Attacks on healthcare in conflict-affected countries: a comparison of temporal trends in ongoing conflicts in Lebanon, Myanmar, occupied Palestinian territory, Sudan and Ukraine using WHO SSA and SHCC data, 2018-2024

BackgroundThe Geneva Conventions form the core of International Humanitarian Law (IHL), safeguarding healthcare and protecting civilians from the brutality of war. Unfortunately, these conventions are often disregarded. Attacks on healthcare have devastating effects on healthcare systems, and it is therefore vital to document such attacks and detect possible temporal patterns. This study aims to assess temporal trends in attacks on healthcare in five conflict-affected countries: Lebanon, Myanmar, occupied Palestinian territory (oPt), Sudan and Ukraine.MethodsThis study used two publicly available databases: the World Health Organization Surveillance System for Attacks on Health Care (WHO SSA) and the Insecurity Insight Safeguarding Health in Conflict Coalition (SHCC). Start dates and key events were determined for each conflict based on grey literature searches. From the start dates onward, data on attacks on healthcare were collected. The data collection ended on December 31, 2024. Statistical analysis entailed chi-square tests for temporal trends.ResultsThe WHO SSA and SHCC database reported a total of 4,289 and 5,454 attacks, respectively, in the five investigated conflict-affected countries. For all conflict-affected countries except Lebanon, there were significant differences between the databases regarding the reported number of attacks. Temporal trend analyses revealed that, in Myanmar, oPt, Sudan and Ukraine, the highest number of attacks occurred during the 0-2 month period. In Lebanon, the highest number of attacks was observed in the 9-11-month period. All peaks in the number of attacks were associated with either the immediate or early phase of the conflict or with major conflict escalations.ConclusionsTemporal trend analyses of five ongoing armed conflicts revealed that spikes in attacks on healthcare were either associated with the immediate or early phases of the conflict or with major conflict escalations. Although major differences exist between the WHO SSA and SHCC database, particularly regarding the reported number of attacks, the observed patterns were largely similar.