Since Médecins sans Frontières' denunciations of the 2015 bombings of hospitals by the United States and Russia in Afghanistan and Syria, respectively, subsequent polemics have taken scholarly and policy debates about Attacks on Healthcare (AoH) in new directions and called on history to better understand their origins and wider long-term impacts. Despite increased calls for more rigorous data collection and research on the social, behavioral, psychological and economic impacts of AoH, recent international meetings organized in the wake of the fifth anniversary of the UN Security Council Resolution 2286 revealed that little has changed for those who continue to be targeted or collateral victims in conflict. Furthermore, data collection in real time remains fragmentary, often under-resourced and unsatisfactory, due in part to inherent difficulties in compiling and cataloguing diverse types of acts of violence whose perpetrators are often unknown. These limitations challenge us to consider how and why the concept of AoH has grown as a mobilizing tool and analytical category among actors of the 'international community' to understand specific acts of violence.

This introduction considers whether there was a 'paradigm shift' and a radical change in our understanding of violence affecting healthcare providers and provisions, in the mid 2000-2010s. Drawing on various strands of historiographies that often exist in isolation from each other, we interrogate humanitarian laws' benevolent self-image regarding the protection of healthcare workers, suggesting that across the 'long' twentieth century the Geneva and the Hague Conventions were regularly employed by states to dehumanize the enemy and legitimize their actions. The meanings of 'medical neutrality' and 'impartiality' were also often contested by healthcare actors on the ground. Crucially, we argue that while the quantification method of recent AoH discussions and their insistence on the global as a relevant site of policymaking emerged in the 1990s, the rhetoric of AoH is reminiscent of earlier campaigns and mobilizations.