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Ethics briefing
  1. Martin Davies,
  2. Sophie Brannan,
  3. Ruth Campbell,
  4. Veronica English,
  5. Rebecca Mussell,
  6. Julian Sheather
  1. Medical Ethics and Human Rights, British Medical Association, London, UK
  1. Correspondence to Martin Davies, Medical Ethics and Human Rights, British Medical Association, BMA House, Tavistock Square, London WC1H 9JP, UK; mdavies{at}

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Endgame in Aleppo

Although the optimism of those times seems to have passed out of memory, the origins of the Syrian civil war reach back to the ‘Arab Spring’ and a burst of political hope throughout the Middle East. Although some countries saw regime change, since 2011, Syria has been engulfed in an increasingly brutal civil war. The war has seen sustained violations of International Humanitarian Law, including the use of the nerve agent sarin—its use being described by President Obama in June 2013 as ‘crossing a red line’.1

As the war has intensified, so the breaches of International Humanitarian Law, including the Geneva Conventions, have increased. The Geneva Conventions seek to bring specified forms of restraint in the waging of war. Article 24 of the 1949 Geneva Convention I states that: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 … shall be respected and protected in all circumstances2

At the beginning of 2016, Amnesty International issued a press release stating that Russia and Syria were targeting hospitals ‘as a strategy of war’. According to Amnesty, during the first 3 months of 2016 they gathered ‘compelling evidence of at least six deliberate attacks on hospitals, medical centres and clinics in the northern part of the Aleppo Countryside governorate’.3

Breaches of medical neutrality have not been confined to Syria. The civil war in Yemen, where a Saudi-led coalition is supporting the government against a Houthi militia, has also seen systematic attacks on health facilities.4 The sustained and deliberate nature of these attacks in Syria, Yemen and beyond have led senior humanitarian commentators to talk of normalisation, an emerging acceptance that hospitals and medical …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • i The term direct care refers to when an individual patient is receiving care or treatment.

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