Munich Security Report 2017

Health Security: Small Bugs, Big Bombs

Threats to global health security continued to arise in 2016: The world addressed the global impact of the mosquito-borne Zika virus, which causes birth defects, while major deliberate attacks on healthcare infrastructures, not least in Syria, were a particularly disgraceful feature of armed conflicts. Concurrently, lessons learned from the Ebola outbreak started to be drawn, notably by the UN High-Level Panel on the Global Response to Health Crises and by the World Health Organization (WHO), which reported that only 65 of the 193 states had necessary frameworks in place to detect and respond to infectious diseases.1 

“Deliberate attacks on hospitals are war crimes. Denying people access to essential health care violates international humanitarian law.”4 


In February 2016, just before the emergency status of the Ebola outbreak was terminated, the spread of the Zika virus led the WHO to formally declare it a global public health emergency. As with Ebola, the military played a significant role in the response to the outbreak: More than 200,000 soldiers participated in Brazil’s efforts to reduce mosquito populations, inspecting buildings for stagnant water and treating potential breeding grounds with insecticides.2 

Globally, since 2014, the WHO has recorded 707 attacks on healthcare resources, 444 of which targeted healthcare facilities.3 58 percent of these attacks were considered deliberate. In 2016, attacks on health facilities brought further opprobrium on the Syrian regime and condemnation of the Russian involvement in Aleppo: for the third quarter of 2016, the WHO recorded 70 such attacks in Syria alone, most of them by bombing. They deprive a population already struck by war of access to essential basic medical care. Such attacks can also undermine the ability to identify and respond to infectious disease outbreaks, potentially enabling epidemics. And they undermine the ability of populations to provide for themselves and their families, contributing to the global refugee crisis. 

But there was good news, too. In response to the Ebola outbreak, there has been important progress on strengthening the impact of the International Health Regulations (IHR), the international legal instrument aiming to help prevent and respond to acute public health risks that have the potential to cross borders. The World Health Assembly accepted external independent evaluation of country capacities. But the process continues to be voluntary. There are no sanctions for refusing to accept such an assessment, and no clear financial incentives for low-income countries to become IHR compliant. An even bigger challenge will be to make progress on International Humanitarian Law (IHL), which governs issues such as attacks on healthcare. The resolution of the conflict in Syria could provide the required impetus to strengthen the IHL regime. In any case, the dangerous relationship between conflict and health will continue to be a major issue on the international agenda. 


  1. Word Health Organization, “Report of the Review Committee on the Role of the International Health Regulations (2005) in the Ebola Outbreak and Response,” 13 May 2016,
  2. Jonathan Watts, “Zika Virus Command Center Leads Biggest Military Operation in Brazil’s History,” The Guardian, 30 March 2016,
  3. World Health Organization, “Attacks on Health Care Dashboard,” 3rd quarter 2016,
  4. Ban Ki-moon, “Ban calls on UN Security Council for Decisive Steps to End Attacks on Hospitals, Medical Staff”, UN News Center, 28 September 2016,
  5. Illustration provided to MSC by Chatham House.
  6. Data provided to MSC by Chatham House. Based on WHO data base on health care attacks. For further information and data, see