Raid on Hospital Violates International Agreements, Endangering Aid Workers, Patients and Troops

Posted: September 7, 2009 in Uncategorized
Tags: , , , ,

Apparently U.S. forces in Afghanistan hadn’t had enough outrage from the Afghanistan public after blowing up two fuel tanks surrounded by civilians, because the soldiers operating as part of ISAF went and raided a hospital, violating both the Geneva Conventions and agreements governing interactions between the military and humanitarian organizations.

KABUL (Reuters) – U.S. troops burst into a Swedish charity-run hospital in Afghanistan and tied up patients’ relatives and staff, the charity said on Sunday, in what it called a breach of deals between the military and aid groups.

The Swedish Committee for Afghanistan operates the hospital. According to their statement (emphasis mine):

[U.S. troops from the 10th Mountain Division] entered the hospital compound, reportedly without giving any reason or justification for entering the hospital compound. They searched all rooms, even bathrooms, male and female wards. Rooms that were locked were forcefully entered and the doors of the malnutrition ward and the ultrasound ward were broken by force to gain entry. Upon entering the hospital they tied up four employees and two family members of patients at the hospital. SCA staffs as well as patients (even those in beds) were forced out of rooms/wards throughout the search.

On leaving the hospital at around 12 pm, IMF issued verbal “orders”/instructions; that on receiving any patient that could be an insurgent the hospital staff has to report to the Coalition Forces who would then determine if the hospital would be permitted or not of treating such patient.

Let that sink in for a second. U.S. troops barged into a hospital, forced patients out of beds, burst into maternity and women’s wards in a super-conservative Muslim country, and tried to order civilians over which they have no command authority to delay treatment for patients while they wait for a potential order from the coalition to let them die.

Aside from the immediate danger to patients’ health and the apparent unlawful detention of personnel without cause, the actions of the NATO troops clearly violated several agreements intended to protect both patients and humanitarian workers.

In response to my email inquiry, SCA’s Country Director Anders Fange pointed to the responsibilities of U.S. forces under the Geneva Conventions and under the Guidelines for the Interaction and Coordination of  Humanitarian Actors and Military Actors in Afghanistan.

Here are some of the relevant provisions from each, which the troops clearly violated, starting with the Geneva Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field.

Chapter III, Art. 19

Fixed establishments and mobile medical units of the Medical Service may in no circumstances be attacked, but shall at all times be respected and protected by the Parties to the conflict. Should they fall into the hands of the adverse Party, their personnel shall be free to pursue their duties, as long as the capturing Power has not itself ensured the necessary care of the wounded and sick found in such establishments and units.

Chapter IV, Art. 24

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, as well as chaplains attached to the armed forces, shall be respected and protected in all circumstances.

Also relevant are the following provisions from the 4th Geneva Convention:

Art. 18. Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack but shall at all times be respected and protected by the Parties to the conflict.

Art. 19. The protection to which civilian hospitals are entitled shall not cease unless they are used to commit, outside their humanitarian duties, acts harmful to the enemy. Protection may, however, cease only after due warning has been given, naming, in all appropriate cases, a reasonable time limit and after such warning has remained unheeded.

In addition to violating the Geneva Conventions, the behavior of the troops from the 10th Mountain Division as described by SCA are a clear violation of the Guidelines for the Interaction and Coordination of  Humanitarian Actors and Military Actors in Afghanistan, and they endanger humanitarian workers whose safety depends on their reputation for independence:

Respect for the neutrality and independence of humanitarian actors: military actors should seek to avoid operations, activities or any conduct which could compromise the independence or safety of humanitarian actors. To the greatest extent possible military operations should be conducted with a view to respecting the humanitarian operating environment. The operational effectiveness of humanitarian actors depends upon the actual and perceived adherence to the principles of neutrality and impartiality. Maintaining a clear distinction between the role and function of humanitarian actors from that of the military is a determining factor in creating an operating environment in which humanitarian organizations can discharge their responsibilities both effectively and safely. Sustained humanitarian access to the affected population may be ensured when it is independent of military and political action.

As explained elsewhere in the document:

Security and Neutrality of Humanitarian Personnel

Humanitarian actors in Afghanistan have adopted a security protocol which relies primarily on acceptance, combined with protection and deterrence strategies. …As all actors who have taken a proactive stance in support of the GoA (including the UN, EU, ISAF and other security actors) are currently targets of armed opposition groups in Afghanistan, a distinction must be retained between the identities, functions and roles of these entities and those actors who seek to preserve their neutrality.

The independence and civilian nature of humanitarian assistance should be clear at all times. Failure to observe this distinction could compromise the perception of neutrality and impartiality of humanitarian activities and thereby endanger humanitarian personnel and intended beneficiaries.

In his email, Fange said:

I’ve heard from our staff and from some patients and relatives to patients…who all seem to be very upset. They are mainly afraid that the Taliban now will suspect staff of being informers (spies) and to have such allegations directed against you is not healthy in Wardak province.

Violating this principle endangers not only the hospital staff but NGO staff across Afghanistan, as the guidelines make clear:

…[A]t a local level if one agency is perceived as cooperating closely with the military the population may assume the same of other local actors.

The disgusting demand for pre-clearance for medical treatment seeks to force SCA staff to violate the principles to which they agreed as humanitarian workers operating under the guidelines:

1)    Humanity: the principle of humanity requires that human suffering must be addressed wherever it is found, with particular attention to the most vulnerable in the population, such as children, women and the elderly. The dignity and rights of all victims must be respected and protected…

2)     Operational independence of humanitarian action: humanitarian actors must retain their operational independence, including the freedom of movement, recruitment of national and international staff, non-integration into military planning and action, and access to communications.

3)    Impartial aid distribution: humanitarian actors and donor governments must ensure that assistance is provided in an equitable and impartial manner without political conditions; it must be provided without discrimination as to ethnic origin, gender, nationality, political opinions, social status, race or religion and solely on the basis of needs.

4)    Neutrality: all humanitarian assistance must be provided without engaging in hostilities or taking sides in controversies of a political, religious or ideological nature.

The behavior of the troops also endangered the troops themselves and their comrades throughout Afghanistan. According to the AP story,

They also barged into the women’s wards, [Fange] said, adding that strange men entering rooms where women are in beds is a serious insult to the local Muslim culture and word of it could turn the community against international troops.

Regardless of the effect of this behavior on troop safety, though, it clearly violated the forces’ responsibilities under the agreement between NGOs and foreign forces:

All humanitarian actors, military actors and other security actors should at all times be respectful of international law and Afghan laws, culture and customs.

So much for winning “hearts and minds.” Heads need to roll.

For the record, ISAF commanders participated in the development of the guidelines. I emailed a request for comment to the ISAF public affairs office in Kabul. So far, no response.

Update 9/9/09: An CJTF-82 official replied to my inquiries about this incident with the following statement. The relevant portions are in bold:

Afghan National Police and International Security Assistance Forces in Wardak province, Afghanistan, entered a medical clinic in Sayed Abad district, Sept. 2., following a report that an insurgent commander, suspected of attacking civilians earlier that day, was being treated on the premises.

Just hours earlier, a civilian escorting a commercial supply convoy was killed and four others were wounded when insurgents ambushed the convoy. Afghan National Police and ISAF troops moved peacefully into the clinic to determine if the insurgent leader was present.

After informing the clinic staff why they were there, the joint ANSF-ISAF forces searched the building but found no insurgents. Troops searched the building and encountered only one locked door, which they were given permission to break by the clinic staff. No patients, relatives, or staff members were restrained in any manner.

The joint Afghan Police-ISAF element left the clinic without incident.

So, the ISAF disputes the SCA staff claim that they restrained clinic staff, and they dispute the implication made by SCA’s statement that locked rooms were entered without permission. The statement does not say they obtained permission prior to entering the clinic, nor does it deny SCA’s assertion that ISAF personnel attempted to give the order about pre-clearance for treatment referenced in the original post. Anyone have a different read on this?

(Derrick Crowe is the Afghanistan blog fellow for Brave New Foundation / The Seminal. You can learn more about the dangers posed to U.S. national security by the war in Afghanistan by watching Rethink Afghanistan (Part Six): Security, or by visiting

  1. sporkmaster says:

    One reason for suspicion could be this.

    The fighting began after US and Afghan forces received a tip-off that a Taliban commander and three other fighters had been brought into the clinic. Snipers in a tower near the clinic fired at the troops as they approached, triggering a five-hour confrontation between about 20 insurgents and Afghan and US forces…….Seven insurgents including the wounded commander were detained, the Americans said.

    RE-Chapter 3 Art 19 The first question that I have is about what care was denied and to what level? I mean if we are talking about routine items against life threatening issues?

    RE-Chapter 4 Art 24. To me it is worded it is referring to a mass causality, not routine level treatment.

    But how about the other side? I mean if the Taliban are using these clinics as a way of keeping their war fighters in the fight we should know about it. The same ones that have no problem using human shields or attacking civilian targets. Yet the clinic does not seem to see it that way.

    When the soldiers left, hospital staff were told to report any potential insurgents they treated to the NATO forces, the Swedish group said. Fange said the SCA did not have to do so.

    Anyone who has a gunshot injury or anything of the like, police can ask questions if they believe that the person got injured committing a crime. Why would it not be reliant here.

    • dcrowe says:

      Hey sporkmaster:
      I saw that story re: the Taliban firing. That’s just as much of a violation on the Taliban’s part as the story I posted above. In fact, as noted in the story linked to above, this exact clinic has been mistreated by Taliban forces as well. Both are very serious violations.

      I strongly disagree with a couple of points you made:

      Chap III Art 19 of Convention I spells out that enemy medical units are never to be the target of military operations and that our troops may not interfere with their operation. So, even if the facility was a wholly owned Taliban operation (and it certainly was not), if it were a designated, clearly marked facility we’d be bound to respect it.

      Chap IV Art 24 of Convention I spells out our obligation to protect the operation of medical staff, no matter what alignment they are in the conflict. As long as those staff are exclusively medical staff carrying out exclusively humanitarian operations, we have to protect them and not interfere.

      So the first provision deals with the facilities, while the second deals more specifically with the activities of the personnel. So again, even if they were specifically enemy personnel, they can’t be interfered with.

      Convention IV deals more specifically with the incident in question, as it was definitely a civilian facility, and again, we have to protect these facilities’ operations. So technically the articles from Convention I never come into play because this was a civilian medical facility.

      But even more to the point, we participated in the drafting of the Guidelines specifically for the operation of military/humanitarian groups in Afghanistan, and in this incident we clearly violated them. End of story, as far as I’m concerned.

      I don’t think you “need to know about it” re: the medical facilities. The only reason you’d need to know about it if your forces planned to honor your agreements would be to know where to stay the heck away from. Medical facilities are sacrosanct, end of story. And as much as I hate to make this kind of argument as a pacifist….it’s just bad strategy to attack a medical facility. Caring for wounded is more expensive in time and resources than burying the dead.

      Re: the police analogy, again, I strongly disagree. The troops had no right at all to enter the facility, they had no right to tie up staff, they had no right to shoo people out of beds. We are not policemen doing police work, and besides that no one ever, *ever*, gets to tell a doctor to not treat a wounded person without checking with someone first. That’s not even remotely ethical. I’m pretty sure that, if you were on the civilian side, and a Talib busted in on you and told you that he was giving you such an order, you’d tell him where to stick it.

  2. Mark Seavey says:

    You don’t even have a rudimentary grasp of what you are talking about, nor could you be bothered to take the extra 5 mins to google the report that the LT in charge of the platoon filed. The fact you have no understanding of why the hospital is claiming this, and what possible motivation they might have is ridiculous.

    I’ve been to that hospital. How much time have you spent there?

    • dcrowe says:


      Thanks for stopping by.

      Since you’re new to this blog, here’s the deal. You are welcome to provide contrary evidence (link, please?). However, the next time you post a nonsense comment like this that’s just a pejorative attack, you’re banned. Fair warning.

      If you had bothered to read the post above, you’d note that I did attempt to contact the NATO public affairs office in Kabul. But since you’re going to be a jerk about this, I’m happy to post the text of the email I sent. To date, no response.

      I am writing a story about the incident reported by the Associated Press involving ISAF personnel entering an SCA hospital in Wardak. I have several questions:

      1) What is the name/rank of the person/people who attempted to order the SCA staff to report possible insurgents seeking treatment and to request permission from ISAF before seeking treatment?

      2) Did this person’s/people’s superior officers authorize them to make such a demand?

      3) What was the name/rank of the highest ranking ISAF officer with prior knowledge of the operation?

      4) SCA staff have asserted that this is “a clear breach of the civil-military agreement” between aid groups ISAF. Do you care to respond?

      Thank you in advance for your prompt response.

      And by the way, you could have lived in that hospital for 10 years, and it wouldn’t make a difference. Post your contrary evidence or stop wasting our time.

      By the way, if the NATO public affairs office responds, I’ll be happy to update my story.

      • sporkmaster says:

        It does shed a different light on things, Also I may be longer in posting becuase I am very busy this week now that I work for two bosses, (medical and unit) but I will try to keep a eye on this subject.

    • sporkmaster says:

      I tried to find the LT of that platoon in the article. if you have a link to it I would love to read it.

      • dcrowe says:

        A couple of points:

        First, even if this account is accurate (of which i am very dubious, since someone’s butt is probably now on the line over this), the person authoring this account seems oblivious that during what I’m sure was a very visible ISAF entrance into the hospital, even a well-intended suggestion that they report people to ISAF forces endangers the humanitarian staff. See above for SCA’s country director saying how dangerous any hint of coordination with ISAF is for humanitarian staff in Wardak.

        Second, not sure that the linked account is a denial that males entered the female wards. Your thoughts, sporkmaster? I see a non-denial-denial.

        Third, if the hospital staff say the forces entered w/o permission, I’m inclined to believe the hospital staff.

        Fourth, again, ISAF personnel should not be entering hospitals to apprehend suspected insurgents, in compliance with the agreements listed above in the post itself. Hospitals are not battlefields. They are neutral ground.

        And finally, this:

        The information for the Afghan article was taken from an area and a group of people who have negative attitudes toward GIRoA and ISAF regardless of how much we try to help them and regardless of what aid we offer.

        basically just says never believe a word the locals say. That closer has a lot of impact on how credible (or not credible, in this case) I find the rest of the report.

        I’m going to take one more stab at getting a reaction from NATO and see if they’re willing to substantiate this report as the “official” version of events. I’ll also send it to SCA’s country director to get his reaction.

  3. dcrowe says:

    For the record, I just resent my request to NATO:


    Would anyone at NATO care to respond to this request? In the absence of an official description of the event from an authorized NATO spokesperson, SCA’s version of the incident will remain unchallenged in my article. In addition to the questions sent yesterday, I’d also like to know:

    – Whether ISAF forces restrained hospital staff in any way.
    – Whether male ISAF forces entered the women’s or maternity sections of the hospital.
    – Whether ISAF could document receiving permission to enter the hospital.

    Subject: Re: SCA hospital incident on Sept. 2

    I am writing a story about the incident reported by the Associated Press involving ISAF personnel entering an SCA hospital in Wardak. I have several questions:

    1) What is the name/rank of the person/people who attempted to order the SCA staff to report possible insurgents seeking treatment and to request permission from ISAF before seeking treatment?

    2) Did this person’s/people’s superior officers authorize them to make such a demand?

    3) What was the name/rank of the highest ranking ISAF officer with prior knowledge of the operation?

    4) SCA staff have asserted that this is “a clear breach of the civil-military agreement” between aid groups ISAF. Do you care to respond?

    Thank you in advance for your prompt response.

  4. sporkmaster says:

    I cannot really answer that in honest because of the different unit types. The rare few times we did enter civilian buildings to do work, we had clearance and permission already done before we even got to the site.

    But because of the differences all I can really do is give educated guesses.

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