The targeting of hospitals and humanitarian workers in war is quickly becoming a “new normal”, a top official at Médecins Sans Frontières has said, describing permanent members of the UN security council as complicit in the killing of medics.

Michiel Hofman, a senior humanitarian specialist at the charity, offered a grim analysis, saying instead of rebel groups it was conventional armies that were repeatedly violating the laws of war. He chided the permanent members of the security council, four of whom are engaged in conflicts where medics are targeted, saying such a situation had not occurred since the Korean war in the 1950s.

He described the fighting in Syria as a “dirty war”, saying both the government of Bashar al-Assad and the rebels have targeted hospitals while adding that the greater destructive firepower was held by states.

“When we talk about the bombing of hospitals, bombing means air forces,” he said. “Rebel groups don’t have air forces, so this is exclusively states who by definition have much larger firepower [...] and they are the ones that actually signed these conventions.”

On Monday night, the national hospital in the opposition-held Idlib city was put out of service after multiple airstrikes hit the area, killing at least two dozen civilians in the latest attack on health services in the conflict.

People inspect the damage at the Médecins Sans Frontières hospital in Aleppo, Syria. Photograph: Abdalrhman Ismail/Reuters

Last month, an MSF and International Committee of the Red Cross-supported hospital in Aleppo was destroyed in an airstrike by the Syrian government, killing one of the only paediatricians left in the ruins of the rebel-held east of the city. Three days later a maternity hospital was partially destroyed in rebel shelling of a government-controlled area in the city’s west.

These were only the latest incidents in a series of attacks on medical facilities that amount to a systematic targeting of aid workers in the war. As early as 2013, the UN independent commission of inquiry investigating alleged war crimes in Syria said attacks on medical facilities were being used systematically as a weapon of war by the Assad regime.

The civil war in Yemen, where a Saudi-led coalition backs the government against Shia Houthi militia and forces loyal to a deposed president, has also seen attacks on medical facilities.

The security council unanimously passed a resolution on 3 May demanding an end to attacks on medical workers and hospitals in war zones, but Hofman said those who passed the resolution, including the UK, are themselves complicit in the killing of medical workers.



Michiel Hofman. Photograph: Médecins Sans Frontières

Hofman was referring to the military and logistical support provided by four of the permanent members of the security council to countries and coalitions that have bombed hospitals.

The US has provided logistical support to the Saudi-led coalition in Yemen, reportedly including targeting data, while the UK and France have both sold hundreds of millions of dollars worth of arms to Saudi Arabia since the launch of the Yemen campaign, decisions that have been repeatedly condemned by human rights groups.

Russia intervened on behalf of Assad’s regime in Syria, saving it from collapse and has been repeatedly accused of killing civilians in its aerial campaign.

Referring to the May agreement, Hofman said: “That’s never a good sign, resolutions that pass unanimously are usually the ones that get disregarded. [The security council members] are responsible because they’re part of coalitions that are part of bombing campaigns. Like Russia they didn’t bomb the hospital in Aleppo, but they’re part of a coalition with the Syrian government that is doing that.

“Maybe we should use the format of an open letter to the president of China saying, as the only remaining permanent member of the security council who is currently not bombing anyone, could you please remind your colleagues?”

In February, an MSF report identified 94 airstrikes and shelling attacks on hospitals across Syria. In February last year, the NGO Physicians for Human Rights said it had documented 224 attacks on 175 health facilities since the start of the conflict, and 599 medical personnel had been killed.

An anti-terrorism law passed in 2012 by the Syrian parliament declared illegal any medical facility operating in opposition-held areas without government approval, effectively making them legitimate targets for Assad’s air force. Since then, clinics in the rebel-controlled parts of the country have gone underground, sometimes literally in caves and basements, and have refused to share their GPS coordinates for fear of being targeted.

“Essentially since 2012, the Syrian army disregarded any kind of protective status to hospitals,” Hofman said.

Saudi Arabia, meanwhile, has questioned the neutrality of MSF’s hospitals, saying Houthi fighters were also being treated there.

“In this case, the Saudi coalition, which has the air forces, is using a similar logic where most of their bombings are quite indiscriminate and so the hospitals are not given any protective status,” he said. “In the conversations, we’ve been challenged as to how far these hospitals are being neutral or not.”

Hofman said medics operating in combat zones had “the right and the duty to treat everyone, including combatants, and that is being challenged by a lot of states at the moment”.