Fallujah: US Declares War on Hospitals, Ambulances

In a series of actions over the weekend, the United States military and Iraqi government destroyed a civilian hospital in a massive air raid, captured the main hospital, and prohibited the use of ambulances in the besieged city of Fallujah.

Saturday morning, witnesses in Fallujah reported that an overnight air strike by U.S. fighter crews had completely razed a trauma clinic, which was recently constructed using Saudi donations. Also destroyed were two adjacent facilities used by health care providers.

A Reuters photograph of the devastation shows only a sign that reads "Nazzal Emergency Hospital" still standing. There have been mixed reports of injuries and deaths resulting from the bombing.

Iraqi Prime Minister Iyad Allawi has ordered everyone except Iraqi and U.S. troops to observe a strict curfew in Fallujah and nearby Ramadi, though it is unclear how well the directive has been conveyed to residents, or if an exemption has been made for medical personnel, in accordance with international law. It is also unclear how noncombatants will be able to observe a strict curfew when much of the city’s running water and electricity has been cut off, according to several witnesses including Fadhil Badrani, a Fallujah resident who is issuing regular reports to the BBC.

On Sunday, Marines said they would use the curfew to their tactical advantage, effectively designating any and all moving civilian vehicles to be free-fire targets. Normally, U.S. troops are expected to establish that a target is hostile before engaging. But Col. Mike Ramos told National Public Radio that U.S. Marines have been relieved of meeting that requirement.

Saying invasion forces will order all vehicles off the streets of Fallujah for the duration of their offensive, Col. Ramos added, "If a Marine feels that it is necessary to protect the lives of his fellow Marines, he is empowered to engage a moving vehicle; he’s empowered to destroy whatever needs to be destroyed."

In contrast, standard rules of engagement, which were written based on international law, dictate that troops determine a target is actually a threat, but make no mention of how the soldier feels.

Addressing reporters on Monday, U.S. Defense Secretary Donald Rumsfeld said he expects minimal civilian casualties, and insisted U.S. troops have been issued "rules of engagement that are appropriate to an urban environment."

In a May interview with The NewStandard, a U.S. Marine Corps spokesperson refused to explain specific incidents of U.S. Marines attacking Iraqi emergency vehicles, but said any ambulances that Marines fired on must have been involved in carrying insurgents or arms, or else the Marines would not have opened fire.

U.S. and Iraqi officials have not indicated whether ambulances will be allowed to move freely through the city, but during the siege of the city in April, U.S. troops fired on Iraqi ambulances on a number of occasions. At least two were completely demolished prior to the current assault; one by Marines in April and another in a September air strike. A Fallujah General Hospital official told Arab News and other agencies that a driver, a medic and five patients died in the latter incident. Photographs reinforced those claims.

General Hospital Seized

Early Monday morning, Iraqi commandos stormed and seized the Fallujah General Hospital, the city’s main health care facility, in the first reported ground operation carried out against the city during the renewed offensive. During the raid they reportedly detained some 50 patients, about 25 of whom were arrested.

This is the second time Marines have sealed off the hospital. Fallujah General is located on the western edge of the Euphrates River, separating it from the rest of the city. Throughout the siege in April, Marines prevented ambulances and other vehicles from transporting sick or injured people to what was at that time – and after Saturday night’s bombing is once again – the city’s only trauma-capable health care facility.

Today, Dr. Salih al-Issawi, the director of Fallujah General, told the South African Press Association that U.S. Marines were again preventing ambulances from delivering patients to emergency care. Al-Issawi said that he believes the U.S. military "thought that they would halt medical assistance to the resistance" by taking his hospital. "But," said al-Issawi, "they did not realize that the hospital does not belong to anybody, especially the resistance."

The Fourth Geneva Convention plainly states, "Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack, but shall at all times be respected and protected by the Parties to the conflict."

Dr. al-Issawi told Agence France-Presse that Marines would not let him or other hospital staff move to another facility inside Fallujah in order to be of actual help to the people of the city.

Of the estimated 30,000 to 100,000 who remain in Fallujah after most of its 280,000-strong population left during October in an exodus of terror, many are presumed to be infirm, impoverished, or otherwise unable to escape the offensive. The entire city must now rely on two or three small clinics, if they can reach care at all, to provide for the sick and wounded.

Another physician, Dr. Hashem Issawi, who works at a clinic inside Fallujah, reported that a lack of water, electricity, and ambulances has made providing emergency care all but impossible, according to AFP. Dr. Issawi reported that his clinic’s ambulance was destroyed during air strikes on Sunday. "Ambulances have also been confiscated," he said. "We lack material and equipment."

Another doctor at Fallujah General, Sami al-Jumaili, told Reuters: "There is not a single surgeon in Fallujah. We had one ambulance hit by U.S. fire and a doctor wounded."

"There are scores of injured civilians in their homes whom we can’t move," al-Jumaili continued. "A 13-year-old child just died in my hands."

The U.S. military has not stated if it intends to destroy or capture any remaining health care facilities.

The Pentagon has made little attempt to explain its repeated attacks on medical personnel and infrastructure. Nevertheless, numerous reporters embedded with the Marines have been told that Fallujah General Hospital was seized to enable care providers to do their jobs unimpeded and to prevent hospital officials from providing inflated death counts to the media as the offensive is underway.

During the April fighting, hospital officials periodically informed the press that U.S. Marines were killing massive numbers of civilians, who were then being counted by local clinics and the hospital. The United States government and media blamed those reports – which were never shown to be inaccurate but have in fact been upheld by independent analysts – as contributing to the widespread unrest that erupted across Iraq during the siege.

The Fourth Geneva Convention offers no provision permitting the seizure of health care facilities in order to prevent hospital officials from releasing statements – whether true or false – to the public.

In fact, the only relevant article states, "The Occupying Power may requisition civilian hospitals only temporarily and only in cases of urgent necessity for the care of military wounded and sick, and then on condition that suitable arrangements are made in due time for the care and treatment of the patients and for the needs of the civilian population for hospital accommodation."

Since the U.S. military has established its own rear-area medical facilities, and since the seizure of Fallujah General marked the first objective of the ground invasion, it is unlikely that the criteria of "urgent necessity for the care of military wounded" has been met.

Additionally, The NewStandard has so far been unable to find reports that rebels or terrorists have inhibited the provision of health care to those in need at Fallujah General. The only reports of such obstruction cite constraints placed on the facility by U.S. personnel.