Attacks on Healthcare in Armed Conflict: Strengthening Legal Protection and Accountability Under International Humanitarian Law

Abstract This article examines the erosion of the protection afforded to healthcare in contemporary armed conflicts under international humanitarian law (IHL). Despite clear legal safeguards for medical personnel, units, and transports, attacks against healthcare by both State and non-State actors have become increasingly frequent and rarely lead to effective accountability. This article advances five lines of analysis. First, it revisits the normative foundations of protection by examining the principle of medical neutrality and its relationship with medical ethics. Second, it assesses the capacity of the existing IHL framework to address contemporary challenges by analysing the special protection afforded to medical missions and the conditions for the loss of such protection. Third, it explores emerging conceptual approaches that seek to reframe attacks against healthcare, focusing on the characterization of healthcare as a global common good and the development of the notion of ‘ medicide ’. Fourth, it analyses persistent shortcomings in documenting attacks on healthcare and the need to strengthen investigative standards, including through the use of open-source intelligence. Finally, it assesses the capacity of international criminal justice mechanisms to ensure accountability for such attacks.