October 06, 2017


PULSE a is bi-weekly video series from Doctors Without Borders/Médecins Sans Frontières (MSF) in which we talk about our work delivering emergency medical care to some of the world's most vulnerable people, and the issues that affect our abilities to engage in lifesaving humanitarian action.


This week: Does even war have rules? International humanitarian law is supposed to protect civilians from atrocities and allows MSF access to people affected by conflict, but governments are failing to live up to their obligations.


How can war have rules?

On October 3, 2015, US airstrikes destroyed an MSF hospital in Kunduz, Afghanistan, killing 42 people, including patients and medical staff. Most evidence suggested the strike was an informed attack on a humanitarian medical facility. MSF called for an independent third-party investigation, rallying under the slogan “Even War Has Rules.”

To some, this sounds naïve: How can war have rules? But there are rules that govern conflict between states, and seek to limit the effects of war on vulnerable people. These rules are collectively known as International Humanitarian Law, and have been agreed to and signed by most of the world’s countries.

International Humanitarian Law is based on the principles of humanity, impartiality and neutrality. It is also based on the notion that the death and suffering of civilians in war zones is not inevitable or acceptable, but is a preventable failure.



Where did the rules of war come from?

For almost as long as human beings have been fighting wars, there have been efforts to contain the atrocities that accompany them. But the modern idea of rules for war can be traced back to a Swiss businessman named Henry Dunant, who was horrified by the thousands of people he saw left dying on a battlefield in Italy in 1859. His calls for warring parties to allow for the medical treatment of wounded soldiers by neutral doctors and nurses led eventually to the creation of the International Committee of the Red Cross. These efforts, based on the sanctity of all human life, helped usher in modern humanitarianism as we understand it today.

Almost a century later, after the Second World War caused unprecedented levels of civilian death and suffering, there were renewed efforts to protect non-combatants from the worst excesses of conflict. One result was the Geneva Conventions, a set of guidelines about conduct in war that has been signed by virtually all member states of the international community.

These form the essence of the “rules of war.” Among other things, they declare that medical caregivers in war zones should be considered neutral, and are not legitimate military targets. They also stipulate that civilians in war zones should be protected from violence and brutality — as should the sick and the wounded, no matter who they are or what side of a conflict they are supposed to be on.



MSF medical staff take shelter during US airstrikes against the organization's hospital in Kunduz, Afghanistan, on October 3, 2015.



Why are rules for war necessary?

International Humanitarian Law makes possible the lifesaving work of MSF and other organizations in war zones around the world. It is what allows us to demand access to people in need of care on either side of a conflict, and protects our medical teams as neutral parties.

But as the airstrikes on Kunduz showed — and other deadly assaults on our facilities in places from Yemen to South Sudan since then have also showed — the rules of war, and the humanitarian space they create, are themselves under attack.


Why are they under threat, and what is at risk?

International Humanitarian Law — and the idea that protecting vulnerable people from the worst horrors of war should be an obligation of all warring parties — was made possible because the world’s biggest powers agreed that an international system based on rules, laws and humanitarian principles was in everyone’s interest.

But while the world’s most powerful defenders of international law and order once made a point of standing up for this system, in recent years they have either reduced humanitarian principles to the point of empty rhetoric or abandoned them completely.



The permanent members of the United Nations Security Council — which is the highest authority in the international system — have been actively involved in conflicts in which the rules of war have been completely ignored: From Yemen to Afghanistan to Syria and beyond, hospitals, patients and medical caregivers have been routinely targeted and bombed. In places where protecting the neutrality of medical workers no longer seems convenient for warring powers, that neutrality has been either undermined or attacked outright.

MSF was founded as a humanitarian organization dedicated to delivering emergency medical care wherever it is needed most, regardless of political limitations or other boundaries.  We will continue to make that our mission, with the support of the world’s powers or without.

But if states, governments and ordinary citizens are serious about creating a world in which every life is worth protecting, then International Humanitarian Law must not only be talked about, but vigorously upheld and defended. And everyone from foot soldiers to heads of state must be reminded: Even war has rules.







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