Medical neutrality


Medical neutrality refers to a principle of noninterference with medical services in times of armed conflict and civil unrest: physicians must be allowed to care for the sick and wounded, and soldiers must receive care regardless of their political affiliations; all parties must refrain from attacking and misusing medical facilities, transport, and personnel. Concepts comprising the principles of medical neutrality derive from international human rights law, medical ethics and humanitarian law. Medical neutrality may be thought of as a kind of social contract that obligates societies to protect medical personnel in both times of war and peace, and obligates medical personnel to treat all individuals regardless of religion, race, ethnicity, or political affiliation. Violations of medical neutrality constitute crimes outlined in the Geneva Conventions.

Historical background

The principle of medical neutrality has roots in many social traditions.
Medical neutrality is violated when health care professionals, facilities, or patients come under attack, or when medical professionals are not allowed to provide treatment. Examples include:

Chile (2019)

Since civil unrest broke out in October 2019, there has been backlash toward police and military forces for their disregard for medical volunteers who aid injured protestors. The best known and evidenced case thus far occurred Friday November 15, 2019. An ambulance was inhibited in its ability to transport a person suffering from cardiac arrest during a peaceful protest in Plaza de la Dignidad. The medical volunteers who were attending to him came under fire from carabineros’ rubber bullets, tear gas and water trucks. They were put at risk and hindered in their efforts to resuscitate the patient. One volunteer sustained a wound to the leg. The medical team‘s inability to safely attend to the patient and transport him to the hospital resulted in his loss of life.

Afghanistan (2015)

On 3 October 2015, U.S. airstrikes killed 42 people and destroyed the MSF trauma hospital in Kunduz, Afghanistan. Many patients in the hospital burned alive in their beds as a US AC-130 gunship made multiple passes firing upon the hospital from overhead. MSF's request for an independent inquiry was never honoured. The U.S. military investigated itself, eventually taking disciplinary action against a dozen service members. No criminal prosecutions followed.

Bahrain (2011 & 2012)

The Bahraini government’s crackdown on the Bahrain uprising in 2011 and 2012 included extensive violations of medical neutrality. An investigative report released by Physicians for Human Rights revealed that many doctors were attacked or incarcerated. Furthermore, Bahraini security forces have seized control of medical facilities, prevented patients from receiving treatment, misused ambulance services, and violently interrogated wounded patients. In September 2011, 20 medical workers in Bahrain were sentenced to up to 15 years in prison for treating protesters. These sentences were immediately condemned by United Nations secretary general Ban Ki-Moon and human rights groups such as Physicians for Human Rights. Apparently in response to international pressure, the Bahrain government ordered that the doctors be retried in civilian court, but the verdict has yet to be decided.

Egypt (2011)

In 2011, during political unrest, state security forces directly attacked protestors and field clinics, injuring and killing numerous people. A state security officer even dressed himself as a doctor and administered fatal shots to those injured in a field clinic outside of Tahrir Square. Medical supplies were confiscated by “military officers and field hospital tents were burned down during a Tahrir raid.”

Libya (2011)

During the 2011 Libyan Civil War, human rights groups documented violations of medical neutrality along with many other gross violations of human rights. Physicians for Human Rights conducted investigations within Libya in 2011, and found that the military had attacked and destroyed hospitals. Several eyewitnesses reported that Gaddafi forces attacked ambulances carrying injured combatants, despite the fact that the ambulances were marked with the emblematic Red Crescent. Medical personnel were kidnapped by Gaddafi’s forces, and military forces used people as human shields.

Syria (2011)

The Syrian civil war has been marked by widespread human rights abuses, including numerous violations of medical neutrality. Government forces have invaded, attacked, and misused hospitals and medical transports, preventing civilians from receiving health care. An estimated 250 doctors have been detained and tortured for treating wounded civilians. An investigation by Physicians for Human Rights revealed that these circumstances have led to the rise of an underground health network.

Iran (2008-2011)

In June 2008, Iranian authorities detained Dr. Arash Alaei and Dr. Kamiar Alaei, two well-known Iranian physicians and leaders in the fight against HIV/AIDS. The physicians, who are brothers, were held in Tehran’s notorious Evin prison for over six months without being charged or tried. On December 31, 2008, a one-day, closed-door trial was held, in which the brothers were tried as conspirators working with an “enemy government” to overthrow the government of Iran. They were also tried at that time on unspecified other charges which neither they nor their lawyer were allowed to know, see the evidence of, or address. They were charged with attempting to overthrow the Iranian government under article 508 of Iran’s Islamic Penal Code. Kamiar was sentenced to three years in prison and Arash to six. The government of Iran used the brothers’ travels to international AIDS conferences as the basis for these claims.
The international community decried the sentences of the doctors, and Physicians for Human Rights launched a campaign for their release. In 2010, Dr. Kamiar Alaei was freed after serving two years in prison. Dr. Arash Alaei was released in August 2011 after more than three years of detention. Since their release, the doctors have reunited in the United States, where they continue their medical and advocacy work.

Sri Lanka (2009)

Sri Lanka’s lengthy civil war was marked by extensive human rights abuses. In 2009, the Sri Lankan air force violated the principle of medical neutrality when it destroyed the Ponnampalam Memorial Hospital in Puthukkudiyiruppu.

Chechnya (1996)

During the Battle of Grozny in 1996 during the First Chechen War, several hospitals were attacked. Municipal Hospital No. 9 was invaded by Russian soldiers and approximately 500 civilians were taken hostage. The ICRC Hospital of Novye Atagi, which was created to symbolize medical neutrality in the war-torn area, was attacked and six members of the ICRC staff were killed.

Thailand (1992)

A year after a bloodless military coup in Bangkok in February 1991, the new government responded to the pro-democracy movement opening fire on a May opposition rally, resulting in 52 deaths, hundreds of injured, and many disappearances. Physicians for Human Rights reported that health professionals were prevented from reaching the wounded and the police shot at ambulances.

El Salvador (1980-1992)

In the Salvadoran Civil War, many field clinics were attacked by guerillas. Patients were commonly abducted from hospitals, and government forces greatly limited the movements of health workers. Medical transports were also attacked, in some cases resulting in the deaths of medical workers.

Mozambique (1977-1992)

During the Mozambican Civil War, the resistance group RENAMO was responsible for many violations of medical neutrality. Attacks on hospitals and health clinics were common. In one instance, RENAMO soldiers raided the town of Homoine, killing 442 civilians including hospitalized patients.

Panama (1988)

Civil unrest and demonstrations began in Panama in June 1987. During the unrest, human rights groups such as Physicians for Human Rights documented a variety of human rights abuses and violations of medical neutrality. The military blocked access to hospitals and interfered with provision of medical care, took control of ambulance services for military purposes, and interrogated wounded patients. In addition, Panamanian physicians were kidnapped, beaten, and tortured for speaking out against government policies which prevented them from providing their patients with adequate care.

United States (2020)

During Police Brutality peaceful marches police force attacks medics huts and personal shooting rubber bullets and tear gas directly at them from close range. Arresting both medics and patients. Medical personnel were forcibly removed from a medic area by police in riot gear in Asheville, North Carolina. Medical staff were on location assisting protestors on what marked the third day of demonstrations in Asheville in response to the death of a black man, George Floyd, in the custody of Minneapolis police officers. Asheville police officers in riot gear held shields forming a protective circle while officers stomped and stabbed water bottles. Other officers destroyed medical supplies such as bandages and saline solution by ripping and puncturing them with knives to render them useless.
On 31 May 2020, police fired "non-lethal rounds" at Tim Lemuel, owner of the Raleigh, North Carolina gay bar Ruby Deluxe, and his staff as they were handing out bottles of water to Black Lives Matter protesters. On 1 June 2020, police officers in Des Moines, Iowa attacked medics and destroyed medical equipment used to treat Black Lives Matter protesters at The Blazing Saddle, a gay bar.

Organizations with a specific focus on medical neutrality

The Medical Neutrality Protection Act of 2011,, is a bipartisan bill introduced by Representatives Jim McDermott, and Walter B. Jones, Jr. that intends to make the protection of medical professionals and access to medical services a global policy priority for the US government.