Introduction to Médicos Sin Fronteras (MSF) and their Recent Report
Médicos Sin Fronteras (MSF), an international medical humanitarian organization, has denounced unprecedented levels of attacks against healthcare in armed conflicts. As the tenth anniversary of the UN Security Council resolution on protecting medical facilities and personnel approaches, MSF warns that warring parties are increasingly disregarding their obligations under International Humanitarian Law (IHL).
Key Findings from MSF’s Report: “Healthcare on Target”
MSF published the report titled “Healthcare on Target,” highlighting that in 2025, the WHO’s Attack Registry recorded 1,348 attacks on medical facilities resulting in 1,981 deaths. This is more than double the number reported in 2024 (944). Sudan was the most affected country, with 1,620 medical workers, humanitarian staff, and patients killed, followed by Myanmar (148), Palestine (125), Syria (41), Ukraine (19), and South Sudan (16).
Shift in Narrative: From “Mistaken Attacks” to “Loss of Protection”
The report indicates a shift in the narrative used by warring parties, moving from justifying “mistaken attacks” to claiming a “loss of protection” for medical and humanitarian infrastructure and personnel under IHL.
Erik Laan, MSF’s political influence expert, explained that this change often reflects prioritizing military needs over the obligation to protect civilians and minimize harm. This trend is evident in both statistical data and statements from government officials and military figures.
While acknowledging that these attacks sometimes result from misinterpretations of IHL norms, Laan lamented that advance warnings are frequently ignored. Moreover, warring parties appear less willing to defend protected combatants who are out of action and thus covered by IHL, effectively stripping them and the facilities treating them of their legal safeguards.
States Responsible for Most Attacks in 2024
According to the Coalition for Protecting Health in Conflict, 2024 saw 3,623 attacks on healthcare, a 15% increase from 2023 and a 62% rise from 2022. Approximately 81% of violent incidents targeting healthcare facilities and personnel in 2024 were attributed to state actors.
Raquel González, MSF Spain’s coordinator, emphasized that state involvement in armed conflicts poses specific challenges for protecting healthcare, as states are more likely than non-state armed groups to conduct aerial attacks and use explosives, especially in densely populated areas.
Local staff are disproportionately affected by these attacks, accounting for 98% of humanitarian workers killed, 96% of those injured, and 94% of those kidnapped between 2021 and 2025. Over 1,240 local staff members died, around a thousand were injured, and approximately 600 were kidnapped worldwide.
End of Impunity
The release of this report comes just months before the tenth anniversary of the UN Security Council resolution on protecting medical facilities and personnel, which called for an end to impunity following US bombing of an MSF hospital in Afghanistan in 2015, killing 42 people.
Laan noted that this resolution was a beacon of hope as it addressed these concerns for the first time in a binding decision. However, only six of the 15 resolution-adopting members had ratified all additional protocols to the Geneva Conventions, which strengthen protection for conflict victims.
More than a decade after the Kunduz attack, MSF criticizes that healthcare and humanitarian action in armed conflicts remain targets, possibly more than ever. Laan urged states to comply with IHL and ensure appropriate military intervention mechanisms for protecting medical services.
States must also be held accountable when they violate these laws, accepting independent investigation missions, conducting their own investigations, and transparently sharing results. These mechanisms are crucial for establishing facts and ensuring accountability, countering the prevailing culture of impunity.
