Recent headlines worldwide reported on the US government’s use of a fake vaccination program for counter-terrorism purposes. Using medical aid as a camouflage for military advantage threatens the lives of patients in the most precarious and embattled places worldwide. Whether this story is true or not, the damage is already done once the slightest suspicion arises that a medical activity like a vaccination campaign may have any motive other than healthcare provision.

In countries like Pakistan, humanitarian aid organizations have struggled to gain access and acceptance within communities already skeptical of the motives of any outside assistance. Providing health care to people in volatile and often remote areas requires painstaking daily work to gain their trust and prove our independence and impartiality. All this work can be easily undone by states’ misuse of medical activities and facilities for intelligence-gathering—at the high price of civilian lives and health.

For Médecins Sans Frontières (MSF) as an international medical-humanitarian organization, the headlines from Abbottabad confronted us with yet another example of a wider, worrying trend toward the exploitation of medical care to advance military operations.

States and armies seeking cover behind medical activities is hardly new but continues to put patients at risk. International military interventions have regularly brought together aid and military objectives, placing medical structures at the front line of military efforts.

Elsewhere in the world, similar abuses of the medical act have breached the trust of patients who seek medical care but instead find themselves under attack. In October 2009, hundreds of women and children gathered for vaccinations in North Kivu, came under fire in seven separate villages during attacks by the Congolese Army against the Forces Démocratiques de Libération du Rwanda (FDLR). These attacks occurred just after MSF teams had received security guarantees from all parties involved in the conflict for a vaccination campaign in these areas, otherwise inaccessible to the national ministry of health. This use of medical aid as bait for military purposes shattered the trust of patients in health services, thereby causing only more suffering for people already confronted with violence and displacement.
 
The trust of patients in health facilities was more recently undermined in Bahrain in April 2011, when government forces used medical facilities to arrest and crack down on protesters, making those wounded during clashes too afraid to seek treatment. As the hospital became a military target, and the health system a tool for the security apparatus, patients could no longer realize their right to treatment in a safe environment, and medical staff could no longer fulfill their primary duty of providing health care regardless of patients’ political affiliations.

In 2010, MSF vaccinated 5.8 million people for measles and meningitis alone. The alleged actions of the CIA in the case of Pakistan cast a shadow over these legitimate and life-saving medical acts. Whenever medical activities are used as a tool of war, it hampers our ability to provide assistance—and patients will no longer dare to seek the healthcare they need.