Insecurity Insight has recently produced a paper regarding the development of the effects of the use of explosive weapons with a specific focus on its impact on healthcare from 2022 to 2023. To do so, it relied on data collected by the Safeguarding Health in Conflict Coalition (SHCC), which it compiled based on the WHO definition of attacks on healthcare and considering the definition of explosive weapons given by the UN Office for Disarmament Affairs. In this paper, Insecurity Insight explains how the impact on healthcare is caused by attacks against healthcare facilities, health workers and infrastructure critical to access healthcare perpetrated by using different types of explosive weapons. 

The dataset recorded that in 2023, there were at least 822 instances where the use of explosive weapons affected healthcare in 20 countries. 80% of the incidents occurred in Myanmar, Ukraine, and lastly, the Occupied Palestinian Territories, where 312 attacks on healthcare were documented in only three months. It must be noted that despite the incident number being very high, and their effects on healthcare severe, the number of territories affected by these incidents decreased by two from 2022 to 2023, meaning that the attacks in 2023 have become more relentless than the past year.

Explosive weapons’ consequences on healthcare

The deployment of explosive weapons can have both direct and indirect consequences on healthcare. 

• Direct consequences

The direct consequences of the use of this type of weapon are, for instance, the damage or destruction of healthcare facilities and the killing or severely injuring health workers. 

About the direct effects on healthcare facilities, in 2023, there were 488 incidents in which 144 healthcare facilities were damaged or destroyed, with these infrastructures being subject to explosive weapons attacks more than once. Additionally, at least 129 healthcare vehicles were damaged or destroyed in 2023. 

In 2023, more than 209 health workers were reportedly killed by explosive weapons, constituting a 207% from the 68 deaths that occurred in 2022. Health workers died due to explosive weapons while on duty inside healthcare facilities, while travelling to reach them and off duty in their residences. 

• Indirect consequences

The use of explosive weapons, especially in urban areas, can easily devastate access to healthcare even when healthcare facilities and their staff are not directly affected by the deployment of such weapons. This is so mainly for four reasons, here listed:  

1. Explosive weapons can create a burden on healthcare, leading it to collapse by simply being used to target populated areas. Indeed, in this case, more people will be affected by the strikes and will probably have to go to a medical facility, overwhelming it. 
2. By targeting critical infrastructure like electricity, water supply and sanitation systems, explosive weapons indirectly affect the functionality of the healthcare services, limiting their chance to improve the health of patients. 
3. The impact of explosive weapons on roads can make them impracticable, resulting in more difficulty for individuals to go to healthcare facilities and for health workers to reach on-site those in need of healthcare.
4. Most health workers do not receive mental health support to deal with anxiety regarding their and their loved ones’ safety and be fully focused on giving effective treatment to their patients. 

Explosive weapons used in 2023 attacks on healthcare 

The attacks on healthcare were perpetrated by using different types of explosive weapons, namely air-delivered and ground-launched explosive weapons and improvised explosive devices (IEDs). Most of the attacks were carried by using ground-launched explosive weapons and IEDs, whose deployment has, however, decreased in 2023 compared to 2022. Indeed, if these types of explosive weapons have been used in 427 instances in 2022, in 2023, they have been used in 337 instances. The sharpest increase in usage between 2022 and 2023, despite having been less used than ground-launched explosive weapons and IEDs in 2023, was of air-delivered explosives, which were used in 328 instances in 2023 compared to the 67 of the year before. 

Attributability of 2023 attacks on healthcare

In 2023, the number of instances where the use of explosive weapons affected healthcare was attributable to state actors, which remain the main perpetrators of these kinds of attacks, increased by 16% compared to 2022, with a total of 655 incidents. On the other hand, non-state actors were attributed only 77 incidents, a 10% decrease compared to 2022 but still a 128% increase compared to the 28 incidents to them attributed in 2021. 

Recommendations

In the last section, the report gives recommendations regarding the use of explosive weapons to different actors, directly or indirectly involved in the conflict. Some of these recommendations are now reported below. 

• Conflict parties: 
• Should refrain from using explosive weapons in populated areas, especially in proximity to healthcare facilities;
• Before perpetrating attacks using explosive weapons, they should consider the immediate and long-term civilian harm and the impact of such on the healthcare system;
• Should communicate the measures they take to comply with international humanitarian law, especially their obligations regarding the protection of healthcare systems.
• States:
• Should endorse the 2022 Political Declaration on Strengthening the Protection of Civilians from the Humanitarian Consequences Arising from the Use of Explosive Weapons in Populated Areas, which reiterates the international humanitarian law obligations and obliges states to strengthen their protection of civilians and civilian objects, especially against attacks involving explosive weapons in populated areas and fully refrain from using explosive weapons in populated areas in conflict;
• Should comply with the Arms Trade Treaty, thus avoiding supplying or enabling the use of explosive weapons to those not complying with international humanitarian law.
• Civil society and the international humanitarian community 
• Can monitor civilian harm following explosive weapons attacks and the impact on the relevant healthcare system;
• Can contribute to strengthening the protection of civilians and civilian infrastructure, including healthcare infrastructure;
• Can increase the mental health support for health workers. 
• Donors:
• Can support mitigation measures and provide funding to protect healthcare systems during conflicts. 

To learn more, please visit: 

• https://insecurityinsight.org/wp-content/uploads/2024/07/The-Effects-on-Health-Care-of-the-Use-of-Explosive-Weapons-July-2024.pdf
• https://www.who.int/activities/stopping-attacks-on-health-care#:~:text=WHO%20defines%20an%20attack%20on,preventive%20health%20services%20during%20emergencies 
• https://disarmament.unoda.org/convarms/explosive-weapons/ 
• https://www.dfa.ie/media/dfa/ourrolepolicies/peaceandsecurity/ewipa/EWIPA-Political-Declaration-Final-Rev-25052022.pdf
• https://thearmstradetreaty.org/hyper-images/file/ATT_English/ATT_English.pdf?templateId=137253

by Ottavia Soldini