03 May 2017

On May 3rd 2016, the UNSC unanimously adopted Resolution 2286 (drafted with MSF &ICRC support), aiming to (1) condemn attacks against medical facilities, personnel and patients in conflict situations; (2) Reaffirm their rightful protection towards the international framework under which all states must abide.

It supersedes national laws or doctrines that may pay less respect to the core of IHL.  It was a record-breaking resolution, co-sponsored by more than 80 nations, including states actively involved in International coalitions such as US, KSA, France or UK, but not Russia.

On August 18, the SG provided the UNSC with recommendations on measures to enhance the protection of, and prevent acts of violence against the patients, health personnel and the Medical Mission (i.e. operationalisation of the resolution). Howeve, this official UNSG document was not discussed nor approved by UNSC/States.

Last year MSF was involved in the drafting of the resolution and the recommendations, together with other actors such as ICRC. At the same time, MSF took strong public position at the UNSC calling for the reaffirmation of basic IHL norms currently threatened by the military practices in the war against terror and denouncing UNSC failure to operationalize the resolution at a time when attacks continued with impunity from Yemen to Syria.

One year later, the content of the resolution remains largely an empty rhetoric at field level and little has been done by States to concretely translate the resolution into sustained action.  

MSF, Doctors Without Borders, resolution 2286
 M10 Hospital supported by MSF, heavily damaged by shelling in Sept. 2016 & forced to suspend activities. Was damaged again while under rehabilitation in Oct. 2016 by bombs & maintenance workers were killed.
Archived image: MSF/Ghaith Yaqout Al-Murjan

Core Messages:

  1. 1 year since its adoption, Resolution 2286 protecting healthcare delivery in conflict had little impact: MSF calls on the UNSC to immediately enforce 2286 content.

Some military forces and non-state actors routinely and flagrantly disregard the protection of civilians, and the norms and laws governing humanitarian operations.

MSF demands the full implementation and enforcement of this resolution by the UN Security Council and global leaders. The resolution 2286 and its recommendations for operationalization are vital to safeguard health in conflict. The UN Security Council and Member states MUST take action.

  1. All Member States must commit to make attacks against healthcare in conflict an absolute redline and ensure that neutral and impartial health care delivery must never be considered as a “material support to terrorism”.

Increasingly, states are engaged in combined non-international armed conflict and counterterrorism situations where counter-terror laws violate the principles of IHL and Resolution 2286. National security interests must never be used to justify wars without limits.

The application of IHL rules and CT legislation applied in the war on terrorism MUST NEVER allow the  criminalization of impartial delivery of health care to anyone in need—including wounded and sick combatants-, hospitals to be attacked, and healthcare systems to be destroyed.

For example, in Syrian opposition-controlled areas, doctors risk being arrested or killed for treating, quote, “terrorists” or criminals. And patients risk their lives by seeking care. As MSF, we will not accept a logic that the “doctor of my enemy is my enemy.”

  1. conflict to integrate the principles of 2286 into their military operational precautionary measures”.

As part of their responsibilities in the conduct of war, parties to a conflict need to do their utmost to spare civilians, protect hospitals, health workers and patients. Bombing of demilitarized hospitals and health/aid actors is a war crime. Specifically, member states contributing to international coalition forces or engaged in international counter-terrorism operations, should make sure that the principles of the protection of the medical mission under IHL is integrated in their national legislation and military operational precautionary measures. They must review and military operational precautionary measures in order to include. Specifically they must recognize:

MSF, Doctors Without Borders, UNSC 2286 resolution
Abs hospital airstrike aftermath, Hajjah, Yemen. Hospital worker salvages the remains of undamaged medication & equipment left in the ER.
Photo: Rawan Shaif


[1] Apart from limited discussion among a small group of diplomatic missions (to which MSF is contributing) in GVA and NY.

[2] “Operational precautionary measures” is the term used in resolution 2286 for Military Manuals, Rules of Engagement, Standard Operating Procedures, …

[3] This is not a naïve request as encouragingly shown by the US who has reaffirmed, in October 2016, its own obligations under international law to protect the medical mission in international and non-international armed conflict settings. The U.S. Secretary of Defense issued a statement of principles on the provision of humanitarian aid. Among other reaffirmations, it declares the following: “Medical care during armed conflict is an activity that is fundamentally of a neutral humanitarian and non-combatant character. Ensuring that medical care during armed conflict is protected requires that parties refrain from acts that undermine its protection and take affirmative steps to distinguish medical care from activities of a combatant character.” It goes on to make clear that “all the wounded and sick, whether or not they have taken part in the armed conflict, shall be respected and protected. The wounded and sick are persons placed hors de combat by sickness or wounds.”

While the document reaffirms the protected status of the medical care provided by impartial humanitarian actors, as well as the wounded and sick, there are still points of divergence between MSF and the US around issues such as (1) the search and capture of a wounded and sick “enemy” inside an hospital, or (2) the potential Criminalization of Medical Care for those treating wounded or sick according to medical ethics when a State has not accepted the services of impartial humanitarian organization.

However, it could be used as a model  to ask other States to review the rules of engagement of their own armed forces. 

Read more about MSF's activities in Yemen and Syria