civilian objects like medical facilities. In both these discussions, states have the responsibility to speak out against the targeting of medical facilities and personnel and to take action to protect those who risk everything to save lives in conflict. 

Jean-Philippe Lambert Ste Marie is an undergraduate student at the University of Ottawa and a Mines Action Canada research assistant and Erin Hunt is the Program Coordinator at Mines Action Canada.

This week something incredibly important is happening in Vienna. The Government of Austria and UNOCHA have invited some states, international organizations and civil society to a two day meeting aimed at addressing harm from the use of explosive weapons in populated areas. Our colleagues at the International Network on Explosive Weapons have the details in the Network's most recent bulletin and press release.

Although Mines Action Canada couldn't be in Vienna, we have released a new paper to contribute to the discussion. Our paper Hidden Victims: Additional Humanitarian Consequences of Explosive Weapons Use explores the less obvious humanitarian impacts of explosive weapons used in populated areas. We go beyond the initial casualty count to look for long term humanitarian harm.

Read the paper here.