‘unjust’, ‘criminal’ or ‘innocent’. Medical codes of conduct universally value trust, respect, and the equal treatment of patients36. This is incompatible with prohibiting or sanctioning health care workers for medically attending persons accused or guilty of criminal acts. Two exceptional situations could be seen as derogations. The first situations would be when the delivery of medical care itself is directly responsible for extreme harm to others, for example when a medical act is performed to enable a criminal action. The second situation would be when confidentiality results in knowledge of imminent harm to others. In fact, medical confidentiality features prominently in many normative documents (ethical and legal). Except for public health reasons, medical confidentiality outweighs utilitarian arguments that would justify the notification of patients to authorities. Revisionists make these exceptional derogations a rule and a matter of law enforcement, instead of a moral dilemma whose resolution should lie in the hands of medical personnel. The second objection is that revisionist theories conflate at least three different understandings of what is just or unjust: (i) just cause, (ii) just retribution, and (iii) fair treatment. Deciding if a cause for aggression is just or not (i), is not the role of humanitarian or medical personnel. Doing otherwise would be a breach of neutrality and, effectively, a case of ‘taking sides’. Neither ought humanitarians to interfere with a judicial sentence to which someone has been legally condemned after due process (ii). Instead, what counts as morally relevant to medical care is the exercise of the ‘duty to protect’, which implies a personal and autonomous judgement (and possibly self-initiated actions) about the safety of patients in terms of humane and impartial treatment (iii). Finally, revisionist views of Just War theories make humanitarian action impossible (liability to be killed), illegitimate (complicity with criminals), and irrelevant (impartiality does not apply). Humanitarianism - and the Dunantist tradition in particular - has been praised since its origins as a moral endeavour worthy to be respected
and pursued. If this is the case, revisionist theories that condemn humanitarianism to its disappearance promote themselves as an unjust cause. By their same reasoning, revisionists could thus be liable to moral condemnation.
It would be naïve to say that such horrific events as the bombing of hospitals in Kunduz or Aleppo are the result of the deviant moral theories summarized in this essay, and their consequences for IHL. Yet, humanitarianism is as much under threat around battlefields as in influential academic circles. In the end, regardless of justifications being doctrinal or legal, the disregard of medical impartiality could impose itself as a new norm of warfare. This is precisely why recent attacks against health care facilities are a testing moment for humanitarian medicine and military medicine alike. When aggression is justified by a worldview where humankind is necessarily split between the just and the unjust, barbarity is not far away.
As part of International Humanitarian Law (IHL), Additional Protocols I and II of 1977 to the Geneva Conventions and other treaties provide for the protection of patients, medical personnel and health infrastructures during armed conflicts 1, 2. They recognize the primacy of medical ethics in times of war, notably the principle of non-discrimination. Attacks against hospitals or health care providers during armed conflicts signal a blatant disregard for such protections. A state of affairs where IHL is ignored, denied or revisited has far-reaching consequences for the medical profession. It affects primarily the security of patients and health personnel, but also it impacts on the integrity and the independence of doctors and other healthcare personnel worldwide. In this paper, I analyse the case of the bombing of Kunduz Hospital (Afghanistan, 2015), considering historical, l