Protection of Civilians: Arria-formula Meeting on the Protection of Medical Care in Armed Conflict
Tomorrow afternoon (5 May), Denmark, along with non-Council members New Zealand and Spain, will convene an Arria-formula meeting to mark the tenth anniversary of resolution 2286 of 3 May 2016, which addressed the protection of the wounded and sick, medical and humanitarian personnel, and hospitals and other medical facilities in armed conflict. The meeting, titled “A Decade of Resolution 2286: Protecting Medical Care in Conflict Amid Evolving Threats”, will take stock of the implementation of the resolution and consider how the Security Council and the broader UN membership can respond to emerging threats in this area. The expected briefers are: Claude Maon, Intersectional Legal Director of Médecins Sans Frontières (MSF); Leonard Rubenstein, Distinguished Professor of Practice at the Johns Hopkins Bloomberg School of Public Health and Chair of the Safeguarding Health in Conflict Coalition (SHCC); Naz K. Modirzadeh, Professor of Practice at Harvard Law School (HLS) and Founding Director of the HLS Program on International Law and Armed Conflict (PILAC); and Elyse Mosquini, Permanent Observer of the International Committee of the Red Cross (ICRC) to the UN.
The meeting, which will begin at 3 pm EST in the ECOSOC Chamber, will be broadcast live on UNTV. In addition to Security Council members, it is open to the broader UN membership, permanent observers, UN entities, and accredited non-governmental organisations, civil society, and academia.
Background
Resolution 2286, which was unanimously adopted in May 2016, remains the Council’s only stand-alone resolution on the protection of medical care in armed conflict. It was co-penned by five elected members—Egypt, Japan, New Zealand, Spain, and Uruguay—a configuration that was notable at the time for its regional diversity and for being a departure from the then-standard practice of permanent members France, the UK, and the US (known as the “P3”) holding the pen on most resolutions. The text strongly condemned acts of violence, attacks and threats against the wounded and sick, medical personnel and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment, and hospitals and other medical facilities, and demanded that all parties to armed conflict comply with their obligations under international humanitarian law (IHL) and international human rights law (IHRL) to ensure their respect and protection. It also demanded that parties to conflict facilitate safe and unimpeded passage for personnel exclusively engaged in medical duties and underscored the importance of bringing to justice those who violate IHL, “as provided for by national laws and obligations under international law”.
Additionally, the resolution established new reporting requirements for the Secretary-General, requesting him to include information on attacks against medical care in conflict in his country-specific reports and other relevant reports which address the protection of civilians (PoC). It also requested him to submit recommendations on measures to prevent such attacks. Those recommendations, transmitted to the Council on 18 August 2016, proposed 13 measures across three areas: reinforcing a framework of respect for and protection of medical care; enhancing operational protection through precautionary measures; and strengthening documentation, accountability, and redress.
Since the adoption of resolution 2286, attacks on medical care in conflict have not only persisted but surged. In 2017, the SHCC documented 660 incidents of violence against medical care, which killed 160 medical personnel. According to the organisation’s most recent annual report, there were 3,623 incidents in 2024—the highest number ever recorded, representing a 15 percent increase from 2023 and a 62 percent rise from 2022—which resulted in the deaths of 927 health care workers. The increase was driven by intense and persistent violence in Gaza, Lebanon, Myanmar, Sudan, and Ukraine, with over 80 percent of incidents attributed to state actors. The SHCC also documented a sharp rise in the use of explosive weapons, particularly drone-delivered explosives, the latter of which nearly quadrupled in 2024 compared with 2023. According to the SHCC’s currently available data for 2025, the frequency of incidents decreased somewhat last year, during which the organisation recorded 2,658 attacks on medical care and 473 health worker casualties. Overall, since the adoption of resolution 2286 ten years ago, the SHCC has documented 18,345 attacks and 3,806 deaths.
Tomorrow’s Meeting
The concept note prepared by the co-organisers describes resolution 2286 as a “milestone affirmation” of the obligations of all parties to armed conflict to respect and protect medical care in conflict. It emphasises, however, that a decade after the resolution’s adoption, “significant implementation gaps remain, and medical personnel and their facilities continue to come under attack in conflicts worldwide”. It notes that the rising frequency of attacks, coupled with a persistent accountability gap and unfulfilled legal obligations to respect and protect medical care in armed conflicts, underscore how far the resolution remains from implementation.
The concept note further observes that new and emerging technologies present both challenges and opportunities for the protection of medical care. Cyber operations have rendered hospital computer systems inoperable, disabled critical medical infrastructure, and compromised patient data, while the use of artificial intelligence (AI) decision-support systems raises concerns about over-reliance on automated outputs that may displace human judgement in decisions concerning IHL obligations. At the same time, the concept note suggests that new technologies may also enhance compliance with IHL through “improvements in design and data”.
Among the questions posed by the concept note to guide the discussion are how the Security Council and the broader UN membership can better respond to the growing dangers facing medical care within the PoC agenda; what measures can strengthen the implementation of IHL and ensure consistent interpretation and application; how to safeguard against the risks posed by new and emerging technologies while utilising the opportunities they present; and what new measures can enhance accountability for attacks on medical care.
At tomorrow’s meeting, Maon may detail the cumulative impact of attacks on medical care on patients, staff, and medical organisations, calling for more concerted political and legal action to ensure compliance and accountability. She might present the findings of MSF’s January report detailing recent trends in this regard and describing the organisation’s operational experience in conflict-affected settings. Mosquini may express concern about increasingly permissive and selective interpretations of IHL—including the principles of distinction, proportionality, and precaution—that have fuelled the deteriorating protective environment for medical care in conflict. She might highlight the “Health Care in Danger” initiative of the International Red Cross and Red Crescent Movement, launched in 2011 and led by the ICRC, which has developed practical recommendations and tools to prevent violence and safeguard medical care in armed conflict and other emergencies. Both Maon and Mosquini may echo the joint call to uphold and strengthen the protection of medical care in armed conflict issued yesterday (3 May) by ICRC President Mirjana Spoljaric Egger, MSF International President Javid Abdelmoneim, and World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus on the occasion of the anniversary of resolution 2286—a commemoration that they describe as marking a “failure of political will”.
Rubenstein may present the SHCC’s latest findings on trends regarding violence against medical care, including the prominent role of state actors and the increasing use of drone-delivered explosives. Modirzadeh might focus on the long-observed gap between the legal protections to which medical care in conflict is entitled and the realities on the ground, including in the context of counterterrorism operations. She may also discuss certain challenges posed to the legal framework by new technologies, such as military applications of AI.
Many Council members are likely to condemn attacks on medical care, reaffirm the obligations of parties to armed conflict under IHL, and call for the full implementation of resolution 2286 and the Secretary-General’s August 2016 recommendations. Some may underscore the importance of accountability and call on parties to conduct credible investigations of alleged violations, while others may emphasise the primary responsibility of states to protect civilians within their territory. Some members—including those that have previously expressed reservations about Council engagement on issues that they consider the prerogative of other bodies—may caution against expanding the Council’s mandate, including in relation to emerging technologies. Geopolitical tensions may also surface, including with respect to attacks on medical care in Gaza, Sudan, and Ukraine, as well as allegations of selectivity in the Council’s engagement on these issues.
The anniversary of resolution 2286 is also likely to feature at the Council’s annual open debate on PoC, which is scheduled to take place on 20 May. That meeting will be informed by the Secretary-General’s annual PoC report, due to be submitted to the Council by 11 May, which is expected to have an expanded focus on the protection of medical care in conflict.
