The deliberate destruction of health services and systems as an act of war should be termed 'healthocide' and medical practitioners should call out and stand firm against this weaponisation of healthcare, insists a thought-provoking commentary published in the open access journal BMJ Global Health.
Silence implies complicity and approval, and undermines international humanitarian law as well as medical and professional ethics, say Dr Joelle Abi-Rached and colleagues of the American University of Beirut, Lebanon.
Although they refer to other conflicts in El Salvador, Ukraine, Sudan, and Syria, the authors focus primarily on the impact of armed conflict on healthcare in Lebanon and Gaza.
Data from Lebanon's Ministry of Public Health show that between 8 October 2023 and 27 January 2025, 217 healthcare workers were killed by the Israel Defense Forces; 177 ambulances were damaged; 68 attacks on hospitals were recorded; and 237 attacks on emergency medical services took place, they say.
Israel's military operations in Gaza since October 7, 2023 have resulted in at least 986 medical workers' deaths: 165 doctors; 260 nurses; 184 health associates; 76 pharmacists; 300 management and support staff; and 85 civil defence workers, they add.
"Both in Gaza and Lebanon, healthcare facilities have not only been directly targeted, but access to care has also been obstructed, including incidents where ambulances have been prevented from reaching the injured, or deliberately attacked," note the authors.
"What is becoming clear is that healthcare workers and facilities are no longer afforded the protection guaranteed by international humanitarian law," they add.
Yet faced with such wanton destruction, doctors have done little, the authors suggest.
"These attacks have been met with astounding silence or, at best, terse and often belated statements from American, European, or Israeli medical associations, professional groups, and journals," they point out.
"Are medical doctors ready to forsake the principle of medical neutrality, first forged amidst the carnage of 19th century wars and profoundly reshaped following the liberation of Nazi death camps in 1945? And if so, at what cost?" they ask.
"As difficult as this question is, it is one that physicians must address as they grapple with the normalisation of healthcare's weaponisation in a world where warfare has changed dramatically, marked by the use of Artificial Intelligence for mass killing, the reliance on drones and killing robots, the deployment of internationally banned weapons, which carry devastating public health and ecological consequences, and, of course, the looming threat of nuclear weapons," they write.
The 'normalisation' of healthcare attacks has increased alarmingly over the past few years, say the authors. "But what we are witnessing today is more pernicious than mere normalisation of such attacks, something that could be described as 'healthocide': the deliberate killing and/or destruction of health services and systems for ideological purposes."
Normalising or excusing healthocide sets a dangerous precedent, the authors argue, as it emboldens future violators and erodes the principle of medical neutrality, which is essential for ensuring impartial and humane care during conflict.
"Medical neutrality is not 'apolitical'; for us it means standing with humanity, social justice, and health-enabling policies, they add.
The actions medical practitioners must take include advocating for enforcement of justice and international humanitarian law; and documenting and exposing abuses to medical neutrality by both state and non-state actors, insist the authors.
"Rather than passively observe the erosion and normalisation of the weaponisation of health and healthcare, [we call] for critical reflection and decisive action, underscoring that silence implies complicity, approval, or the toleration of double-standards — all of which stand in clear opposition to international humanitarian law and medical deontology [ethics]," they conclude.
