International humanitarian law prohibits attacks against hospitals and healthcare facilities, or against patients, doctors and their means of transportation, during a conflict. A health facility can lose its protected status if it is used to “commit acts harmful to the enemy,” according to the International Committee of the Red Cross (ICRC).
“Hospitals have special protected status under the Geneva Conventions and the law of armed conflict,” says Nathaniel Raymond, a human rights researcher and co-author of the study. “To intentionally attack a hospital, the required protocol is the most restrictive for any type of civil infrastructure. An armed party to a conflict must ensure that the hospital is notified that it has lost its protected status and efforts must be made to ensure the evacuation of those facilities prior to any kinetic attack. “That is what the law requires.”
In a lengthy response to WIRED’s questions about what measures it has taken to prevent damage to healthcare facilities, the IDF defended its military operations. “A central feature of Hamas’ strategy is the exploitation of civilian structures for terrorist purposes,” says an IDF spokesperson. “It is against this backdrop of widespread exploitation of medical facilities and intelligence indicating its knowledge and even involvement in terrorist activities that Israel has detained and interrogated people in Gaza, including medical personnel. “We reiterate that people who have not been involved in terrorist activities are released after being interrogated.”
He The IDF has alleged that Hamas was operating from tunnels beneath Al-Shifa, Gaza’s largest hospital, thus making it a legitimate target. IDF forces stormed the hospital on November 15. It has not been proven that the tunnels had a military function, and the legality of that IDF military operation still in dispute.
Even in cases where the military has taken advantage of civilian structures, combatants are expected to exercise what IHL calls “proportionality” and “precaution,” meaning that any attack must be carried out in such a way that civilian damage does not exceed the military benefit. “This does not mean that there is freedom to attack,” Cordula Droege, ICRC legal chief saying in an ICRC video published on November 2 on X. “The party to the conflict must do everything possible to avoid or at least minimize harm to patients and medical staff.”
Although the destruction of health facilities in Gaza is much broader, the WHO also Recorded “33 attacks on healthcare in Israel during the violent events of October 7”. The WHO warned Hamas and Israel to remember “their obligation under international humanitarian law to respect the sanctity of health facilities and actively protect them.” An independent commission of the UN Human Rights Council also says it is “collecting and preserving evidence of war crimes committed by all parties since October 7, 2023.”
The implications for Gaza’s health system have been disastrous. Even in the first weeks of the conflict, doctors warned that hospitals were running out of space to treat the wounded and were operating without access to anesthetics or even drinking water. Hospitals and the healthcare system have also suffered continued destruction. On January 3, the WHO estimated that only 13 of the 36 hospitals in Gaza it continued to function. The WHO also says that cases of disease in Gaza have skyrocketed as access to healthcare, food and clean water has plummeted.
Poole says he hopes the investigation will lead to further investigations to “determine whether or not medical complexes received the principles of distinction, proportionality and precaution that protect them through IHL” during the course of the conflict.
“If the principle of distinction were respected in this conflict, there would be a marked difference in our findings between special protected infrastructure (in this case, health facilities) and infrastructure not related to health facilities,” says Raymond. “What we found instead is that there is no difference.”