The term “healthocide” was introduced this week.
The intentional destruction or damage of health services is one definition given in a commentary that was published in the journal BMJ Global Health.
According to co-author Joelle Abi-Rached, a medical professor at the American University of Beirut, “We mean the intentional, systematic destruction of not only health care infrastructure, hospitals, health care workers, and medical supply lines, but also the devastation of a population’s health and its well-being in its entirety.” To put it another way, healthocide is the destruction of the very completeness that health itself denotes.
Abi-Rached hopes to express the urgency of addressing what she claims are egregious transgressions of international law by coining this new phrase. She also hopes it will serve as a reminder to the international medical community to defend health care people and facilities from attacks, wherever they may occur.
The humanitarian community has responded to the neologism in a variety of ways.
A consistent increase in attacks on health care
The new word reflects the growing criticism of health care in conflict areas around the world.
In a study released earlier this year, the Safeguarding Health in Conflict Coalition (SHCC), which has around three dozen member groups, quantified this glaring and concerning trend. More than 3,600 occurrences were reported in 2024, a 15% rise from 2023 and a 62% increase from 2022.
In the past, such attacks were “viewed as collateral damage or accidental, something that was cause for condemnation and immediate apologies or denials by the fighting forces,” according to Sam Zarifi, executive director of Physicians for Human Rights.
But there has been a deadly change. “Attacks on health care are now seemingly part of the strategy of the conflict,” according to him. “And that is new and it’s very, very worrisome.”
This concern stems, in part, from the fact that fatalities and injuries are increased when medical personnel are hurt or murdered and hospitals and clinics are destroyed. The fact that these attacks are becoming more widespread also worries specialists.
“This weaponization of health has drastic consequences,” Joelle Abi-Rached asserts the statement. It is “used to sow fear, cripple care and magnify the human toll.”
A troubled region
The events that have transpired in Abi-Rached’s native Lebanon are linked to the origin of this name. She returned a year ago after over twenty years of living overseas. The tit-for-tat battle between Israel and Hezbollah, which had been simmering since Hamas’ October 7 attack on Israel, turned into a full-fledged war the following month, in mid-September 2024.
Israeli assault of Lebanese medical institutions and staff occurred from mid-September to late November 2024. Len Rubenstein, the chair of the SHCC and director emeritus of the Program on Human Rights, Health, and Conflict at Johns Hopkins University, says, “The number of attacks in such a very short period in Lebanon is unique.” According to the coalition’s assessment, medical facilities suffered at least 208 damage incidents and at least 408 health professionals were slain.
Abi-Rached’s losses mounted against the backdrop of the Gaza War. According to data from the World Health Organization, in the 22 months since October 7, about half of all attacks on medical facilities worldwide have taken place in Palestinian areas, including Gaza. More than 1,500 medical personnel have died, according to the Palestinian Ministry of Health, and the United Nations estimates that half of all hospitals are only partially operating.
Israel frequently uses the excuse that enemy troops, weapons, or infrastructure are concealed inside or beneath healthcare facilities to defend its operations.
“I would be the last to underestimate what happened in Syria or Ukraine or Tigray [in Ethiopia] or Myanmar,” Rubenstein asserts. However, the attacks in Gaza are incredibly and singularly unrelenting. It’s nearly impossible to comprehend the kind of nauseating regularity.”
“We’re talking about the obliteration of an entire health care system,” Abi-Rached states.
The widespread attacks on hospitals and healthcare professionals, particularly in Gaza and Lebanon, served as inspiration for Abi-Rached and her colleagues’ statement suggesting the term “healthocide” be adopted. They were also driven by what they saw as a general lack of response from the international medical community to the devastation of Gaza’s healthcare infrastructure.
Zarifi concurs with this evaluation. “Those states who previously supported the norm [prohibiting attacks on health care], at least rhetorically, seemed reluctant to defend the norm in the context of Israel and Palestine (and to some extent Lebanon),” according to him.
Abi-Rached hopes that the term “healthocide” will inspire the medical community to defend health systems and healthcare professionals worldwide.
Not everyone thinks the new word is necessary
According to Zarifi, the term “healthocide” was coined at a crucial juncture. “I think we need to escalate the importance of that prohibition and the attention that it deserves,” he states.
He contends, however, that the new word does not, in fact, define a new wrong. rather, “it describes behavior and activities that are already criminalized with the highest level of protection that international law has to offer,” according to him.
According to Zarifi, when defining these activities, Physicians for Human Rights typically uses language that is consistent with international law. “We view attacks on health care as war crimes in the context of a conflict,” he says. “If they are systematic and grave as crimes against humanity.” Furthermore, he claims that these assaults occasionally support the notion that a group has carried out a genocide.
The word is also useless to Rubenstein. “I don’t particularly think that the coining of a new term is either necessary or particularly essential,” he asserts. “I don’t believe it contributes anything [to] what we already know about the holiness of war and health care. I don’t believe it.”
Zarifi says that explicit accountability is the antidote to the spread of impunity, regardless of whether the new phrase becomes more widely used. “That’s the only way that we can ensure the safety and protection of people,” he states.
There isn’t much precedent for holding offenders accountable, according to Zarifi, but he cites one encouraging exception. “The International Criminal Court [is] looking at Russia’s attacks on health care in Ukraine as war crimes and crimes against humanity,” according to him. “And I think if there is accountability there, that’s really, really important.”
“I was very pleased”
The new term is welcomed by Amal Elamin, a global health specialist at the University of Greenwich who has written about the civil war-related breakdown of the health care system in Sudan.
“To say the least, I was very pleased to see this term being coined,” she continues. “It reinforces the fact that the targeted attacks on health care settings and health workers is no longer an isolated precedent.”
Elamin claims that although the specifics of the atrocities differ from one location to another, the deliberate intentionality is always present, even in Sudan, where she has lived for parts of her life and where her parents were raised. She cites several assaults on the nation’s same medical facilities.
“You will find that a major hospital would be attacked,” she says. “They will be able to raise money, and when it has been repaired, it will be assaulted once more. So it’s a deliberate destruction that is intended to dismantle the system that we are not going to leave any place untouched.”
Elamin has also noted that, like Gaza, the international community has not reacted consistently and firmly to attacks on Sudan’s healthcare system.
“It creates a vicious cycle that the very people who are meant to help the victims of violence become victims themselves,” she continues. “So, who will assist those medical professionals? No one has ever been held responsible. A general passiveness is present. And despite these difficult circumstances, health professionals are nevertheless expected to perform and offer.
According to her, this is the reason why medical personnel in conflict areas may feel ignored and undervalued.
Elamin thinks the new term “healthocide” will help move things along more positively. She thinks it will spark challenging discussions that eventually come together to form a broader movement that holds people accountable.
“Currently what we see is often just condemning the attack without any further action,” she continues. “But when we have such a term, [it] requires the same urgency that we see in other forms of genocide.”
“That’s why such a term is very timely,” she continues. “Very needed.”
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