Why are hospitals bombed?
By the War and Law League

     The Department of Defense ought to explain why hospitals have been subject to attack despite the prohibition against such attacks in the Geneva Convention of 1949. At least four were hit recently in Iraq. U.S. bombs had also struck hospitals in Afghanistan, Yugoslavia, and Iraq in the 1990s.

     “It is inhumane beyond belief to bomb hospitals, whose staff are devoted to the healing of the sick and injured, and thereby to kill the sick and injured,” said Dr. Helen Caldicott, Australian pediatrician, peace activist, and founding member and former president of Physicians for Social Responsibility. Other doctors, from the U.S., also had comments (quoted below). At the University of California, San Francisco, 364 doctors, staff members, medical students, etc. signed a statement protesting the attack on Iraq generally. And a group of Belgian physicians appealed for help to alleviate a “humanitarian catastrophe.”

     Article 18 of the “Convention (IV) relative to the Protection of Civilian Persons in Time of War,” a U.S.-approved treaty, says, “Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack but shall at all times be respected and protected by the Parties to the conflict.” Article 25 of The Hague Convention on laws of war on land (1907), another U.S. treaty, forbids attacking or bombarding any “buildings which are undefended.” Under the Constitution, Article 6, treaties are federal law.

Summary of the attacks

     Associated Press reported on March 30 that a children’s hospital in Rutbah, in Iraq’s western desert, had been destroyed by bombs on March 28. Then on April 3 Reuters said that U.S. aircraft bombed a Red Crescent maternity hospital in Baghdad the day before along with other civilian buildings, killing several people and wounding at least 25.

     The number of casualties in the first attack was not reported. A source at the International Federation of Red Cross and Red Crescent Societies said three were killed and 27 injured in the latter attack; it had been directed at a nearby building, but the roof of the maternity hospital collapsed and windows were smashed. It was part of a compound including Iraqi Red Crescent headquarters, fair grounds, and a surgical hospital. Evidently the hospital had been mostly evacuated some days earlier. Reports differed. An official Iraqi source said nine women died. Arabic News placed the toll at 30 killed, 215 wounded.

     U.S. forces stormed a hospital in Nasiriya on April 1 and 2 and later showed evidence that it had been illegally used by Iraq for military purposes. But the Pentagon did not explain how the hospital could be legally attacked in the first place.

     CARE reported April 15 that shells had directly hit the large Al Yarmuk Hospital in Baghdad the week before, destroying the third floor. Nothing was said about casualties.

     Scores of hospitals and clinics were said to have been hit by U.S. bombs in the last dozen years; sources differ on the numbers of raids and casualties. Iraqi hospitals were bombed under George H. W. Bush in his 1991 Persian Gulf War and under William J. Clinton starting in December 1998. During the Clinton-NATO war on Yugoslavia, air attacks on hospitals in various cities, including Belgrade, Nis, and Surdulica, took lives in April and May 1999. In George W. Bush’s war on Afghanistan, 2001-2002, bombs struck hospitals in Herat, Kabul, and Kandahar; some reports placed the death toll in the hundreds.

High toll of civilian casualties

     The International Committee of the Red Cross said that the staffs of Baghdad hospitals were stretched to their limits and that the number of casualties in the city were so high, hospitals there stopped keeping count. About 100 wounded civilians were being admitted each hour during the height of the U.S. bombing on April 6 and the start of Baghdad ground operations by U.S. troops resulted in worse injuries and a massive increase in doctors’ workloads, BBC said (April 8). They were running out of medicines and anaesthetics, performing surgical operations with the aid of headache pills or no pain killers at all. With no government to pay them, doctors were working for nothing.

     Iraqi hospitals did not escape the looting and anarchy in occupied Iraqi cities. In Mosul, all eight ambulances and some doctors' cars were reported stolen at gunpoint at Jumhuriya Hospital. A worker at Saddam General Hospital told a New York Times reporter that doctors left after their offices were looted (nytimes.com, April 11). “We see injured people and we cannot do anything.” Hospitals in Baghdad were ransacked, divested even of baby incubators. Most closed down. Shiite militia seized Baghdad’s Al-Kindi Hospital, using it for a base (AFP and Reuters, April 12).

     Red Cross workers said that in two days in Hilla, or Babylon, at least 400 people entered the hospital, far beyond its capacity; physicians worked around the clock; “a truck was delivering totally dismembered dead bodies of women and children” (Canadian Press, April 3). Sixty-one people from six hamlets were dead at the hospital from cluster bomb attacks; probably many others were buried in their home villages, said the Independent (UK, April 3). It described wailing, maimed children and adult civilians with metal buried deep in the flesh and “10 patients upon whom doctors had to perform brain surgery to remove metal from their heads” after the sky rained thousands of bomblets that exploded both outdoors and indoors. Eighteen died in a bus (nytimes.com, April 3).

     The Red Cross suspended operations in Baghdad when a team leader, from Canada, was shot dead; he was in one of two cars marked with Red Cross emblems; other civilian cars were also attacked by gunfire, and a total of 13 died in the incident (Australian Broadcasting Corp., April 10).

     The number of civilians killed in the latest war on Iraq was estimated at between 2,180 and 2,653 as of May 1, according to iraqbodycount.net.

U.S. physicians protest

     Dr. David Levinson, internist and emergency physician at Kaiser Hospital, Richmond, Calif., comments on the attacks against hospitals. Under the auspices of International Physicians for the Prevention of Nuclear War, to which he belongs, he traveled to Iraq in 1991 to assess the effects of the first U.S.-Iraq war on health care.

     “I am horrified by reports of the attacks on and destruction of health care facilities by U.S. and allied forces. Such attacks are clear violations of international law, which, coupled with the illegality of the U.S. invasion itself, make the U.S. guilty of war crimes. Following the Gulf War of 1991, I personally witnessed the terrible toll which that war had taken on health care through the destruction of both health facilities and infrastructure necessary to support civilian life. The result was the immeasurable death and suffering of innocent people. We have now compounded horror upon horror. War such as this must never be allowed to happen again.”

     The statement at the University of California at San Francisco (UCSF), published April 3 in its newspaper, Synapse, called the attack on Iraq incompatible with the healing professions, contrary to international law, and in reckless disregard for lives and security. Among the 364 signers were the following two MDs, who also react to the hospital attacks.

     Dr. Biljana Horn, pediatrician and assistant clinical professor, UCSF: “If it is true that the hospitals were attacked, which I still have a very hard time believing, we should all be ashamed of ourselves for letting it happen. I don't think that anyone should be content or pleased with the course of this war, seeing all the blood and destruction it has left. It is not only Iraq that is attacked; all people around the world with conscience are attacked and victimized with this war.”

     Dr. Meg D. Newman, associate professor of clinical medicine, UCSF, and director of AIDS education at San Francisco General Hospital: “The notion that the armaments in this war would avoid civilian casualties was unrealistic, as many of us anticipated. The depth of civilian casualties and direct destruction of facilities caring for the injured has been shameful. As a U.S. citizen, and more importantly as a citizen of the world, I stand committed to making the U.S. accountable for this victimization. It is entirely within our capabilities as world citizens to settle even complex conflicts non-violently despite what has been our historical tendency to do otherwise.”

Urgent appeal by Belgian doctors

     Medical Aid for the Third World, a group from Brussels, Belgium, that has had a small delegation of physicians in Baghdad since March 16, has called attention to a “humanitarian catastrophe” caused by the U.S.-British bombings and invasion of Iraq. On April 16, the doctors demanded that the occupying powers carry out their responsibilities under the fourth Geneva Convention and asked the UN to resume humanitarian operations at once. They said, in part:

     “We have seen hundreds of civilians, including many children, injured and killed, often by prohibited weapons such as cluster bombs. We have seen how ambulances and civilian cars have been hit by US troops.

     “We have experienced how patients and health workers had difficulties passing US military checkpoints and reaching medical facilities.

     “We now see how the Iraqi civilian hospitals and other medical facilities are plundered and neglected. Many Iraqi health professionals can no longer report to work. Without electricity, safe water supply and the provision of medicines and other medical supplies, many patients are simply left to die.”

     They placed the blame on U.S. and British authorities for launching a war of aggression in violation of international law and repeatedly breaching the Geneva Conventions. They said that at the request of victims, they asked a lawyer to explore the possibility of a war crimes trial. Ultimately, a solution required the unconditional withdrawal of occupation troops, full restoration of Iraqi sovereignty, and payment by the U.S. and the U.K. for all damages inflicted on the people and society, the group stated. Nevertheless:

     “In the meantime, as occupying powers, the US and Great Britain have the duty of ensuring the food and medical supplies of the population (Article 55 of the Fourth Geneva Convention). They likewise have the duty of ensuring and maintaining, with the cooperation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory. They must allow medical personnel to carry out their duties (Article 56 of the Fourth Geneva Convention)....

     “ We call on the relevant UN agencies, such as the UNFP, UNICEF and the WHO, to immediately resume their humanitarian operations in Iraq.”

     The signers were Doctors Geert Van Moorter, Colette Moulaert, Harrie Dewitte, April Claire Geraets, and Bert De Belder, the group’s coordinator.

May 1, 2003

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