Issue No. 846

Published 14 Jul 2025

Hospitals in Armed Conflict

Published on 14 Jul 2025 21:33 min

Hospitals in Armed Conflict

Hospitals and health clinics are generally not targeted deliberately in armed conflict because a belligerent could lose international credibility immediately and be liable for prosecution under the International Humanitarian Law. In recent years, as armed conflicts have surged and the fog of war rendered any reporting hard to verify, hospitals are increasingly becoming targets in themselves.

In Somalia, there is no hard evidence of an armed group targeting hospitals, but in July 2023 during the Laas Anood conflict, a hospital came under indirect fire and was partially destroyed. The SSC-Khatumo rebels claimed the Somaliland army was deliberating shelling the hospital. Activists cited the shelling of the hospital as evidence of ‘war crimes’ and demanded the Muse Bihi administration be taken to the International Court of Justice at The Hague. The authorities in Hargeisa denied the claims. The Somaliland Army’s use of imprecise artillery and the SSC-Khatumo rebels’ use of areas near the hospitals to launch mortar attacks certainly played a big role in transforming the hospital and its surrounding areas into an active combat zone.

Protection of medical facilities, patients and staff is a value enshrined in guidelines for conduct of war – a binding blueprint that has been signed by almost every state in the world: the Geneva Conventions. Put simply it states that all people have the right to medical treatment: civilians, children and combatants from all sides. Not only should the clinic or hospital be considered neutral and outside of the conflict, but ambulances, staff and those seeking medical care have access to the hospitals/clinics. Even your enemy should receive medical care. The principle of medical neutrality dictates that medical personnel and facilities must be allowed to care for all sick and wounded people and ensure access to care for all, regardless of their affiliation or involvement in the conflict. Sadly, we are witnessing a steady rollback of such universal values in many countries and Somalia is no exception. Many Somali doctors and nurses have fled over the past decades to more safe environments abroad. Insecurity in the health environment has forced many closures of services in Somalia since the fall of the Siyad Barre regime in 1991. They can broadly be categorised into basic groups. Failure in the aftermath of state collapse in the early 1990s led to government closure of a robust health care system. The myriads of governments since then have categorically failed to resurrect governmental health care despite billions in assistance. Therefore, the initial conflict led to a state breakdown of healthcare that almost completely was not filled by ensuing government institutions.  

Into this gap, stepped NGOs (both international and local) and private health care providers.  The insecurities they faced were different. Many security incidents were not headline driven massive military assaults. For 25 years, they fell broadly into two categories: people that had grievances about the perceived quality of care for a loved one and issues relating to internal structure (i.e. hiring of local staff). In both of these categories, international organizations and staff and local Somalis abilities to both understand their respective cultures added an accelerant to disagreements.  

Over time, Somalia’s insecurity has turned medical professionals - both foreign and local - into high-value targets. Skilled health workers have been abducted or held for ransom, transforming them into bargaining chips in a wider web of political and criminal violence. Most infamously, in April 2019, Al-Shabaab militants abducted two Cuban doctors who had been deployed to Kenya as part of a bilateral healthcare agreement. These doctors were held captive for ransom for approximately 18  months, during which the militants are believed to have exploited their medical skills to treat injured fighters and local communities in areas under their control. Fear of abduction and lack of protection have made both local and international medical personnel increasingly unwilling to work in Somalia. The international NGO footprint in the Somali medical realm is but a shadow of what it was even during the difficult contextual times in the 2000s.

Hundreds if not thousands of trained staff have left the country. The attack at the medical graduation ceremony  in December 2009,  put a generational chill in aspiring medical personnel training. A suicide bomber targeted the graduation ceremony for medical students at the Shaamo Hotel in Mogadishu. The attack  killed at least 19 people - mostly students - including the minister of Health, and injured dozens more. Government malaise has not re-invigorated the situation. Kidnapping and security incidents have crippled international medical response. But Somalia and the world continues to evolve with regards to attacks on healthcare. 

When it comes to security for medical personnel and structures, Somalia can be thankful that it has not had targeted airstrikes on medical facilities or ambulances. As the country works toward a more stable and resilient health system, past incidents should be treated not as anomalies, but as warnings. Strengthening protections for medical staff, reinforcing the neutrality of healthcare spaces, and building contingency protocols must form part of any sustainable healthcare strategy. In a context where health workers have so often been forced to operate under threat, ensuring their safety is a humanitarian imperative and is essential in rebuilding public trust in the system.

The Somali Wire Team

To continue reading, create a free account or log in.

Gain unlimited access to all our Editorials. Unlock Full Access to Our Expert Editorials — Trusted Insights, Unlimited Reading.

Create your Sahan account Login

Unlock lifetime access to all our Premium editorial content

You may also be interested in

Issue No. 966
A New Spring in His Step: How HSM Engineered His Rebound
The Somali Wire

Today marks exactly two months since Somali President Hassan Sheikh Mohamud (HSM) unveiled his unilateral one-year term extension. While it is too early to draw definitive conclusions, HSM has evidently survived, rebounded, and consolidated power in ways that defy earlier predictions. A leader whom many had been wont to dismiss as too tarnished to retain executive power beyond May 2026 remains firmly in the saddle, holding the political initiative and dictating terms. His opponents, meanwhile, are in deep disarray. Their cohesion is fracturing, they lack a coherent, unified strategy, and they are locked in a dialogue of attrition designed to wear down their will and force their capitulation.


24:38 min read 16 Jul
Issue No. 965
The Somaliland-Ethiopia MoU: Ethiopia Missed a Milestone While Somaliland Avoided a Historic Mistake
The Somali Wire

The Somaliland–Ethiopia Memorandum of Understanding (MoU) was hailed as a historic breakthrough. In reality, it was a strategic gamble built on contradictions—and its apparent failure may prove to be a blessing in disguise for Somaliland and Ethiopia.


6:03 min read 10 Jul
Issue No. 964
Part II/The Human Rights Deficit in Somalia's New Penal Code
The Somali Wire

For the first time in over six decades, Somalia has overhauled its foundational criminal law - the 1962 Law No. 5. Now awaiting parliamentary and presidential approval, the Draft Somali Penal Code (SPC) nonetheless struggles with multiple hurdles and will likely face significant objection, not least, from Somalia’s Western partners and liberal-minded younger generation of Somalis disappointed with the new text’s failure to break away from its historical illiberal roots.


16 min read 08 Jul
Issue No. 963
Part I/The Fault Lines in Somalia’s Penal Reform
The Somali Wire

The Federal Government of Somalia (FGS) has published a new Draft Somalia Penal Code (SPC) - marking its first comprehensive legal overhaul in 64 years. The 136-page draft was first submitted to Parliament in January 2026 and underwent its first reading but the process of endorsing it became entangled with the escalating electoral and constitutional dispute, forcing the government to shelve it. The changes aim to update the 1962 Law No. 5 Penal Code and codify Islamic criminal law (uqubat). If endorsed by parliament and approved by the President, they will formally embed the three pillars of the Sharia punitive framework into the statute - fixed punishments (hudud), retributive justice (qisas), and statutory judicial discretion (ta'zir).


16:49 min read 03 Jul
Issue No. 129
Centring North Eastern Kenya - The Rise Of Kenya's Ethnic Somalis
The Horn Edition

A president does not pay a visit to Wajir by accident. When William Samoei Ruto chose Wajir as the centre stage for Kenya’s Madaraka Day celebrations on 1 June — the first sitting president to do so — he was not merely varying the ceremonial calendar. He was making a premeditated statement about who belongs at the centre of Kenya’s state and who no longer belongs at its margins. The message was not merely ‘taking Nairobi to NorthEastern.’ It was the centring and mainstreaming of an ethnic Somali-dominated region that, for much of Kenya’s post-colonial history, has been treated as a security issue rather than a political constituency.


28:45 min read 26 Jun
Issue No. 962
Somaliland’s Recognition Angst
The Somali Wire

Somaliland President Abdirahman Irro’s trip to Israel in June (from 14-17) was far more than symbolism. Not only was it a calculated strategic diplomatic play, and a chance for Somaliland to appear on the world stage, but also an opportunity for Somaliland to present itself as a fully-functional state, able to conduct foreign relations and cut bilateral deals. Irro, a seasoned former diplomat, navigated the intricate demands of state protocol with remarkable ease - cutting an immaculate, regal figure in his navy-blue suit. Accorded full head-of-state honours, he laid a wreath at the Theodore Herzl mausoleum, engaged in high-level talks with President Isaac Herzog and Prime Minister Benjamin Netanyahu, opened the new Somaliland embassy in Jerusalem and convened meetings with Knesset members, senior officials, and business leaders. For Israel, hosting President Abdirahman Irro in Jerusalem functioned to signal its strong commitment to deepening strategic ties while also countering perceptions of waning diplomatic momentum.


22:37 min read 24 Jun
Issue No. 961
Deciphering Al-Shabaab's Radio Silence
The Somali Wire

Never interrupt your enemy when they are making a mistake. Napoleon Bonaparte’s classic rule of combat seems to be the guiding doctrine behind Al-Shabaab’s sudden, uncharacteristic radio silence as Mogadishu’s political elite tear themselves apart. As the ‘government-in-waiting’, one would have assumed the militants would take full advantage of its adversaries’ internal divisions, maximising the propaganda opportunities this offers, and campaign for their own cause. Typically quick to weaponise any intra-Somali division, the militant group's decision to sit out the latest intra-Somali fracturing is intriguing. By withholding its usual blitz of propaganda, the group is playing a longer, quieter game - waiting for the federal house to implode further before stepping in.


20 min read 17 Jun
Issue No. 960
The Galmudug Vote – The Next Powder Keg
The Somali Wire

While much international attention is on Mogadishu – understandably so - another electoral crisis is brewing in the regional state of Galmudug. Historically unstable, prone to Al-Shabaab violence and destabilisation and wracked by chronic inter-clan frictions and periodic armed hostilities, the looming vote appears likely to aggravate the situation and foment more divisions.


7:13 min read 10 Jun
Issue No. 959
Mogadishu on the Edge: The Danger Has Not Passed
The Somali Wire

Two days of heavy clashes (3–4 June) in the Somali capital, Mogadishu, between federal troops and opposition-aligned forces have underscored both the fragility of the city’s security environment and the volatility of electoral politics. Although relative calm has since returned to the two hardest-hit districts - Hawl Wadaag and Abdiaziz - and mediation efforts have intensified, tensions remain high, fuelling fears of renewed armed skirmishes. Credible reports of mass clan militia mobilisation on the edges of Mogadishu speak to a conflict that is widening. The militarisation of politics and elite fragmentation over the electoral process have shattered a core assumption: that Somali leaders will ultimately step back from the brink to negotiate a way forward. Consequently, the country is entering a perilous phase in which domestic factions alone cannot resolve the impasse, making neutral, external mediation a necessity.


10:12 min read 08 Jun
Scroll