This week, a new word was unveiled: healthocide.
In a commentary published in the journal BMJ Global Health, it's defined in part as the deliberate damaging or destruction of health services.
"We mean the intentional, systematic destruction of not only health care infrastructure, hospitals, health care workers, medical supply lines," says co-author Joelle Abi-Rached, a professor of medicine at the American University of Beirut, "but also the devastation of a population's health and its well-being in its entirety. In other words, healthocide refers to a shattering of the very wholeness that health itself implies."
By creating this new term, Abi-Rached seeks to convey the urgent need to address what she says are flagrant violations of international law. In addition, she hopes it will serve as a wakeup call to the global medical community to stand up against attacks on health care infrastructure and personnel, no matter where they are occurring.
The reaction of the humanitarian community to the neologism has been mixed.
A consistent increase in attacks on health care
The new term reflects the fact that within conflict zones worldwide, health care has come under increasing fire.
The Safeguarding Health in Conflict Coalition (SHCC), a group consisting of nearly three dozen member organizations, quantified this clear and alarming trend in a report published earlier this year. In 2024, they tallied more than 3,600 incidents – a 15% increase from 2023 and a 62% jump from 2022.
Such assaults are not new, but they were once "viewed as collateral damage or accidental, something that was cause for condemnation and immediate apologies or denials by the fighting forces," says Sam Zarifi, the executive director of Physicians for Human Rights.
There's been a lethal shift, however. "Attacks on health care are now seemingly part of the strategy of the conflict," he says. "And that is new and it's very, very worrisome."
That worry is due in part to the amplification of injury and death when hospitals and clinics are damaged or destroyed and medical professionals are harmed or killed. In addition, experts are unnerved by the increasingly global nature of these attacks.
"This weaponization of health has drastic consequences," says Joelle Abi-Rached. It's "used to sow fear, cripple care and magnify the human toll."
A troubled region
The birth of this word is tied to what has unfolded in Abi-Rached's home country of Lebanon. After living abroad for nearly two decades, she returned a year ago. The following month, in mid-September 2024, the increasingly violent tit-for-tat conflict between Israel and Hezbollah that had been brewing since Hamas' deadly October 7 attack on Israel morphed into a full blown war.
From mid-September until late November 2024, Lebanese health care facilities and personnel suffered from Israeli bombardment. "The number of attacks in such a very short period in Lebanon is unique," says Len Rubenstein, the chair of the SHCC and director emeritus of the Program on Human Rights, Health and Conflict at Johns Hopkins University. The coalition's report documents that at least 408 health workers were killed and health facilities were damaged at least 208 times.
These losses accumulated for Abi-Rached against the backdrop of the war in Gaza. The World Health Organization has tabulated that in the 22 months since October 7, roughly half of all global attacks on health care have occurred within the Palestinian territories, which include Gaza. The Palestinian Ministry of Health reports that more than 1,500 medical workers have died and the U.N. estimates that half of all hospitals are partly operational.
Israel often justifies its attacks on health care infrastructure by claiming that enemy soldiers, weapons or infrastructure are hiding within or below these facilities.
"I would be the last to underestimate what happened in Syria or Ukraine or Tigray [in Ethiopia] or Myanmar," says Rubenstein. "But the relentlessness of the attacks in Gaza are astonishing and unique. The kind of sickening regularity, it's almost hard to fathom."
"We're talking about the obliteration of an entire health care system," Abi-Rached says.
The global targeting of hospitals and medical workers, especially in Gaza and Lebanon, helped motivate Abi-Rached and her colleagues to write their commentary that proposes the adoption of the word healthocide. They were also compelled by what they perceived as an overall silence from the global medical community in the face of the destruction of the health care system in Gaza.
Zarifi agrees with this assessment. "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)," he says.
Abi-Rached is hopeful that the existence of the word healthocide will encourage the medical profession to stand up for health systems and health workers everywhere.
Not everyone thinks the new word is necessary
Zarifi concludes that coining the term healthocide comes at a critical moment. "I think we need to escalate the importance of that prohibition and the attention that it deserves," he says.
Still, he argues that the new word doesn't actually 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," he says.
Zarifi says that Physicians for Human Rights tends to adhere to international legal language when describing these acts. "We view attacks on health care as war crimes in the context of a conflict," he explains. "If they are systematic and grave — as crimes against humanity." And he says that these attacks sometimes contribute to the conclusion that a group has committed a genocide.
Rubenstein doesn't find the word useful either. "I don't particularly think that the coining of a new term is either necessary or particularly essential," he says. "I don't think it adds [to] what we already understand about the sanctity of health care and war. I'm skeptical."
Regardless of whether the new term gains wider popularity, Zarifi suggests the antidote to the contagion of impunity is clear — accountability. "That's the only way that we can ensure the safety and protection of people," he says.
Zarifi says there's not much precedence for holding perpetrators responsible, but he points to one promising break with that tradition. "The International Criminal Court [is] looking at Russia's attacks on health care in Ukraine as war crimes and crimes against humanity," he says. "And I think if there is accountability there, that's really, really important."
"I was very pleased"
Amal Elamin, a global health expert at the University of Greenwich who's written about the collapse of the health care system in Sudan due to civil war, welcomes the new word.
"To say the least, I was very pleased to see this term being coined," she says. "It reinforces the fact that the targeted attacks on health care settings and health workers is no longer an isolated precedent."
Elamin says that the details of the atrocities vary from place to place but the willful intentionality is consistent, including in Sudan, where her parents grew up and where she has spent portions of her life. She points to repeated attacks on the same health facilities in the country.
"You will find that a major hospital would be attacked," she explains. "They will manage to mobilize fund[s] and once it's rehabilitated, it will be attacked again. So it's a deliberate destruction that is intended to dismantle the system — that we are not going to leave any place untouched."
In addition, Elamin has observed that, similar to Gaza, the international community has failed to speak out uniformly and forcefully against assaults on health care in Sudan.
"It creates a vicious cycle that the very people who are meant to help the victims of violence become victims themselves," she says. "So who's going to help those health workers? There's no one that has been held accountable. There is a general passiveness. And the health workers are still expected to perform and provide within these challenging situations."
In her view, this is why health workers in conflict zones can feel overlooked and neglected.
Elamin believes that the new word healthocide can help push things in a better direction. She hopes it will lead to difficult conversations that coalesce into a larger movement that ultimately holds people responsible.
"Currently what we see is often just condemning the attack without any further action," she says. "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 says. "Very needed."
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