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Raid on Hospital Violates International Agreements, Endangering Aid Workers, Patients and Troops

Posted by Derrick Crowe on September 7th, 2009

Apparently U.S. forces in Afghanistan hadn’t had enough outrage from the Afghanistan public after blowing up two fuel tanks surrounded by civilians, because the soldiers operating as part of ISAF went and raided a hospital, violating both the Geneva Conventions and agreements governing interactions between the military and humanitarian organizations.

KABUL (Reuters) – U.S. troops burst into a Swedish charity-run hospital in Afghanistan and tied up patients’ relatives and staff, the charity said on Sunday, in what it called a breach of deals between the military and aid groups.

The Swedish Committee for Afghanistan operates the hospital. According to their statement (emphasis mine):

[U.S. troops from the 10th Mountain Division] entered the hospital compound, reportedly without giving any reason or justification for entering the hospital compound. They searched all rooms, even bathrooms, male and female wards. Rooms that were locked were forcefully entered and the doors of the malnutrition ward and the ultrasound ward were broken by force to gain entry. Upon entering the hospital they tied up four employees and two family members of patients at the hospital. SCA staffs as well as patients (even those in beds) were forced out of rooms/wards throughout the search.

On leaving the hospital at around 12 pm, IMF issued verbal “orders”/instructions; that on receiving any patient that could be an insurgent the hospital staff has to report to the Coalition Forces who would then determine if the hospital would be permitted or not of treating such patient.

Let that sink in for a second. U.S. troops barged into a hospital, forced patients out of beds, burst into maternity and women’s wards in a super-conservative Muslim country, and tried to order civilians over which they have no command authority to delay treatment for patients while they wait for a potential order from the coalition to let them die.

Aside from the immediate danger to patients’ health and the apparent unlawful detention of personnel without cause, the actions of the NATO troops clearly violated several agreements intended to protect both patients and humanitarian workers.

In response to my email inquiry, SCA’s Country Director Anders Fange pointed to the responsibilities of U.S. forces under the Geneva Conventions and under the Guidelines for the Interaction and Coordination of Humanitarian Actors and Military Actors in Afghanistan.

Here are some of the relevant provisions from each, which the troops clearly violated, starting with the Geneva Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field.

Chapter III, Art. 19

Fixed establishments and mobile medical units of the Medical Service may in no circumstances be attacked, but shall at all times be respected and protected by the Parties to the conflict. Should they fall into the hands of the adverse Party, their personnel shall be free to pursue their duties, as long as the capturing Power has not itself ensured the necessary care of the wounded and sick found in such establishments and units.

Chapter IV, Art. 24

Medical personnel exclusively engaged in the search for, or the collection, transport or treatment of the wounded or sick, or in the prevention of disease, staff exclusively engaged in the administration of medical units and establishments, as well as chaplains attached to the armed forces, shall be respected and protected in all circumstances.

Also relevant are the following provisions from the 4th Geneva Convention:

Art. 18. Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack but shall at all times be respected and protected by the Parties to the conflict.

Art. 19. The protection to which civilian hospitals are entitled shall not cease unless they are used to commit, outside their humanitarian duties, acts harmful to the enemy. Protection may, however, cease only after due warning has been given, naming, in all appropriate cases, a reasonable time limit and after such warning has remained unheeded.

In addition to violating the Geneva Conventions, the behavior of the troops from the 10th Mountain Division as described by SCA are a clear violation of the Guidelines for the Interaction and Coordination of Humanitarian Actors and Military Actors in Afghanistan, and they endanger humanitarian workers whose safety depends on their reputation for independence:

Respect for the neutrality and independence of humanitarian actors: military actors should seek to avoid operations, activities or any conduct which could compromise the independence or safety of humanitarian actors. To the greatest extent possible military operations should be conducted with a view to respecting the humanitarian operating environment. The operational effectiveness of humanitarian actors depends upon the actual and perceived adherence to the principles of neutrality and impartiality. Maintaining a clear distinction between the role and function of humanitarian actors from that of the military is a determining factor in creating an operating environment in which humanitarian organizations can discharge their responsibilities both effectively and safely. Sustained humanitarian access to the affected population may be ensured when it is independent of military and political action.

As explained elsewhere in the document:

Security and Neutrality of Humanitarian Personnel

Humanitarian actors in Afghanistan have adopted a security protocol which relies primarily on acceptance, combined with protection and deterrence strategies. …As all actors who have taken a proactive stance in support of the GoA (including the UN, EU, ISAF and other security actors) are currently targets of armed opposition groups in Afghanistan, a distinction must be retained between the identities, functions and roles of these entities and those actors who seek to preserve their neutrality.

The independence and civilian nature of humanitarian assistance should be clear at all times. Failure to observe this distinction could compromise the perception of neutrality and impartiality of humanitarian activities and thereby endanger humanitarian personnel and intended beneficiaries.

In his email, Fange said:

I’ve heard from our staff and from some patients and relatives to patients…who all seem to be very upset. They are mainly afraid that the Taliban now will suspect staff of being informers (spies) and to have such allegations directed against you is not healthy in Wardak province.

Violating this principle endangers not only the hospital staff but NGO staff across Afghanistan, as the guidelines make clear:

…[A]t a local level if one agency is perceived as cooperating closely with the military the population may assume the same of other local actors.

The disgusting demand for pre-clearance for medical treatment seeks to force SCA staff to violate the principles to which they agreed as humanitarian workers operating under the guidelines:

1) Humanity: the principle of humanity requires that human suffering must be addressed wherever it is found, with particular attention to the most vulnerable in the population, such as children, women and the elderly. The dignity and rights of all victims must be respected and protected…

2) Operational independence of humanitarian action: humanitarian actors must retain their operational independence, including the freedom of movement, recruitment of national and international staff, non-integration into military planning and action, and access to communications.

3) Impartial aid distribution: humanitarian actors and donor governments must ensure that assistance is provided in an equitable and impartial manner without political conditions; it must be provided without discrimination as to ethnic origin, gender, nationality, political opinions, social status, race or religion and solely on the basis of needs.

4) Neutrality: all humanitarian assistance must be provided without engaging in hostilities or taking sides in controversies of a political, religious or ideological nature.

The behavior of the troops also endangered the troops themselves and their comrades throughout Afghanistan. According to the AP story,

They also barged into the women’s wards, [Fange] said, adding that strange men entering rooms where women are in beds is a serious insult to the local Muslim culture and word of it could turn the community against international troops.

Regardless of the effect of this behavior on troop safety, though, it clearly violated the forces’ responsibilities under the agreement between NGOs and foreign forces:

All humanitarian actors, military actors and other security actors should at all times be respectful of international law and Afghan laws, culture and customs.

So much for winning “hearts and minds.” Heads need to roll.

For the record, ISAF commanders participated in the development of the guidelines. I emailed a request for comment to the ISAF public affairs office in Kabul. So far, no response.

(Derrick Crowe is the Afghanistan blog fellow for Brave New Foundation / The Seminal. You can learn more about the dangers posed to U.S. national security by the war in Afghanistan by watching Rethink Afghanistan (Part Six): Security, or by visiting

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