The Observer Research Foundation reported that attacks on hospitals, clinics and health workers reached record levels across the world’s conflict zones in 2025, a trend that has closed whole regions to any form of patient travel. An Indian policy institute, the foundation timed its account, titled Health in the Line of Fire, to World Health Day, whose 2026 theme is “Together for Health. Stand with Science.” It drew on the World Health Organization, on Médecins Sans Frontières and on two conflict-monitoring databases, and the picture across those sources held together. Care that used to be treated as off-limits in war is now a target.
The scale of the attacks
Through its Surveillance System for Attacks on Health Care (SSA), the World Health Organization recorded 1,348 incidents against medical facilities in 2025, the foundation reported, and those incidents killed 1,981 people. The count set a record. The total roughly doubled the 944 deaths logged in 2024. Sudan accounted for 1,620 of the dead, the foundation said, followed by Myanmar with 148, Palestine with 125, Syria with 41 and Ukraine with 19. A separate count by the Safeguarding Health in Conflict Coalition put the number of incidents against health care in 2024 at 3,623, up 15 per cent on 2023 and 62 per cent on 2022, with state forces implicated in about 81 per cent of them.
Local staff carried most of the risk. Figures from the Aid Worker Security Database, cited by the foundation, showed 1,241 locally hired aid workers killed between 2021 and 2025, with 1,006 injured and 604 abducted. The local personnel made up 98 per cent of the aid workers killed over the period, 96 per cent of those injured and 94 per cent of those abducted. Médecins Sans Frontières (MSF) has lost 15 staff since the violence in Gaza began in October 2023, and its own report, Medical Care in the Crosshairs, published in January 2026, traced the same pattern back several years. MSF has said as much for years.
Disease follows the bombing
Even where hospitals are not struck directly, the loss of clean water, sanitation and immunisation revives diseases that vaccines had long held down. Preventable illness returns first. Gaza recorded its first polio case in a quarter of a century in August 2024, in an unvaccinated infant of ten months, after the United Nations Children’s Fund and the World Health Organization warned in July 2024 that viral markers had surfaced in six wastewater samples. Fewer than 14 of Gaza’s original 36 hospitals were offering even partial services, the foundation said. In Sudan, where the health ministry declared a cholera outbreak in 2024, the foundation reported 113,000 infections and 3,000 deaths, with the disease reaching all 18 states amid malnutrition and mass displacement.
For anyone tracking medical tourism, the point is blunt. A country that cannot keep cholera out of its camps or polio out of its infants is not a healthcare destination, whatever its brochures once said. The same corridors that carried this year’s fall in Gulf medical travel run through the airspace above these wars, and the West Asia conflict that cut Gulf patient flows to Asia showed how fast a working trade can stall once the map around it turns hostile.
Medical neutrality under pressure
The duty to treat the wounded and to protect those who treat them has sat at the centre of international humanitarian law (IHL) since 1864, the foundation said, codified in the Geneva Conventions of 1949 and the Additional Protocols of 1977. IHL is not being repealed so much as reinterpreted. Belligerents increasingly treat medical neutrality as a tactic rather than a limit, striking clinics with near impunity. The foundation reported a shift in how attacks are explained, away from the language of mistaken strikes and towards claims that a hospital or a medic had somehow lost protected status. Its effect reverses the old presumption: a clinic is no longer assumed to be civilian, but is pressed to prove it is not a military object. “Even wars have rules,” the United Nations Secretary-General said, in words the foundation used to close its own case.
The precondition the trade rarely prices
Medical tourism rests on a condition it seldom states out loud. A destination needs a health system that works and that patients abroad trust, and war removes both faster than any marketing can rebuild them. Clinical quality at a single hospital counts for little when the water supply, the vaccine chain and the staff who run the wards are themselves under fire. Trust, once broken by attacks on health care, does not return on the timetable of a tourism ministry. Regions named in this report are not competing for foreign patients; they are trying to keep their own alive, and the Middle East turmoil reshaping medical tourism has already pushed that demand towards calmer destinations. Conflict is not a temporary dip in arrivals but a reset of the base condition on which arrivals depend.
What to watch
The tests are dated and countable. The SSA is the cleanest signal available. Whether the SSA records a 2026 tally back near the 944 deaths of 2024, or holds close to the 1,981 of 2025, will show whether the record was a peak or a new floor. The Safeguarding Health in Conflict Coalition will issue its next annual count against the 3,623 incidents it logged for 2024. Gaza’s return past 14 working hospitals, and Sudan’s cholera case count across its 18 states, are the two figures that will say whether either health system is recovering or still falling.
