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In May 2021, we commemorated the 5th anniversary of the adoption of the Resolution 2286 by the UN Security Council on the Protection of civilians in armed conflict. It is thus a particularly apposite time to reflect on how historians have approached the issues of violence, health and care in wartime and how historical approaches might be relevant in contemporary debates about data collection (How can data be desegregated? How have concepts gender and race shaped medical experiences of violence and impacted on delivery of care throughout time?), accountability mechanisms (What count as an attack?) and advocacy efforts against attacks against healthcare (Why have some attacks been considered as more inacceptable than others?).
Our starting point is that understandings of the impacts of ‘attacks’ on healthcare have changed significantly within the last twenty years. In other words, in the past, these acts of violence were framed and reported differently and for a different purpose. Significantly, the 1864 Geneva convention for the Amelioration of the Condition of the Wounded, detailed the objects to be protected by laws (medical personnel and patients) but did not stipulate what might be classified as an ‘attack on healthcare’. The subsequent convention (1906, 1929) did not offer more precisions. Over the last twenty years, however, the concept of attacks on healthcare took on new meanings within military, academic and humanitarian communities. Until the 2000s, the concept of ‘attack remained largely used to describe ‘violent incidents in healthcare setting’, in other words as either a ‘descriptor of violence inflicted on healthcare workers by patients or their kin’ or as a way of talking about the ‘structural violence of toxic medical environment’. From the 2000s, the concept became more widely associated with violations of international humanitarian law. The World Health Organisation (WHO) defines an attack as ‘any act of verbal or physical violence or obstruction or threat of violence that interferes with the availability, access and delivery of curative and/or preventive health services during emergencies’. In this new definition, killings and violence against medical staff and structures were interpreted as assaults on healthcare systems, beyond the hurt and injuries inflicted to human beings.
Since then, the concept of attacks on healthcare has grown as both a mobilising tool and analytical category through which to examine the nature of violence in conflict as well as its long-term consequences for the societies afflicted. In this context, ‘attacks against healthcare’ are not seen anymore as anecdotal forms of brutality: they give broader meaning to conflicts and their calculated excesses and their systemic consequences. This transformation, perhaps even a paradigm shift, was manifested but also fuelled by the launch of the International Committee of the Red Cross (ICRC) programme’s ‘Health Care in danger’, Médecins Sans Frontières’ ‘Medical Care Under Fire’, the Safeguarding Health in Coalition (SHCC) and World Health Organisation (WHO) media and research campaigns, which often sustained the impression that this violence was new.
With this in mind, we are inviting historically minded reflecting on the centrality of violence in the lived experiences of medical staff and patients across the long twentieth century and considering how the realities of war (whether regular or irregular) has often complicated in practice the definition of who should be considered as a ‘medic’ or a ‘wounded’ and thus who should be protected. We also welcome papers that will take a gendered and critical race theory approach.