In multiple situations of armed conflict throughout the world, parties to the conflict routinely deny civilians access to humanitarian aid as a tactic of war. For example, in Yemen, the Saudi Arabia-led coalition has maintained a de facto aerial and naval blockade since March 2015. Because Yemen imported 90 percent of its food and medicine and 70 percent of its fuel before the start of the conflict, the impacts of the blockade have been devastating. More than 7 million Yemenis are on the verge of famine and a cholera epidemic afflicting more than 300,000 people has wracked the nation. In South Sudan, government forces and armed groups routinely delay or deny passage to humanitarian convoys carrying lifesaving nutrition and medical supplies to populations in desperate need. Famine has already been declared in parts of the country and the United Nations Children’s Fund (UNICEF) has warned of a looming cholera outbreak.

Children are disproportionately impacted by these epidemics and typically comprise more than 50 percent of the populations affected. Yet, in Yemen, South Sudan, and many other countries, children’s (and adults’) ability to access the health care needed to treat them has contracted sharply—in part the result of deliberate attacks on medical facilities and personnel, another tactic of war. The International Committee for the Red Cross (ICRC) has reported that parties to the conflict carried out more than 160 attacks throughout Yemen between March 2015 and December 2016. An approximate number of incidents has not been reported for South Sudan, however a May 2017 report by the Safeguarding Health in Conflict Coalition (SHCC) is the most recent to document a pattern of attacks against medical facilities and personnel since the escalation of conflict in 2013. In both countries, denial of access to humanitarian aid and attacks on medical facilities and personnel have led to tens of thousands of children suffering from or dying of diseases that are simple to prevent or treat.

As part of the Children and Armed Conflict (CAC) agenda, attacks against medical facilities and personnel and denial of access to humanitarian aid are two separate grave violations. However, in these two countries and elsewhere, the separation is not so clear. Is denying passage of a convoy filled with food and medical supplies an attack or a denial? What about burning a warehouse filled with nutritional supplements? Such questions are important to ask and answer. An attack on a medical facility or related personnel is a trigger violation, with a clear definition as specified by a Guidance Note issued by the Office of Special Representative for Children and Armed Conflict (OSRSG-CAAC), for which parties responsible can be listed in the annexes of the Secretary-General’s annual report on children and armed conflict. Denial of access, however, is not a trigger violation (the last remaining grave violation to not be elevated as such through a Security Council resolution) and each Country Task Force on Monitoring and Reporting (CTFMR) independently determines the type of incidents reported as part of the Monitoring and Reporting Mechanism (MRM). In the Secretary-General’s 2016 report, this resulted in the documentation in South Sudan of 277 verified incidents of denial and no documented incidents of attacks. Yet, the SHCC report, along with others, documented numerous attacks in South Sudan for that year. In Yemen, only 16 incidents of denial compared to 59 attacks were documented in the 2016 annual report. However, Amnesty International and other reports documented repeated denials. Differences in status (trigger vs. non-trigger) and definition (clear vs. amorphous) have and continue to matter when it comes to listing parties to the conflict in the annexes of the Secretary-General’s annual report and subsequently the prospect of changing parties’ behavior.

In the coming months, Watchlist will continue conducting research on attacks on medical facilities and personnel and denial of access to humanitarian aid, analyzing the interrelationship between these two violations, and advocating for strengthened accountability for perpetrators.