Childbirth is a trepidatious experience for every expectant mother anywhere in the world. Imagine, then, being in a maternity ward that comes under a blaze of gunfire.
On May 12, the maternity ward of the Dasht-e-Barchi hospital in Kabul, Afghanistan, run by Médecins Sans Frontières (MSF), was attacked by militants, resulting in at least two dozen deaths – including mothers, newborn babies, and healthcare workers. Eyewitness accounts describe gunmen on a rampage followed by Afghan special forces mounting a counter-attack to defeat the insurgents, rescue survivors, and recover victims. The attack came a day after the head and two other leaders of the “Islamic State in South Asia and the Far East” (i.e. IS or ISIS) were arrested by Afghanistan’s intelligence services in Kabul. Although no armed group has claimed responsibility for the attack as of yet, the deliberate, reckless, and reprehensible targeting of the hospital marks a new low point in the conflict in Afghanistan. It also comes at an extremely fragile time when the already food insecure country braces for the COVID-19 pandemic that has spread rapidly in neighboring Iran and Pakistan, while also facing a critical juncture in its path to peace after decades of war.
An agreement in February of this year between the United States and Taliban left many urgent but unanswered questions about peace between warring factions in Afghanistan. Moreover, the Unity Government of Afghanistan is still shaky, after a disputed 2019 election between incumbent President Ashraf Ghani and his challenger Abdullah Abdullah. The May 12 attack exacerbates concerns about the ability of the government to ensure security both in the capital and in remote areas of contested control. In the aftermath of the attack, Ghani and Abdullah announced a power-sharing deal. President Ghani also ordered the resumption of counterinsurgency offensives against the Taliban. Statistical data from around the world suggests that the ongoing pandemic has done little to abate political violence and – despite the United Nation’s call for a global ceasefire – even where there have been brief pauses in hostilities, it is too early to tell whether these will translate to any meaningful momentum for peacemaking.
Attacks on hospitals are at once morally indefensible and categorically illegal. The Geneva Conventions and their Additional Protocols prohibit the targeting of and afford protections to civilians, medical care providers, and aid workers (plus prisoners of war, the shipwrecked, and the injured or sick) (see here for an overview of applicable provisions). Notably, Article 18 of the fourth Geneva Convention states that “[c]ivilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack,” while Article 20 states “[p]ersons regularly and solely engaged in the operation and administration of civilian hospitals, including the personnel engaged in … caring for … maternity cases, shall be respected and protected” (emphasis added to both articles). Indeed, attacking hospitals is a war crime during both international and non-international armed conflicts.
Despite the clear illegality – indeed criminality – of the recent attack, enforcement is inconsistent and existing accountability mechanisms are inadequate. Notwithstanding the efforts of groups like Geneva Call, getting non-state armed groups to comply with international humanitarian law – which were originally developed to regulate inter-state armed conflict – is especially difficult. Although attacks on healthcare providers are outlawed in all armed conflicts, irrespective of whether between governments and/or rebel groups, research shows that both state and non-state parties to armed conflict seek to justify attacks on hospitals oftentimes in instrumental terms, by exploiting exceptions in applicable humanitarian law, typically without substantiating evidence, while in other instances ignoring the law for ideological reasons.
While outlawed under international humanitarian law, the targeting of medical facilities is unfortunately all too common. According to the U.N. Assistance Mission in Afghanistan (UNAMA), there has been a marked uptick in violent attacks on hospitals and clinics in recent years. Globally, both rebel and state forces commit such attacks, which vary in frequency and form from one context to another. For example, Physicians for Human Rights has systematically tracked and mapped military assaults on healthcare facilities and medical workers in Syria since 2011, the overwhelming majority of which have been carried out by the Syrian government and its allied foreign forces, especially in the eastern part of the country. International humanitarian organizations and advocacy groups – such as MSF, International Committee of the Red Cross, and Amnesty International – warn that aerial bombardments of hospitals and clinics have become what Amnesty has called a routine “strategy of war” in Syria. Over the course of the long-running conflict in the Democratic Republic of the Congo (DRC), various armed groups have attacked healthcare providers many times, including those treating Ebola and the attempted assassination of Dr. Denis Mukwege, who gained international renown and was awarded the 2018 Nobel Peace Prize for treating survivors of conflict-related sexual violence.
The deliberate targeting of a maternity ward – the gunmen bypassed a number of other wards in the hospital which were closer to its entrance – is all the more troubling in what it portends for the future of women in Afghanistan. As MSF’s head of programs observed when surveying the scene after the attack, “[The attackers] went through the rooms in the maternity, shooting women in their beds. It was methodical.” Violence against women, whether in private by family members or in public as political attacks, remains commonplace. Threats to hard-fought gains made by Afghan women in recent decades — in education, health, politics, and economics — are real, complex, and dynamic. Though largely sidelined from the formal peace process and despite dangers to their safety, women have mobilized in recent months to amplify their voices and exercise their agency to shape Afghanistan‘s future. Women’s fundamental human rights and, with them, prospects for democracy are at stake as the government and Taliban negotiate a compromise in the shadow of the drawdown of the US military presence in Afghanistan.
Alongside the rights of women is the right to health in a country that, even with progress made in recent years, continues to rank amongst the worst in the world for maternal mortality. Though the under-five mortality rate in Afghanistan has, on average, decreased by two-thirds over the last thirty years, much of that improvement has been possible thanks to the work of international humanitarian organizations such as MSF. Attacks like the one on May 12 make it close to impossible for patients to receive care safely and health-workers to serve patients effectively. The consequences of such an attack are not only devastating for immediate victims and their families who must grapple with trauma and loss, but also for all those who will be fearful and therefore dissuaded from seeking professional medical help in the future. That, after all, is what terror does.
Ordinary Afghans continue to struggle to survive and thrive in the face of ostensibly insurmountable challenges. Despite the uncertainties and risks that abound, now is not the time for the international community – including donor countries, humanitarian organizations, solidarity groups, and investigative journalists – to collectively turn its back on Afghanistan. Last week’s odious attack reminds us that it is not merely the political stability of the country that hangs in the balance, but also the very lives of its people, not least future generations.