Responsibility for protection of medical workers and facilities in armed conflict.

Assaults on patients and medical personnel, facilities, and transports, denial of access to medical services, and misuse of medical facilities and emblems have become a feature of armed conflict despite their prohibition by the laws of war. Strategies to improve compliance with these laws, protection, and accountability are lacking, and regular reporting of violations is absent. A systematic review of the frequency of reporting and types of violations has not been done for more than 15 years. To gain a better understanding of the scope and extent of the problem, we used uniform search criteria to review three global sources of human rights reports in armed conflicts for 2003-08, and in-depth reports on violations committed in armed conflict during 1989-2008. Findings from this review showed deficiencies in the extent and methods of reporting, but also identified three major trends in such assaults: attacks on medical functions seem to be part of a broad assault on civilians; assaults on medical functions are used to achieve a military advantage; and combatants do not respect the ethical duty of health professionals to provide care to patients irrespective of affiliation. WHO needs to lead robust and systematic documentation of these violations, and countries and the medical community need to take steps to improve compliance, protection, and accountability. Copyright 2010 Elsevier Ltd. All rights reserved.