Are hospitals becoming fair game in war?

Even in combat zones, hospitals are considered sanctuaries from enemy fire, and according to the Geneva Conventions, attacking a medical facility is a war crime. But in recent months, serial attacks on hospitals in Syria, Afghanistan, and other conflict-ridden countries are exposing the failure of the international community to prevent and punish such cruel disregard for the rules of war.

“Health facilities, which are meant to be places where people can go for relief of suffering, for survival and safety, have become instead places of brutality and death,” said Susannah Sirkin, a director with The Physicians for Human Rights. The group called the attacks in Syria the most widespread and systematic assault on healthcare documented in the world to date.

But not everyone agrees on how this spiraling humanitarian crisis should be remedied. For the French nonprofit group Médecins sans Frontières (MSF), also known as Doctors Without Borders, the issue is both visceral and personal. In the past year, aerial shell and bomb attacks have devastated more than 80 MSF-supported and operated health structures, killing at least 100 people and wounding another 130.

“We can no longer assume that fully functioning hospitals—in which patients are fighting for their lives—are [a safe place],” said MSF international president Joanne Liu, in an address to the UN Security Council earlier this month. “Hospitals and patients have been dragged onto the battlefield.”

But Syria’s top diplomat to the United Nations has accused MSF workers of being French spies and said they should be blamed for the attacks, since the clinics operate outside government control.

Earlier this month, MSF said it was pulling out of the inaugural World Humanitarian Summit, blasting the two-day meeting as a “fig-leaf of good intentions” that would only shrink states’ power to protect medical facilities.

“For us, the word ‘humanitarian’ has dropped out of the humanitarian summit,” Vickie Hawkins, MSF’s U.K. director told The Guardian. “It has become a summit about a much broader and longer-term political agenda, rather than being about core humanitarian assistance.”

Hospitals and physicians in the Middle East and elsewhere have been attacked simply for treating people on both sides of the conflict or because the facilities were located near what was perceived to be a military target. Some say Syrian President Bashar al-Assad’s military is deliberately striking civilian targets to crush the will of the population, a charge the military denies.

According to a recent BBC report, most Syrian hospitals are shifting operating rooms underground: “The surgeons need to be focused … their hands can’t be [shaken] by an explosion or an airstrike,” said Zahed Katurji, a doctor who works at a clinic in Aleppo.

Since the start of Syria’s civil war in 2011, nearly 740 doctors and staff have been killed in more than 260 hospital attacks, a rate that averages to one assault and 21 deaths each week for five years. The bloodiest of these attacks came last month, when airstrikes obliterated Al Quds Hospital in Aleppo, with a death toll of 55 people, including one of the city’s last pediatricians.

The Associated Press contributed to this report.