|The ICRC said thousands have not received treatment due to targeted attacks on medical facilities [GALLO/GETTY]
The International Committee of the Red Cross (ICRC) has said that there has been a rise in attacks on medical workers and healthcare facilities in war zones.
In a report published on Wednesday, the organisation called for a halt to deadly assaults on medical facilities and personnel around the world.
"The shocking finding of our report is that people die in large numbers not because they were shot, not because they were hit by an air strike or killed in a bomb blast," Bijan Farnoudi told Al Jazeera.
"A lot of the time they die because the ambulance didn't make it in time, because the hospital they were trying to seek shelter in was destroyed the night before, or because they were simply too scared to travel to make it to the nearest clinic."
The report documents 655 incidents in 16 countries between 2008 and early 2011 that disrupted the delivery of healthcare, many of them deliberate attacks violating international humanitarian law.
"Hospitals in Sri Lanka and Somalia have been shelled, ambulances in Libya shot at, paramedics in Colombia killed and wounded people in Afghanistan forced to languish for hours in vehicles held up at checkpoints," Yves Daccord, ICRC director-general, told a news briefing.
"People get used to it. Hospitals are attacked, doctors are arrested and it now seems to be a normal part of armed conflict."
In all, 1,834 people have been killed or injured in such attacks, including 159 healthcare workers, in incidents which the organisation called "the tip of the iceberg".
About 128 medical personnel were kidnapped and 32 ambulances were damaged, it said.
"There does not seem to be a culture of protecting the wounded and sick, but also health staff and infrastructure," said Farnoudi.
The violence, often accompanied by looting, leads to doctors and nurses leaving their jobs, hospitals running out of drugs or fuel to run generators, and vaccination campaigns grinding to a halt.
This leaves patients even more vulnerable to diseases which can break out in conflict areas such as polio or cholera.
Caught in the crossfire
Under the Geneva Conventions, the wounded and sick, whether civilians or combatants, must receive prompt medical treatment.
Yet many armies and fighters flout humanitarian law, according to the ICRC, which has launched an awareness campaign.
"In conflicts all over the world, combatants overlook their responsibility to care for civilians caught in the crossfire," it said, noting that relatives and neighbours bring most civilian casualties to hospital.
The ICRC plans to help train soldiers to speed inspections of ambulances at checkpoints.
"It should take maybe five minutes to inspect an ambulance, not five hours," said Dr Robin Coupland, a British war surgeon, who led the ICRC research.
"And you don't have to put dogs in the ambulances to run all over the patients, as we've seen, to check for explosives."
Hospitals have been used to store weapons or launch attacks, including in the Palestinian territories, the report said.
'Cover for snipers'
Afghanistan, Iraq, Sri Lanka and Somalia have suffered some of the worst attacks against medical centres and staff, the ICRC said.
Somalia lost what was only its second batch of medical graduates in 20 years when a suicide bomber blew himself up at a university ceremony in Mogadishu in December 2009, killing 22.
Taliban fighters in the southern city of Kandahar used an ambulance packed with explosives last April to kill 12 people at a police training base, the ICRC said.
During Israel's 2008 to 2009 war on Gaza, four starving Palestinian children were found sitting near the bodies of their dead mothers, four days after shelling, but Israeli forces prevented ambulances from reaching the victims, it said.
In Libya, a healthcare system that relied on foreign workers was crippled when the war prompted an exodus, leaving hospitals in Misurata and Benghazi critically understaffed.
Libya's Ajdabiyah hospital appears to have been "used as cover for snipers," the report said.
"In recent unrest in Bahrain, Syria and Yemen, protesters have been too afraid to use medical facilities for fear their wounds will identify them and provoke harsh reprisals," the ICRC said.