Excerpts from Reviews of Perilous Medicine
For Rubenstein the elevation of counterterrorism over respect for the laws of armed conflict poses the greatest threat to the protection of medical workers, hospitals, and patients. Prosecuting doctors is done as much to dehumanize as it is to punish. . . . Rubenstein shows “that the fight to protect medical and humanitarian workers is not new, but we are running out of time before it becomes futile. . . Rubenstein identifies [the leader of the campaign for the first Geneva Convention’] Dunant’s central truth—that the real story of war is suffering. This is the moment to build the infrastructure to safeguard the people who are trying to protect the innocent. Attacks on health care aren’t a niche concern—they are war crimes. The global stakes are high.”
Perilous Medicine is a foundational text for anyone working on conflict and health issues. The book’s language and style, however, make it accessible to a broader readership, including the lay public. Scholars and students of conflict and peace studies, international humanitarian law, and human rights should read it so they can bring health closer to their work. Humanitarian protection advocates will find Perilous Medicine an indispensable tool to shame governments and decision makers in international bodies into action to protect health care in conflict settings. In this way the book fulfils its objective of addressing
Walt Whitman lamented the American Civil War’s “unending universal mourning-wail” and saw the conflict’s “Untold and Unwritten History” in hospitals where “the marrow of the tragedy [was] concentrated.” Leonard Rubenstein quotes these words as an epigraph for his “Perilous Medicine: The Struggle to Protect Health Care from the Violence of War,” and he concisely describes both the principles meant to safeguard medical practice in wartime and the repeated failure to live up to them. It is a sad and necessary read. Sad, because the brutal targeting of doctors and nurses has become a familiar fact of modern warfare, and necessary, because our civilization depends on a willingness to bear witness to our moral failures. Recognizing our failures is our only hope, however slim, of not repeating them.
It is to be hoped that the mourning-wail of “Perilous Medicine” provokes outrage and helps secure more protection for health-care workers. We don’t want to live in a world where basic humanity is ignored, and we don’t have to. In many countries, those in power can be held accountable by citizens. We don’t have to accept moral impunity. We can bear witness to these inexcusable crimes and act to stop their recurrence. Rubenstein’s book is sad and necessary work. If only we take heed, we can make medicine less perilous and reaffirm our own humanity.
Perilous Medicine: The Struggle to Protect Healthcare from the Violence of War, a major new book on healthcare in armed conflict from Leonard Rubenstein, is destined to become a landmark in its field.
The backbone of this sobering, deeply humane book is a series of case studies—accounts of the targeting or politically motivated corruption and misuse of healthcare during times of conflict. Many of the places the book visits have become bywords for inhumanity, places of bitter, often enduring hostility or calamitous political failure.
Perilous Medicine chooses its case studies carefully. Not only are they accounts of healthcare and its professionals under attack, each example reveals different dimensions of the contemporary threat to international humanitarian law (IHL). For each case study is also an account of a certain kind of failure—a failure by one or other combatant to show even residual respect for the laws hammered out in response to the limitless suffering of war waged without restraint.
Perilous Medicine is an important and necessary book. Partly this is to do with the precision and thoroughness of its account of violations of health-related international humanitarian law. But also because it deliberately asks an urgent question. Although it is unlikely that there was ever “a golden age” of warfare, where restraint prevailed in pursuit of just military goals, it can nonetheless feel as if we are sliding back into barbarism. . . though countering this brutality will take a supreme effort “the costs in suffering and death are too great not to try.”
Health and Human Rights Journal
Perilous Medicine is a significant milestone for a body of work that spans decades, continents, and professional métiers. Approaching the subject from multiple ethical, legal, and historical angles as Rubenstein has done (and more than this review has space to describe adequately) does due justice to a complex, longstanding, and morally thorny subject. . . . The principal contribution of this book is in laying bare and dissecting the problem and providing coherent explanations for why it persists. In terms of what to do about it, the author calls on the global community to reinforce norms that protect health care that have been chipped away, often without acknowledgement, [on] governments, state militaries, and armed groups … to follow through on commitments they have made to undertake the actions needed to prevent attacks on health care and end impunity, [and on] new sources of leadership and solidarity [to] demand action and support those dedicated to protecting health care in war and in circumstances of political violence.
These sensible and necessary (if broad) calls to action are undercut to some degree by the author’s account, immediately following, of a promising report and series of robust recommendations by the United Nations Secretary-General never meaningfully taken forward by the member states of the Security Council: “[I]n the years that followed, the Security Council annually discussed violence against health care but never acted on the recommendations.” The answer to the question of who is ultimately responsible and where is the leverage point for addressing the current state of impunity seems every bit as elusive as it was in the 1860s.
If Perilous Medicine sounds a less than hopeful note, it nonetheless serves as a needed alarm bell, alerting us to the fragility of this most vital of humanitarian norms.
As a U.S. Army medevac pilot, I read Leonard Rubenstein’s Perilous Medicine with considerable interest and sympathy. Rubenstein traces the journey of humanitarian principles from the Geneva conferences of the 1860s to their present pride of place in international law. He also demonstrates that, during the last quarter century, military necessity was often invoked to dismiss these principles and justify atrocities.
Rubenstein provides a clear-eyed recent history of violence against health care. Though the topic is pessimistic, he remains optimistic about the value of humanitarian efforts. For proponents of military necessity, Rubenstein articulates why humanity matters and how combatants suffer when it fails. For the aspiring humanitarian, he shows what it takes to make humanitarianism work. When weighing military necessity and humanity, Rubenstein puts his thumb on the scale for humanity. To maintain patient evacuation in future conflicts, the U.S. Army should follow his lead.
Medicine, Conflict and Survival
Advocacy and research on attacks on healthcare have increased in recent decades, even if concrete action to prevent them has been inadequate. This book is a very timely and significant contribution to confronting this devastating issue. The author places attacks in an historical and legal context, provides a wealth of detail in the form of case studies and makes carefully thought-through recommendations. He also situates these attacks in a wider context: how the characteristic of individual conflicts influence different actors and how the attacks on healthcare fit into more generalized violence. This is all essential: the motivations and drivers behind attacks have to be understood if they are going to be prevented….
[Rubenstein’s] final recommendation is that medical and health worker communities everywhere should try to take this subject forward. Let’s hope they – and many others – read this book.
Perilous Medicine inspires us with the ideals and accomplishments of Dunant and Lieber, and then illustrates in harrowing detail how much additional progress still needs to be made. … Whether one fancies himself an idealist or realist, a deontologist or consequentialist, effective leaders will need a broad and deep understanding of the challenges, ethical considerations, and legal obligations that surround the provision of health services in war. Perilous Medicine is essential reading for anyone who desires that deeper understanding.