In 2023, civilian fatalities surged by an alarming 72%, with conflicts across the globe claiming three times as many children’s lives and twice as many women’s lives compared to the previous year. Children aged five to nine are among the hardest hit, their futures cut tragically short before they have a chance to unfold. Beyond the devastating loss of life, the daily attacks on critical infrastructure—particularly hospitals—compound the suffering, leaving entire communities trapped in cycles of fear and despair.

In the theatre of war, healthcare systems become silent casualties. These lifelines, essential for survival, are pushed to the brink, as medical workers face life-threatening risks, resource shortages, and overwhelming emotional and physical strain. Millions of people caught in the crossfire depend on these systems to treat injuries, manage psychological trauma, and provide care for chronic conditions that require consistent treatment.
Amid this chaos, patients battling cancer, HIV, mental health disorders, and other critical illnesses face a grim reality: the collapse of healthcare services in a world ravaged by hostility. Through individual stories, the staggering human cost of these shattered systems comes into sharp focus.
The global impact of these attacks is exemplified in regions such as Gaza, Ukraine, and Syria, where hospitals and clinics have become battlegrounds. Healthcare workers endure deliberate attacks, and life-saving infrastructure crumbles under aggression from both state forces and external actors.
Meanwhile, the international response remains fragmented. Weapons continue to flow into the hands of warring factions, humanitarian aid efforts have ground to a halt, and the enforcement of binding legal norms remains woefully inadequate. As a result, the right to health—enshrined in international law—becomes a distant dream for millions caught in the crosshairs of conflict.
This article examines health care in the three conflict zones and argues that despite their different pre-war conditions—ranging from Ukraine's developed infrastructure to Gaza's under-resourcing and Syria's authoritarian governance—they share a similar trajectory of health system collapse, humanitarian burden and resilience of local actors.
Central to this analysis is the failure of international law, as seen by the lack of accountability for violations of the Geneva Conventions in all three contexts. By showing the underlying patterns across all three cases, this article attempts to highlight the universal vulnerability of healthcare in modern conflict and contributes to a broader understanding of the challenges faced by international and local actors trying to end the war.
Ambiguities in International Law
There is little practical protection in international law. While attacks on hospitals as well as buildings dedicated to education are considered war crimes, hospitals can legally be attacked if they are used for acts considered “harmful to the enemy” (First Geneva Convention, Article 22), given notice and leaving enough time for evacuation. The attacking country has to prove that the hospital was used for military purposes and provide a two-day notice, leaving enough time for evacuation. If not, the attack is considered an act of war crime.
But since the concept of “harmful to the enemy” is not well defined and can be broadly interpreted, it has justified various brutal attacks on hospitals in the past which have cost the lives of innocent medical workers and patients, often including children and women.
International law thus offers a loophole for attacks on hospitals and other essential healthcare facilities instead of protecting these vital facilities.
This ambiguity in the legal framework has led to real-world tragedies. A prominent example of this loophole is the US attack on a Médicines Sans Frontières (MSF) hospital in Kunduz, Afghanistan, by a US aircraft which caused the death of 42 people on October 3rd, 2015.
The Pentagon report of the case concluded that the attack was not a war crime and only a result of “unintentional human error and equipment failure.” Despite the deaths of civilians and medical staff, the incident resulted in minimal repercussions for the US military.
Not satisfied with the US investigation, the lack of an independent investigator, and the limited punishment, MSF released its investigation of the case on November 5th, 2015, concluding on two main points.
First, the US justification of attacking due to members of the Taliban being in the hospital is countered by MSF who state that the Taliban were patients of the hospital, and thus proving, by referencing the Fourth Geneva Convention, Article 19 (“the fact that sick or wounded members of the armed forces are nursed in these hospitals {...} shall not be considered to be acts harmful to the enemy”), that the US attack was unjustified.
Second, the Pentagon report claims that the aircrew was unaware that they were firing on a hospital despite the provision of exact GPS coordinates of the hospital by MSF earlier that week.
The punishment following the attack is thus clearly based on the US investigation, which disregards the facts provided in the MSF investigation. This demonstrates a clear disregard for international law by the United States but also shows the failure of international law to take rightful measures and hold them accountable. If even international law cannot be relied on in times of war, the thin thread of hope threatens to tear.
As a result of this event and the global outrage over the failure of international law, the Security Council adopted Resolution 2286 in 2016. It condemns attacks on healthcare, reminds of legal obligations regarding protecting medical staff and facilities, and calls for taking measures when the law is violated.
Trigger Warning: Sensitive Images Ahead (Blood and Injury)
The case of Kunduz is not an isolated case, with the number of successful prosecutions being significantly lower than the many cases where attacks on medical personnel and facilities and the unjustified killing of civilians remained unpunished despite substantial evidence of violations. The most prominent ones are the attacks on healthcare facilities and personnel in Gaza, Ukraine and Syria. One is more brutal than the other, not sparing a single soul.
Gaza’s Healthcare Under Siege
Gaza has become the epicentre of violence. As of November 10, according to the United Nations, “16 of the region’s 36 hospitals remain partially operational”, while the rest are in ruins. The first six months, from October 2023 until April 2024, show a fierce conflict, characterised by targeted attacks and indiscriminate shooting. It has generated the highest number of attacks on healthcare, more intense than any conflict in the last six years, according to a Save the Children report, with 435 attacks on health infrastructure and personnel reported.

The high number of daily attacks over only a short period leaves the population of Gaza in constant fear, resulting in families taking radical measures, like Farah, an MSF doctor and mother who “decided to write the name of her children on their wrists and legs after surviving a 5 am airstrike [so that her] children’s bodies would be identifiable if the family were hit again.”
The collapse of healthcare as a result of Israel’s active targeting of the most essential infrastructure such as hospitals, deepens Gaza’s struggle for survival, leaving behind a humanitarian crisis and a population that endures an endless cycle of grief and despair.
A report by the Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem and Israel, extensively describes all of Israel's attacks on medical facilities and personnel as well as reproductive healthcare and pediatric care in Gaza. These attacks take the form of both being the result of collateral damage and the deliberate targeting of facilities and arrests, tortures and killing of medical personnel are “war crimes of wilful killing and mistreatment” and “crime against humanity”.
According to the Commission, the additional cutting off of basic supplies like water, food, and medicine were actions taken “as collective punishment against the Palestinians in Gaza”. Consequently, it calls for an end to the unlawful occupation, reconstruction of healthcare facilities and an immediate cease of all kinds of ill-treatment and targeting.
Even though international organizations recognize that Israel’s actions in Gaza are war crimes and violations of international law and reports of commissions call for an end to Palestinian occupation, Israel has not yet faced the consequences of its actions. This shows once again the failure of the law to keep up with the chaos of war, leaving millions of people to bear the burden of injustice and having to pay for it with their lives.
The continuous war allows the healthcare of Gaza to collapse even further, unleashing new deadly threats such as the return of eradicated diseases. Cases of Polio haunt the children of Gaza, causing paralysis and in extreme cases even leading to death. The decline in vaccination rates resulted from the crackling healthcare system and high-risk circumstances which led to a decline in material and staff.
The precarious living conditions and a lack of clean water and sanitary products also create a blooming hub for diseases and viruses. War might end when the fighting stops but the fight between life and death will go on, not allowing for a minute of calm or recovery. Even when physical wounds will eventually heal, mental scars will remain a constant reminder of the brutality of war.
Medecins Sans Frontieres’s reports from Ruba Suliman, a doctor working at Rafah Indonesian Field Hospital who says “We are alive, but we are not okay. We are tired.” The emotional toll is unbearable, especially for those whose task is to take care of others while slowly losing “all the small things that made you who you are.”
The daily pressure and choice between protecting one's own family or saving the lives of others result in various cases of anxiety, insomnia or depression. While mental health awareness and psychological treatment are also essential, the ongoing war neither offers a safe environment nor time to cope with the daily trauma, both for healthcare workers and patients.
Before the conflict, UNICEF estimated that 500,000 children in Gaza needed mental health assistance. Since the conflict evolved, these numbers more than doubled, now including all children of Gaza. The children suffer especially from trauma related to the daily attacks, the death of loved ones as often witnessed by the child, separation from family and overall stress and uncertainty about their future, let alone the next 24 hours.
The current humanitarian and healthcare crisis in Gaza stands concerning geopolitical and economic events of the past years, especially the blockades imposed by Israel, cutting Gaza off from the outside world and the West Bank. Entry and exit to Gaza are strictly regulated, impacting Gaza’s health care system as essential medicine and medical services could not regularly enter and no longer be provided for the population.
Gaza’s critical economic and humanitarian situation before the war offered many vulnerable spots for the war to spread and consume the entire country. Israel’s direct targeting of hospital and healthcare infrastructure in connection with years of blockade and its economic and humanitarian impacts could not be met with a stable system to fall back on resulting in today’s drastic crisis.
Gaza is the most recent case of active conflict which shows immense numbers of death and destruction in a short period. In this vulnerable time, where victims of war and those kept alive by essential treatment meet on the edge of survival, allocating scarce lifesaving resources becomes an impossible task to manage, leaving millions without care.
Gaza’s situation is dire but it is not an individual case. Ukraine presents another stark example of the devastation wrought on healthcare by war. But other than Gaza, Ukraine’s pre-war healthcare conditions were strong as a result of recent reforms.
Ukraine’s Healthcare in Ruins
In 2015, Ukraine took a step towards reforming its healthcare to improve health outcomes and provide financial protection from out-of-pocket healthcare payments. The healthcare reforms strengthened the system but the effects of war and continuous Russian attacks, especially the destruction of medical institutions, and lack of personnel and medicine still leave many people without essential care and on the brink of survival.
When the day revolves around surviving, the mind is under constant pressure while facing trauma and horror from all sides. As a consequence, the kind of healthcare provided needed to shift towards services for noncommunicable diseases and mental health as millions are fighting a silent battle against trauma, anxiety and depression.

Additionally, many suffer from diseases like HIV, for whom the collapse of Ukraine’s healthcare system equals a death sentence. Where Ukraine once provided a hopeful and strong treatment campaign treating more than 130,000 people and showing a suppression rate of 96% (Health Policy Watch). The Russian invasion has diminished that hope. This comes as healthcare centres that offer lifesaving treatment have been destroyed, posing a serious threat to the lives of HIV patients who are now left to face the unforgiving reality of their disease.
War does not stop at the sick or the healthy. The website Attack on Health Care in Ukraine counts more than 1,500 attacks on Ukraine’s health care system since February 2022 where more than 770 hospitals and clinics have been destroyed and 234 health workers have been killed. These are not just numbers but represent lives torn apart, families left without care and health workers killed on duty for saving the lives of the innocent.
Russia’s constant attacks on the most essential yet vulnerable pillars of survival are motivated by breaking the resilience of the population and government, forcing them into submission.
But while the UN acknowledges that Russia has committed and is committing war crimes in Ukraine, only a few individuals have been convicted. There are currently no criminal prosecutions of Russia's various war crimes and violations of international humanitarian law. Knowing that victims of Russian aggressions in Ukraine cannot hope for lawful punishment of their aggressor anytime soon, makes coping with these attacks and their impact on the present and future even more difficult.
While Gaza and Ukraine are fairly recent cases of active conflicts, Syria has been in the grip of a civil war since 2011. It is a haunting example of what happens to an already war-torn country when healthcare too is obliterated. Years of destruction and violence have left behind a country pervaded by a humanitarian crisis so deep that its wounds will take generations to heal and even then the scars may never fully fade.
From Progress to a Weaponized Healthcare Collapse in Syria
Since the Ba’ath Party came into power, Syria’s healthcare system and infrastructure have undergone significant improvements. The pharmaceutical industry has grown, medical education has come into focus, mortality rates have fallen and life expectancy increased. However, since the 2000s, Syria’s bright future has been obscured as its economic and political trajectory has shifted drastically.
When the war broke out, the state’s grip on education and healthcare tightened and turned deadly. Healthcare assistance not approved by the state became illegal and healthcare workers and doctors were arrested and threatened. The government actively arrested wounded protestors in hospitals and tortured doctors who treated them. The counter-terror laws issued in 2012 also officially criminalized medical aid provided to the opposition and its supporters.
Healthcare was dealt a major blow as the majority of healthcare workers fled the country out of fear of further prosecution and aggression. Those that remained developed an underground system of medical facilities, providing medical treatment in an unstable but safer environment. These hidden clinics, an act of courage in the face of danger, have sparked new hope for those wounded by war.

However, Syria is a case that shows how the state itself affected the collapse of the healthcare system during the war by actively threatening and targeting the lives of its people, and how the control of healthcare by the state destabilized the system. The Assad regime used its power over healthcare as a weapon, aiming to control the spirit of Syria's people.
In addition to the internal actions of control and destruction, external factors like Syria’s heavy reliance on Western imports of medicine resulted in the breakdown of the healthcare system after sanctions were imposed on Syria and the supply from the West was shut down. As a consequence, the overall quality of health declined as medical equipment could not be upgraded to the newest standard and essential medicine was limited, resulting in an increase of prices by 50% forcing many families to choose between medication or basic food supply.
Conclusion
War has transformed the three countries into volatile battlegrounds, where rapid developments make every passing hour a matter of life and death.
The healthcare crisis in Gaza, Ukraine, and Syria reveal an alarming pattern of destruction and neglect. From Gaza’s long-standing blockade and isolation, Ukraine’s promising reforms undone by war, to Syria’s once-progressive system weaponized by its government, each case highlights the systemic vulnerabilities of healthcare under conflict.
Despite their unique histories, these regions share a similar fate—healthcare systems that become targets, tools of control, or collateral damage in war, leaving populations to face humanitarian crises with little hope for change.
Uniting these cases is not only the endless disruption and violence but also the failure of international law to protect healthcare systems and enforce accountability. In each conflict zone, actions of deliberate targeting of medical infrastructure and personnel that violate international law are neither condemned nor successfully prevented.
When international law fails, diseases resurface, others go untreated, mental health deteriorates, and violence feels unending, the future becomes a shadowy void, threatening to extinguish the last glimmers of hope. Yet, despite relentless cycles of fear, trauma, death, disrupted supply chains, and the scarcity of medical supplies, the spark of courage within the bravest never fully fades. Healthcare workers stand unwavering, bound by their oath and driven by their unwavering commitment to those in desperate need.
Their efforts are bolstered by external support, including financial aid and the contributions of NGOs. However, the effectiveness of this aid—and the ability of NGOs to make a meaningful impact—hinges on the interplay of geopolitical strategies and competing interests, which often influence and constrain their work.
The future does not wait for the hesitant; it calls for those willing to stand on the side of humanity, turning the darkness of war into the light of recovery. The question now is about ending these conflicts and ensuring that this chapter of despair is not written again. Millions of lives depend on our answers.
Edited by Anish Paranjape and Eshal Zahur
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Keywords: Healthcare in conflict zones, impact of war on healthcare systems, civilian casualties in war, attacks on hospitals in war zones, Gaza healthcare crisis, Ukraine healthcare during war, Syria healthcare under attack, war crimes and healthcare, mental health in war zones, Geneva Conventions and war crimes, humanitarian crises in conflict zones, global healthcare collapse in wars, children affected by war, international law failures in war, healthcare worker safety in conflicts.
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