Impunity Must EndThey should offer care and safe refuge, but a startling new report shows “health facilities are too often the most dangerous places in communities.”

Attacks on health workers happened in 23 countries last year, according to the “Impunity Must End” report released last week by the Safeguarding Health In Conflict Coalition. Those attacks included bombing, shelling and looting of hospitals and clinics. In the worst cases, health workers were arrested, punished or even killed while trying to provide care in war-torn areas.

Lack of a global data collection system makes it tough to pinpoint the exact number of attacks, but the report says Syria fared worst in 2016, with at least 108 attacks on health facilities. Most attacks came from Syrian government or Russian forces. Other hard-hit areas included Afghanistan and Yemen. Mortar rounds fired near a medical facility in one province damaged the building and forced patients to be evacuated. Some of the atrocities documented in the report include shelling of hospitals, using ambulances as car bombs and execution of health workers in Iraq.

Often, a bad situation has turned even grimmer due to attacks on health care facilities, according to the report. A “major humanitarian crisis, including aid blockages” in South Sudan that has left just 43 percent of health facilities operational was worsened last year by attacks on clinics and health workers.

Warning that attacks have become even more intense and frequent in Syria in recent months, the report includes recommendations such as better data collection, adherence to international law and prevention measures.

“This report should once again serve as an alarm about the scale and scope of attacks on health care,” the report says. “In many cases, these violations amount to war crimes and crimes against humanity, and collectively they threaten the health, well-being, and the lives of people who may number in the millions.”

Learn more about the Safeguarding Health in Conflict Coalition. APHA is a coalition member.