Professional Ethics and Protection of Workers’ Health in Conflict Zones: Challenges, Ethical Responsibilities, and Evidence-Based Strategies

Protecting healthcare workers during armed conflicts is an ethical, humanitarian, legal, and public health imperative, but it also involves complex operational, organizational, and managerial challenges. This perspective article, employing an analytical and narrative review approach, examined the ethical conflicts encountered by healthcare workers in wartime conditions, elucidated the responsibilities of relevant stakeholders, and proposed evidence-informed strategies. The analysis indicated that decision-making in situations such as resource scarcity, triage, and security threats requires the simultaneous application of philosophical ethical frameworks, particularly deontological and utilitarian approaches, together with a clear distinction between “ethical responsibility” and “legal obligation”. A review of international evidence, including documents from the World Health Organization (WHO), the International Committee of the Red Cross (ICRC), the World Medical Association (WMA), and recent reports published in the BMJ, demonstrated that attacks on healthcare workers and infrastructure continue to occur and have consequences extending beyond physical destruction, including disruptions to the continuity of healthcare services, reduced patient access to care, supply chain interruptions, psychological distress among healthcare workers, and diminished health-system resilience. A 2026 official report by the WHO further documented 13 verified attacks on healthcare facilities and services in Iran and emphasized the necessity of respecting international humanitarian law and the principle of medical neutrality. Accordingly, this study proposed a three-level framework encompassing individual, organizational, and governmental responsibilities for protecting healthcare workers and introducing the establishment of Crisis Operations Ethics Committees as a practical mechanism to support ethical decision-making, enhance organizational resilience, and translate ethical principles into operational actions in crisis situations.