What is the cost for killing humanitarians?

On Saturday, 3 May, we at Médecins Sans Frontières/Doctors Without Borders (MSF) woke to shock, grief, and outrage. Our hospital in Old Fangak, South Sudan had been attacked: a helicopter gunship destroyed the pharmacy, shelling followed, and drones bombed the market. Patients and staff fled as shrapnel tore through hospital. It was terrifying – and a clear violation of international humanitarian law.

These same emotions ran through us with the news of two other horrific mass attacks that killed medical workers in recent weeks. ​ 

On 23 March, the Israeli military in Gaza killed 15 people, including eight staff from the Palestinian Red Crescent Society (PRCS). Eight days later, their bodies and destroyed vehicles were discovered in a mass grave. Videos showed the attack was deliberately carried out on clearly identified medical staff and ambulances. No aid at all had been allowed into the Gaza Strip for the month prior, a complete siege that lasts through today.

On 11 April, in Zamzam displacement camp, in Sudan’s North Darfur region, nine medical workers from the humanitarian organisation Relief International were ruthlessly killed as Rapid Support Forces soldiers entered a clinic – the last one still running – during their assault on the camp. 

These are just the latest, and particularly shocking, examples of attacks against medical and humanitarian workers worldwide. We’ve also seen horrific attacks in Ukraine, in Haiti, in Democratic Republic of Congo, amongst others. Whether they directly target staff or hospitals from MSF, or from other organisations, we – humanitarians – feel attacked. We share the grief of all medical and humanitarian colleagues who work alongside us, acting with the same urgency to care for sick and injured people.

These recent assaults on humanitarian and medical workers are exceptionally grave – not only for their brutality and toll, but for the profound indifference that followed. Aside from statements by the United Nations and isolated calls from some states – like the UK’s request for investigations into attacks in Gaza, or France’s response after the strike on Old Fangak’s hospital – there is no shared global outrage. There is no strong political momentum, and certainly no concrete action against the perpetrators. Verbal condemnations ring hollow without real consequences.

It almost feels futile to ask the question: what is preventing this from happening again... even tomorrow?

All such attacks should be met with strong, unequivocal condemnation. We should expect emotion, mobilisation, and strong reaction. Independent investigations should be launched automatically to identify those responsible, and existing laws and international conventions applied – their enforcement should not be up for negotiation or compromise. Justice should be delivered to the families and the colleagues of the victims, and concrete pressure applied to political stakeholders who tolerate, enable, or even actively encourage, such attacks. Nearly four years on from the brutal killing of our three colleagues in Tigray, Ethiopia, the Ethiopian authorities have failed to conduct a credible, transparent, impartial, or timely investigation.

In the absence of a meaningful international response, it seems to us that carrying out these attacks is increasingly cost-free for the perpetrators. What political, legal, economic, social, or moral price are they paying? And what state, body, or institution is truly ready and committed to hold them accountable? It should be unthinkable that killing humanitarians or medical staff – people risking their lives to deliver care – comes with little or no consequence. This isn’t only about preserving the feasibility of our work; it’s about defending fundamental values like solidarity and empathy. 

Let me be clear: attacks on healthcare staff and aid workers are not new. We don’t yearn for a mythical ‘golden age’ where our work was universally respected, or our security guaranteed. On the contrary, MSF has consistently denounced such attacks and called for change. In 2016, after a wave of assaults on our staff – including the US bombing of Kunduz hospital in Afghanistan – and amid systematic campaigns against hospitals in Syria and Yemen, we supported the adoption of UN resolution 2286, aimed at protecting the wounded and sick, medical personnel, and humanitarian workers in armed conflict. But since then, we have seen its impact remain disastrously limited.

We are not alone in this fight. The International Committee of the Red Cross continues to lead its “Healthcare in Danger” campaign. In 2024, the UN Security Council passed Resolution 2730 – initiated by Switzerland – calling on all states to respect and protect humanitarian workers. That same year, an interministerial group from Australia, Brazil, Colombia, Indonesia, Japan, Jordan, Sierra Leone, Switzerland, and the UK issued a joint statement committing to develop a new Declaration for the Protection of Humanitarian Personnel. However, the collective effort has so far failed. We have not seen the transparency, accountability, and change that should be expected. It is rare to even obtain basic acknowledgement from the perpetrators.

The death and injury of medical and humanitarian workers are often part of a broader, equally shocking and intolerable pattern of indiscriminate – and even deliberate – violence against the communities they serve. In Gaza, more than 52,000 people have been killed since 7 October 2023, according to local authorities. In Sudan, it is impossible to have a realistic estimate of the civilian death toll, though studies suggest it may number in the hundreds of thousands.

Today, in the face of an unprecedented assault on multilateral organisations, the United Nations, and legal institutions – exemplified by the growing number of countries opposing the International Criminal Court – it is not merely a lack of political pressure or justice, but a deliberate dismantling of the very channels for accountability and change. We call on all those who still believe in humanity and solidarity to strongly condemn these attacks. We need them, wherever they are, to unite and rally around renewed calls for legal and political accountability. Citizens must demand that states who claim to uphold international conventions and treaties take tangible political action and apply political pressure to stop to the normalisation and concealment of attacks against health staff and humanitarian workers – in Gaza, in Sudan, South Sudan, and around the world.

Now, more than ever, we need warring parties – as well as the states who politically, economically, or militarily support them – to recognise that attacking and killing humanitarians is an assault on the very values they stand for.

Killing humanitarian workers should not just be costly – it should be utterly unaffordable.