Just as doctors have a duty of care and respect to their patients, so the rest of us have an obligation to doctors. It is a basic tenet of civilised societies that medics should be allowed to care for the sick and wounded in wartime as well as in peace. The concept of medical neutrality was enshrined in the first Geneva convention more than a century and a half ago, and over those years it has offered countless doctors, nurses and their patients a degree of protection in the cruellest times. Attacking medical facilities, transport and personnel intentionally is outlawed. No one should need to be reminded of that; yet it appears that we must be – repeatedly. In May, the security council adopted a resolution to strengthen protection for healthcare workers, the sick and wounded, and hospitals and clinics in war zones. The measure was prompted by increasing assaults on such facilities; according to the International Committee of the Red Cross, 959 people were killed in 600 such attacks in 2014 and 2015 alone. It has proved fruitless. The strikes are now so frequent they are in danger of being normalised. On Wednesday the United Nations secretary general was forced, for the second time in four months, to spell out international law’s protection of medical services and its demand that the wounded and sick, whether civilians or fighters, be spared: “Deliberate attacks on hospitals are war crimes. Denying people access to essential healthcare violates international humanitarian law.” Ban Ki-moon spoke hours after the two largest hospitals left in rebel-held areas of Aleppo were bombed out of service. Physicians for Human Rights says there were 382 attacks on 259 health facilities in the country between March 2011 and June this year, killing 757 medical personnel. There can be no doubt that many of those have been targeted. The bald numbers fail to capture the true impact: murdering a dozen doctors may cause the deaths of hundreds or even thousands of civilians, who are either too frightened to access healthcare or are simply left without services at all. Those who attack facilities intentionally know that they are destroying the morale of the communities they serve. Such assaults are intended to exacerbate suffering and drive people from contested territory. Syria is far from an isolated case. In South Sudan, the Central African Republic, the Democratic Republic of Congo, Libya and many more places, healthcare workers are suffering. Médecins Sans Frontières has been forced to withdraw from the north of Yemen following the fourth attack against its facilities by the Saudi-led coalition in less than a year, killing 32 and injuring 51. The US and UK are not only failing to rein in Saudi Arabia, but continue to sell it arms. And though Monday will mark the first anniversary of the US bombing which killed 42 at an MSF hospital at Kunduz in Afghanistan – including patients who burned in their beds and medics attacked as they fled the building – the organisation still awaits an independent investigation. In that case, as in Yemen’s, the facility was targeted despite the fact that MSF had repeatedly given its location; and the strike continued despite MSF alerting US forces that they were hitting a medical facility. As the organisation’s president observed earlier this year, four of the five permanent members of the security council have, to varying degrees, been associated with coalitions responsible for attacks on health structures. It is important to acknowledge profound differences between cases. In Syria, attacks are routine and clearly intentional; there is little doubt that the Assad regime and its allies are calculatedly hitting the healthcare system. Reckless as well as deliberate actions can be war crimes. But it is significant that MSF continues to share the coordinates of its facilities in Afghanistan and Yemen, to protect them. In Syria, it keeps them secret. In all instances, however, medics not only deserve to work safely; they have a right to do so. States must adopt clear policies for their militaries and train personnel accordingly. Attacks upon health workers and their workplaces should be investigated and documented thoroughly. Where countries fail to hold fighters to account for human rights violations, they should be pursued internationally. A dedicated UN high representative, as suggested by MSF, would help to keep the issue on the agenda. We must refuse to accept strikes on facilities and staff as aberrations or – worse – as a new rule of war, if doctors and the patients they so courageously serve are to be protected.