(CNN) -- A Libyan rebel fighter collapses to the ground during a firefight in the city of Misrata. Shrapnel rips through an artery in his leg, and he is rapidly losing blood. Medics battle to save his life in an abandoned building that doubles as an emergency operating theater.
They come under fire. The man dies.
Photographer Andre Liohn's images of the grim scene provide insight into the risky conditions under which medical personnel in conflict zones operate. It used to be that a red cross on a vehicle or building meant protection. But not anymore.
Assaults on medical personnel and facilities have become all too common, the International Committee of the Red Cross said Wednesday in releasing a new report.
"Violence against health-care facilities and personnel must end. It's a matter of life and death," said Yves Daccord, the director-general of the organization.
"The human cost is staggering: civilians and fighters often die from their injuries simply because they are prevented from receiving timely medical assistance," Daccord said.
Louis Lillywhite, former surgeon general of the British armed forces, said in World War II a British hospital on the front lines was able to function even with fighting on the premises.
"Both the Germans and the British respected the neutrality of the area that was actually reserved as the hospital," he said. "And it was on the basis that they did not participate in any military activities at all."
But these days, convincing warring parties of the neutrality of medical personnel is a challenge.
Michiel Hofman of Medecins Sans Frontieres (Doctors Without Borders) said in a place like Afghanistan, for instance, medics can only operate if there is no military presence whatsoever.
"It is the old concept of the gun-free hospital," Hofman said. "This concept was there for a reason. Once there (are) guns inside a hospital, the hospital is no longer a neutral zone, and it will get attacked by different military forces."
The Red Cross report said that millions of lives could be saved if the delivery of health care were more respected.
"The most shocking finding is that people die in large numbers not because they are direct victims of a roadside bomb or a shooting," said Robin Coupland, whose research in 16 countries formed the basis of the report.
"They die because the ambulance does not get there in time, because health-care personnel are prevented from doing their work, because hospitals are themselves targets of attacks or simply because the environment is too dangerous for effective health care to be delivered."
Medical workers are becoming war's first casualties, Daccord said. Hospitals in Sri Lanka and Somalia have been shelled, ambulances in Libya, shot at. Paramedics in Colombia were killed and the wounded in Afghanistan languished for hours in vehicles held at checkpoints.
All of it presents "one of the most urgent yet overlooked humanitarian tragedies," Daccord said.
"The issue has been staring us in the face for years. It must end."
CNN's Atika Shubert contributed to this report.