An MSF worker surveys the destruction of the hospital in Kunduz, October 2015. Najim Rahim/AP/Press Association Images. All rights reserved.In the year since an American gunship bombed and rocketed the Médecins Sans Frontières trauma hospital in Kunduz, northern Afghanistan, killing 42 staff, patients and visitors, front-line medical workers have been subjected to an unprecedented level of violence. It has culminated in this month’s orgy of death and destruction in Aleppo and represents the biggest threat to humanitarianism and its ideals since World War II.

The eight still-functioning hospitals in eastern Aleppo have been hit repeatedly in recent weeks. Three of them – the Al Bayan, the M2 and the M10 hospitals – have each been struck on at least three occasions. There were eight attacks on ambulances in the course of a month.

It is surely time to turn the clock back to the founding principle of modern humanitarianism.  Because the wounded had to be cared for, the First Geneva Convention of 1864 laid down that ambulances, hospitals and their staff were to be formally recognised as neutral and “protected and respected by the belligerents.”

The International Committee of the Red Cross (ICRC), modern guardians of the Geneva Conventions, has established that in the past three years in 11 countries, there have been an astonishing 2400 attacks involving patients, health personnel and medical transport.  Much of the responsibility for these outrages lies with the strongest states in the world, from the Russians in Syria to the western powers over Yemen.

MSF has had three hospitals it supports in Yemen bombed by the Saudi-led coalition in the past year. One of them has been hit twice. Two ambulances and a mobile clinic have also been attacked. As well as using British and American bombs, there are UK and US military advisers on hand to guide these coalition air forces.

After the worst of these attacks in August – on the Abs hospital in northern Yemen which killed 19 – MSF was forced to pull out of the country. They complain of the “utter disregard for civilian life by all warring parties.”

The Kunduz attack in the early hours of 3 October 2015 was the worst bombing in MSF’s history. It has led to 12 months of public dispute with the US government over the facts and implications of the raid. MSF wanted it independently investigated as a war crime. The US offered its “deepest condolences”, issued a heavily censored report and declared the incident a tragic error borne of incompetence on the ground and in the air. But it was not a war crime, because it was not intentional.

But it was not a war crime, because it was not intentional.

Important discrepancies persist. MSF says that the bombing lasted from 2:08am to 3:15am: a total of 67 minutes. In the US account, the attack was called off after 30 minutes. The US report confines responsibility for the raid – and all the mistakes – to American personnel. Other accounts cite the role of Afghan forces in urging the Americans on and their distrust of MSF for treating Taliban wounded. Afghan officials have claimed that the hospital was under Taliban occupation.

The Americans say they mistook the hospital for another building, but their purpose was certainly to help their Afghan allies or, as they put it, “to soften the target for partner forces.”   In response to a query about human figures seen on the ground, now known to be hospital staff, the circling gunship was told that the compound was “currently under the control of TB [Taliban] so those 9 PAX [personnel] are hostile.”

There was one way to resolve these differences, and MSF shrewdly adopted it. They approached the organisation established under the Geneva Conventions to investigate potential breaches of International Humanitarian Law. The International Humanitarian Fact-Finding Commission (IHFFC) has been in existence for 25 years, and has yet to record a single solid achievement. It is at the service of governments, and governments have shown consistent unwillingness to be investigated.

Nothing changed over Kunduz. Neither the US nor the Afghan government was going to submit itself to independent inquiry over a potential war crime. But in publicly acknowledging the MSF approach, the IHFFC did wonders for the agency’s noisy campaign to gain respect for the rules of war. MSF has since brought two more potential war crimes to the commission’s attention. One was the bombing of a hospital they supported in Yemen, the other a hospital raid in northern Syria.

The IHFFC is at the service of governments, and governments have shown consistent unwillingness to be investigated.

Lacklustre international responses to humanitarian outrages are not confined to little-known organisations in Geneva. In May, the United Nations Security Council passed a resolution condemning attacks on health facilities and demanding an end to impunity for those responsible. In the field in Syria and in Yemen, MSF noted a reduction in the regularity and intensity of attacks, but it proved temporary.

The UN failed in another initiative. In its preparation for the first-ever World Humanitarian Summit in Istanbul in May – boycotted by MSF as “a fig leaf of good intentions” – officials allowed front-line humanitarian emergencies to become entangled with longer term development objectives stretching to 2030 and beyond. As for measures to end conflict and respect international law, the UN now admits the summit gained “few new and concrete commitments that would lead to change on the ground.”

International institutions are as good or as bad as the governments that subscribe to them. The big powers often invoke the good name of humanitarianism, but do precious little to promote its principles. After years of planning, a major international conference staged by the Red Cross in Geneva last December made no progress at all in establishing a formal mechanism to ensure compliance with humanitarian law.

The wretched truth is that if the Geneva Conventions did not exist today, no one would invent them. If they were presented to governments today, surprisingly few would sign them.

In a world indifferent to upholding humanitarian principles, there is only one bright spot. It is the work and commitment of the two aid agencies in direct line of descent from their original Swiss foundation: the International Committee of the Red Cross and Médecins Sans Frontières. 

A year on from the air raid, MSF wants to go back to work in Kunduz where the surgical needs are overwhelming. But it dares not risk more staff lives until the Americans can assure them that the same thing would not happen again.

Peter Gill is the author of Today We Drop Bombs, Tomorrow We Build Bridges: How Foreign Aid Became a Casualty of War (2016) published by Zed Books.