MSF: Record level of attacks on medical care in armed conflict, as States neglect obligation to protect civilians

Embargoed until 2300 GMT, 20 January 2026 – Attacks on medical care in armed conflicts have reached record levels. Warring parties – including States – are increasingly shirking their obligation under international humanitarian law (IHL) to protect medical facilities, personnel, patients and vehicles, according to a new report from Médecins Sans Frontières/Doctors Without Borders (MSF). Nearly 10 years after UN Security Council resolution 2286, which condemned attacks on healthcare and called for an end to impunity, States must comply with IHL, respect civilian lives, ensure accountability, and reverse the culture of impunity.

The report, Medical care in the crosshairs, draws figures from existing international databases and MSF’s own experience in armed conflict. In 2025, the World Health Organization's Surveillance System for Attacks on Health Care (SSA) reported a total of 1,348 attacks on medical facilities, resulting in the deaths of 1,981 people. This marked a significant increase in fatalities among medical personnel and patients in conflict zones, which doubled from 944 in 2024. Sudan was the most affected country, with 1,620 people killed, followed by Myanmar with 148, Palestine with 125, Syria with 41, and Ukraine with 19 people killed.

The MSF report highlights a troubling decline in warring parties respecting IHL. This trend is evident in both statistical data and the statements made by government members, military figures, and others involved in armed conflicts.

“Warring parties have shifted the narrative from one of ‘mistaken attacks’ to a justification that medical facilities and humanitarian personnel have “lost protection” under IHL. This shift often reflects a prioritisation of military necessity over the obligation to protect civilians and mitigate civilian harm”, says Erik Laan, an advocacy expert with MSF.

In some instances, attacks may arise from misinterpretations of IHL or exploiting ambiguities in both treaty and customary law. Consequently, the burden of responsibility has changed: instead of automatically being seen as civilians and therefore protected, communities and healthcare facilities now must prove that they are not military targets.

“Core obligations by warring parties, such as the requirement to provide timely warnings before an attack, are often overlooked,” explains Laan. “This neglect prevents medical facilities from responding to allegations of loss of protection or evacuating patients.”

In 2024, the latest available data from the Safeguarding Health in Conflict Coalition documented 3,623 incidents targeting healthcare,15% more than in 2023 and 62% more than in 2022. In 2024, approximately 81% of incidents of violence against healthcare were attributed to state groups.

“State involvement in armed conflict poses specific challenges to protecting medical care, as State groups are more likely than non-state armed groups to carry out air-launched attacks and use explosives, especially in densely populated areas,” says Raquel González, MSF Spain coordinator. “Violence against medical and humanitarian care leads to the closure of essential medical services and the withdrawal of humanitarian organisations, thereby cutting access to healthcare for communities that often have no alternatives. People living in conflict areas are already affected by violence, and the loss of medical care makes their lives even more unbearable.”

Locally hired staff are particularly affected by these attacks. According to the Aid Worker Security Database, between 2021 and 2025, 1,241 locally hired staff members were killed, 1,006 were injured, and 604 were kidnapped worldwide. They represent 98% of the total of aid workers killed, 96% of those injured, and 94% of those kidnapped.

On 03 October 2015, MSF experienced one of the deadliest attacks on our staff, patients and facilities when a United States AC-130 gunship bombed the Kunduz trauma centre in Afghanistan. The attack killed 42 people, including 14 MSF staff. Seven months later, following advocacy from the humanitarian sector, the UN Security Council adopted Resolution 2286 on the protection of medical facilities and personnel, which called for an end to impunity for those responsible and to respect IHL. More than ten years later, medical care and humanitarian action in armed conflicts continue to come under fire – arguably more than ever.

“This resolution was a glimmer of hope, as it was the first time these concerns were addressed in a binding decision,” says Laan. “However, only six of the then-15 Security Council members who adopted Resolution 2286 had ratified all Additional Protocols to the Geneva Conventions, which enhance the protection of victims of armed conflict.”

A country’s own laws and legislation, which ultimately incorporate international legal obligations, plays a crucial role in this context. National legislation, if not crafted carefully with due consideration for IHL, can undermine IHL obligations in practice, particularly the right to medical care for everyone, including those labelled as “enemies” by a warring party.

“States must comply with international law, and all warring parties must ensure proper mechanisms for military engagement to ensure the protection of medical care, prevent the use of medical facilities for military purposes, and integrate the protection of medical missions into military doctrine and decision-making,” says Laan. “States must also be held accountable when they fail to comply with such laws. They must accept independent fact-finding missions, conduct their own investigations and share findings transparently. These mechanisms are essential to establish the facts and contribute to ensuring accountability and countering the prevailing culture of impunity.”

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