War on Doctors The Deadly Business of War-Zone Medical Care

With governments bombing hospitals and militias attacking medical staff, the work of Doctors without Borders is in jeopardy. Rules to protect aid workers in war zones are increasingly being ignored.

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Dr. Muhamed brought the baby girl into the world in the midst of a war zone in southern Syria. A few hours later, his hospital lay in ruins.

The baby's tiny head shimmered, she blinked her eyes and her first cry sounded light but strong. It was a difficult birth and the mother needed blood from the rare O-negative group. Dr. Muhamed issued a call for blood donors at his city's mosque -- and that was when the catastrophe began.

Their rotors pounding loudly, helicopters approached the hospital that evening and the first barrel bombs struck the operating room, injuring dozens of patients. The call for blood donations had led the Syrian regime to believe that a large number of enemy rebels was being treated in Muhamed's hospital.

After the attack, Dr. Muhamed had two hours to evacuate the hospital. Then the helicopters returned. The next barrel bombs destroyed the gynecology department, the laboratories and the dialysis ward. This was the account Dr. Muhamed gave in a conversation via Skype with members of the organization Doctors Without Borders in Jordan, who provide him with support from afar.

For decades, hospitals had been treated as the last havens of humanity in times of war. In keeping with the Hippocratic oath, doctors treated the wounded without regard for their political views, race or religion. Whether farmer, scholar, Assad supporter, Taliban member, Huthi rebel or Islamic State (IS) fanatic, every human being must receive medical care, even in a war, if he or she is stricken and no longer fighting. Under the Geneva Conventions, ratified by 196 countries, human beings have a right to medical treatment. Doctors and hospitals are also protected under the Geneva Conventions.

The conventions are a sliver of civilization in the midst of the barbarity of war. But with a number of countries no longer abiding by international law in armed conflicts, this achievement is now under threat. In fact, four of the five permanent members of the United Nations Security Council are currently participating in coalitions that have bombed hospitals in Syria, Yemen and Afghanistan.

Death Traps

In the era of the War on Terror, governments are increasingly ignoring the rights of their wounded enemies, who they characterize as terrorists or criminals. In contrast to the combatants in earlier wars, they seek to refuse treatment to their enemies.

This development is extremely dangerous for humanitarian aid workers. Many warring parties see them as supporters of terrorists and are disregarding the neutrality of medical professionals in war zones. As a result, hospitals have gone from being protected zones to death traps.

One organization affected especially dramatically by this development is Doctors Without Borders, known as Médecins Sans Frontières, or MSF in French, the language of its founders. It is the world's largest, best-organized medical aid organization, with 37,000 volunteers working in 69 countries, funded almost entirely by private donations.

They are experts in coping with natural disasters and civil wars. They are viewed as activists, as courageous members of a flexible organization prepared to take risks, with little conceit and hardly any bureaucracy. Since its founding almost 45 years ago, MSF has become an enormous aid organization and received the Nobel Peace Prize in 1999. It is confident and convinced that it is among the best of aid organizations. Still, in 2016 its self-assurance has been shaken to the core, with volunteers now wondering: "How can I save lives without losing my own?"

Hospital Attacks

They refer to the unsettling trend that has made their work extremely dangerous, leaving thousands upon thousands without medical treatment, as "medical care under fire." Hardly a week goes by without horrific reports of hospitals being destroyed and attacks on aid workers.

On Oct. 3, 2015, the US Air Force fired on an MSF hospital in Kunduz, Afghanistan. Forty-two people died, including 14 members of the organization.

On Jan. 20, 2015, a jet operated by the Sudanese regime dropped bombs on an MSF hospital in the town of Farandalla. There were 150 patients and staff inside.

On May 18, 2016, unknown assailants attacked an MSF off-road vehicle in the Central African Republic and shot the driver.

In late July 2016, the Syrian regime attacked four hospitals supported by MSF in Aleppo. Two hospitals came under fire as patients were being transferred between their facilities.

In Yemen, both the Saudi-led coalition and Huthi rebels have repeatedly launched air strikes on MSF hospitals. On Aug. 15, 2016, 19 people died and more than 20 were injured in one such attack. Four days later, MSF announced that it was withdrawing its staff from six hospitals in northern Yemen.

What does it mean for the world's most important medical aid organization when its employees are being threatened and shot at, and its hospitals bombed? Doctors Without Borders provided SPIEGEL with an in-depth look at its work over a period of several months in the bush of the Central African Republic; at its Geneva headquarters; and in Jordan, along the Syrian border. A reporter hoping to describe the world of Doctors Without Borders in armed conflicts can only do so by becoming embedded, which means living in compounds with MSF staff and following their rules.

There are two developments in particular that endanger MSF staff during their work. The first is the disintegration of states. In failed states like the Central African Republic, aid workers who provide services that would normally be administered by the government are at risk, because there is no authority to protect them. The second development is the growing incidence of targeted attacks by warring parties on aid workers, in violation of the provisions of humanitarian international law.

This journey begins in the Central African Republic, one of the world's poorest countries, a place where Doctors Without Borders must pay close attention to security. The curfew for staff members in the nation's capital begins at 6 p.m. After that, they are permitted to frequent six selected restaurants, provided a vehicle waits for them outside. They are instructed to walk no more than 300 meters (984 feet) on the street and otherwise travel in motor vehicles. When they begin their deployment, they leave behind passwords for Facebook and Twitter in a safe so that their accounts can be deleted if they are killed. They think up questions to which only they know the answers, so that coworkers can identify them if they are abducted. Those who end up here know that they can die at any time.

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