Attacks on Health Care, Personnel, and Patients: From Bad to Worse? An Analysis of the WHO’s Surveillance System (SSA)

OBJECTIVE: Attacks on health care are war crimes. This study aims to investigate the types, scales, and patterns. METHODS: The secondary analysis explores public data from WHO's "Surveillance System for Attacks on Health Care (SSA)" from January 2018 to December 2024. RESULTS: The analysis shows that the attacks on health care and number of affected countries increased strongly. A total of 8,012 attacks on health care were recorded across 22 countries. Just over half of the attacks impacted health care personnel, and almost a quarter affected patients. Attacks can vary widely in type, complexity, and impact, which have regional specificities. The occupied Palestinian territory and Ukraine have suffered the most attacks on health care worldwide. Country-specific attack strategies are identified. Furthermore, the combination of violence with individual and heavy weapons in an attack accumulated the probability of injuries or deaths. Improvements were observed in a few countries. A 2-step cluster analysis reveals that the heterogeneous attacks can be well clustered into approximately 2 halves. It identifies patterns across countries. The most important predictor for clustering of the attacks on health care is violence with heavy weapons, which is frequently observed, for example, in Ukraine. CONCLUSION: The global trend has worsened dramatically. Prevention and protection are needed.