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The weaponisation of aid and healthcare

By Bette Browne - 19th Mar 2023

aid and healthcare

Humanitarian aid and healthcare are increasingly exploited as weapons of war. Bette Browne reports

The aftermath of the earthquakes in Turkey and Syria highlighted the life-saving work of aid workers. However, in the broader context, humanitarian aid is increasingly exploited as a weapon of war and doctors and other aid workers face intimidation, attacks and threats to their lives.

The “weaponisation” of humanitarian aid and healthcare in conflict zones takes many forms, including bombing medical centres and killing healthcare workers; and the starvation of people by withholding food aid to one side in a conflict and diverting it to the other side.

Human rights groups and researchers say such weaponisation of medical and other humanitarian aid is imperilling the lives of huge numbers of people.


According to Dr Peter Gleick, founder of the Pacific Institute water expert group: “Of special concern is civil unrest over water scarcity and the control of local water resources, and a growing number of attacks on civilian water infrastructure during conflicts and war around the world.”

An update to the group’s Water Conflict Chronology in 2022 provided information on events related to water and conflict. On 4 January 2022, for example, Israeli military forces demolished Palestinian-owned agricultural facilities in Ibziq, West Bank, including a water tank. A few days earlier, in Somalia, Al Shabaab militants killed 10 people and injured 15 in an attack on a water tank. At the start of its war in Ukraine last year, Russian troops destroyed a Ukrainian dam that had blocked water to Crimea, which Moscow had annexed in 2014.

The weaponisation of aid can also occur following natural disasters. Amid the additional suffering in his war-torn country after the 6 February earthquakes, Syrian President Bashar al-Assad took a week to agree to border crossing points being used for humanitarian aid to reach a rebel-held province.

Human rights groups have also denounced the trial in January 2023 of 24 humanitarian workers, including Irishman Mr Seán Binder, who participated in migrant rescue operations in Lesbos, Greece. The prosecution alleged that smuggling offences were committed. The defendants denied all charges.

Amnesty International and other organisations have criticised the Greek authorities for using “farcical” and “baseless” charges to make an example of humanitarian workers. Some charges have since been dropped, but Amnesty International has called on the Greek authorities to drop all charges against the workers.


In a statement on 13 January, the UN human rights office said the case had a chilling effect on humanitarian organisations in the region. “Trials like this are deeply concerning because they criminalise life-saving work and set a dangerous precedent,” said Ms Elizabeth Throssell of the UN’s Office of the High Commissioner for Human Rights. “Indeed, there has already been a chilling effect with human rights defenders. We reiterate our call for charges against the 24 to be dismissed.”

The aid workers were affiliated with the Emergency Response Centre International, a non-profit search and rescue group operating in Lesbos from 2016 to 2018. The island was then on the frontline of Europe’s refugee crisis with scores of asylum seekers arriving daily on its shores. “Saving lives and providing humanitarian assistance should never be criminalised or prosecuted,” Ms Throssell said. “Such actions are, quite simply, a humanitarian and human rights imperative.”

In 2023, according to the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), a record 339 million people will need humanitarian assistance and protection. This is a significant increase from 274 million people at the beginning of 2022. The UN and partner organisations aim to assist 230 million people most in need across 68 countries, which will require €58.5 billion.

In July 2022, it was announced the European Investment Bank (EIB) agreed to disburse €1.6 billion to Ukraine. This was the second package of support for Ukraine under the EIB Ukraine solidarity urgent response developed in close cooperation with the European Commission. It followed an emergency support package of €668 million fully disbursed within a month of the war’s beginning. In addition, the Ukraine regional response in 2023 will combine both a humanitarian and refugee response plan, aiming to support 13.6 million people with a total requirement of €5.3 billion.

A resolution on “Safety and security of humanitarian personnel and protection of United Nations personnel” was adopted at a meeting of the UN General Assembly in New York on 6 December 2022. It condemned all acts of violence, attacks and threats against humanitarian workers, as well as UN and associated personnel. It also called on states to explore and scale up measures for more systematic monitoring, reporting and investigation of attacks against humanitarian and medical personnel.

The Head of the EU delegation, Mr Björn Olof Skoog, said member states were committed to protecting humanitarian space and deterring violations of international humanitarian law (IHL). Continued violations was preventing vital assistance from reaching those in need, he said. “Humanitarian actors and medical workers must never be targets, perpetrators must be held accountable.”


The weaponisation of healthcare in Syria was highlighted in a report for The Lancet – American University of Beirut Commission on Syria in 2017. “The weaponisation of healthcare – a strategy of using people’s need for healthcare as a weapon against them by violently depriving them of it – has translated into hundreds of health workers killed, hundreds more incarcerated or tortured, and hundreds of health facilities deliberately and systematically attacked. Evidence shows use of this strategy on an unprecedented scale by the Syrian Government and allied forces, in what human rights organisations described as a war-crime strategy, although all parties seem to have committed violations.”

It described this war-crime strategy as multi-dimensional. “It includes practices such as attacking healthcare facilities, targeting health workers, obliterating medical neutrality, and besieging medicine. Through large-scale violations of international humanitarian laws, weaponisation of healthcare amounts to what has been called a war-crime strategy.

“The pattern of attacks on health facilities suggests intention to target, which is a war crime. Targeting of health workers, largely by pro-government forces, has continued and takes many forms in attacks on health facilities, executions, imprisonment or threat of imprisonment, unlawful disappearance (ie, kidnapping), abduction, and torture sometimes leading to death. As a consequence of the targeting of health workers, hundreds of health workers have been killed.”

Physicians for Human Rights (PHR) has verified more than 600 attacks on 400 health facilities in Syria and the killing of at least 945 medical staff since the start of the conflict in March 2011.

According to the global health reporting site Health Policy Watch, Russia’s invasion of Ukraine has also sparked a global health crisis. 

“Russia’s war in Ukraine has sparked a global health crisis – from the death, suffering and displacement of people in the country to the global food and fuel insecurity, and diminished donor funds to support other health issues.” Health Policy Watch quoted Ms Ulana Suprun, a former Ukrainian health minister, as highlighting the fact that the UN High Commissioner for Refugees estimated that about 17.6 million Ukrainians, which is about 43 per cent of Ukraine’s population of 41 million, will need humanitarian assistance in 2023.

“It is very nice to say that healthcare is not political or that global health doesn’t get involved in politics,” Ms Suprun said. “But we can see today that global health is being impacted by the war that Russia started in Ukraine.”

International Rescue Committee

The CEO of the International Rescue Committee (IRC), Mr David Miliband, emphasised in an essay in March 2022 for Time magazine that there was a need for vigilance about violations of international humanitarian law around the world.

“It is… vital that civilians also suffering in other places don’t pay the price in loss of attention and resources,” he said. “The opposite should be the case. Support for Ukrainians should not come at the expense of Afghans, Yemenis, Ethiopians, or Syrians who face equally brutal tactics and disregard for the laws of war.

“Too often, violators of international humanitarian law face no consequences. The IRC is calling for an end to an era in which laws intended to protect civilians are seen as optional.

“We have also called for more support for humanitarian workers who need to reach the most vulnerable people in crisis areas, but are hindered by parties to a conflict.”

Mr Miliband also called for these efforts to be supported worldwide with the establishment of an Organisation for the Protection of Humanitarian Access, a body that would highlight the “strangulation and weaponisation of humanitarian aid” in conflict zones.

Others had shown little has been done to halt such attacks. “The international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences,” according to The Lancet – American University of Beirut Commission inquiry on Syria. “There have been repeated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality needed to sustain the operations of global health and humanitarian agencies in situations of armed conflict.”

International humanitarian law

IHL forbids intentional attacks on civilians. It stipulates that targeting civilians or critical civilian infrastructure, such as hospitals, could constitute a war crime. It also prohibits attacks on military objectives that do not take adequate precautions to avoid collateral harm to civilians.

“IHL plays an important part in protecting those of us who travel to dangerous places on humanitarian grounds,” the Irish Red Cross states on its website. “Our many aid workers need knowledge of IHL to protect themselves and those they assist. For Irish Defence Forces on peacekeeping missions with the UN and EU, IHL is often a critical aspect of their mandate. Respect for IHL saves lives, reduces human suffering and ensures protection of human dignity.”

Efforts for greater accountability have gained momentum in ensuring community engagement and accessible systems for feedback into operations, according to the UN. For example, in the Central African Republic (CAR), community consultations are helping humanitarian responders to understand how affected people experience the crisis as well as the response. The CAR humanitarian fund is also prioritising funding for projects that focus on collective accountability to affected people.

Ireland has ratified a large number of IHL treaties and in 2008 helped to broker an agreement on the Convention on Cluster Munitions adopted by 107 states in Dublin.

In a speech marking the 60th anniversary of the Geneva Conventions on human rights in 2009, the then Minister for Foreign Affairs, and current Tánaiste, Micheál Martin said the four Geneva Conventions of 1949 remained at the centre of modern international humanitarian law.

“It is a tribute to the power of the ideas represented by these Conventions that they are now universally applicable, that is that every state in the world has either ratified or acceded to them. This is a very rare distinction for any multilateral treaty. The four Conventions have been supplemented by two additional protocols concluded in 1977 and a third in 2005. Between them, these instruments constitute a very significant body of law that has played a vital – and continuing – role in limiting the horrors of warfare.”

He also stressed that accountability was important when humanitarian laws were breached. 

While Ireland was prepared to join with other countries to develop the law if necessary, he suggested it was more a question of respecting the existing rules which “by and large were neither insufficient nor obsolete”.

“But where they are not followed there must also be accountability,” he stressed. “Successive Irish governments have consistently advocated the effective investigation and prosecution of violations of international humanitarian law. Ireland has also been a consistent and strong supporter of the International Criminal Court, recognising it as an essential means of ending a culture of impunity and of ensuring respect for international humanitarian law at the highest levels.”

Basic rules of international humanitarian law (IHL)

  • The parties to a conflict must at all times distinguish between the civilian population and combatants in order to spare the civilian population and civilian property.  Neither the civilian population as a whole, nor individual civilians, may be attacked. Attacks may only be made against military objectives. 
  • People who do not or can no longer take part in hostilities are entitled to respect for their lives and for their physical and psychological wellbeing. They must in all circumstances be protected and treated with humanity, without distinction. It is forbidden to kill or wound an enemy who surrenders or who can no longer take part in the fighting.
  • Neither the parties to the conflict nor members of their armed forces have an unlimited right to choose methods and means of warfare. It is forbidden to use weapons or methods of warfare that are likely to cause unnecessary losses or excessive suffering.
  • The wounded and sick must be collected and cared for by the party to the conflict which has them in its power. Medical personnel and medical facilities and vehicles may not be attacked. Personnel wearing the distinctive emblem of the Red Cross, Red Crescent or Red Crystal on white backgrounds, and facilities and vehicles bearing the emblems, must be respected.

Ireland’s role in IHL

The core of modern IHL is set out in the four Geneva Conventions of 1949 and their additional protocols and amendments.

Every state in the world has adhered to the Geneva Conventions and although not all states are yet parties to the two additional protocols of 1977, many of the rules set out in these instruments enjoy the status of customary international law applicable to all states.

Ireland was one of a core group of states that promoted the development of a new instrument of IHL on cluster munitions that culminated in the adoption of the Convention on Cluster Munitions at a conference in Dublin in May 2008. 

Ireland signed and ratified the Convention on 3 December 2008. The Convention entered into force on 1 August 2010.

Ireland also participated in the Initiative of the International Committee of the Red Cross (ICRC) and the Swiss government to develop proposals to enhance the effectiveness of mechanisms to ensure compliance with international humanitarian law.

The Initiative was one of the principal outcomes of the 31st International Conference of the Red Cross and Red Crescent in 2011. Proposals to improve compliance with IHL were presented at the 32nd international conference of the ICRC in 2015. A resolution was adopted mandating the continuation of the process.

(Sources: Irish Department of Foreign Affairs, Irish Red Cross, UN)

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