Israel's war on hospitals in Gaza

For more than a week, Gaza City’s Al-Shifa hospital was the focal point of Israel’s war on the Gaza Strip, which has so far killed over 14,000 people - at least 5,800 of them children - in response to the 7 October attack by Hamas on southern Israel that left some 1,200 people dead.

Al-Shifa, the largest hospital in the besieged Palestinian territory, hosted hundreds of patients and medical staff along with thousands of people from other areas of north Gaza displaced by the conflict.

Last Wednesday, Israeli forces launched a raid on the Al-Shifa complex to target what they claimed to be a Hamas-operated command centre located under the building, after encircling and bombarding the enclave’s main medical centre for days. This allegation was denied by the group and health officials.

In the days that preceded the invasion of Al-Shifa, staff were already describing a “catastrophic” situation inside the hospital. There had been heavy fighting nearby, no movement of people in or out, scarce oxygen and medical supplies, little to no water or food, and no power to operate life-saving medical equipment.

"Since the beginning of the war, Israel has been strategically attacking healthcare facilities"

Doctors had been forced to work by candlelight and perform surgeries without anaesthesia, premature babies were dying in incubators, and dead bodies decomposed outside the morgue.

“I cannot imagine that in the 21st century hospitals are being bombed, threatened, and patients evacuated,” Al-Shifa hospital director Mohammad Abu Salmiya said just days ahead of the Israeli raid.

On Saturday, the Israeli army gave doctors, patients and those displaced one hour to evacuate the establishment, according to medical sources, even though there were no ambulances or means to transfer them.

The UN estimated 2,300 patients, staff, and displaced Palestinians were at Al-Shifa before the Israeli military stormed the medical compound last week.

Israel has effectively turned Gaza’s largest medical facility into a war zone, but this is far from an isolated case. Since the start of the onslaught on Gaza, hospitals have come under fire as the Israeli army has accused Hamas of using them for military purposes.

According to the Palestinian Ministry of Health, 26 out of the 35 hospitals across Gaza are non-functional because of damage sustained during the Israeli military assault or the lack of power. There are nine hospitals and 18 primary healthcare centres that remain, mainly in the south, running under limited capacity, with barely sufficient medical supplies to sustain critical and lifesaving surgeries and provide care.

All hospitals in northern Gaza, where fighting has been most intense, have stopped functioning. The World Health Organization (WHO) reported 164 “attacks on healthcare” in Gaza since 7 October.

“Israel is now launching a war on Gaza City hospitals,” Mohammad Abu Selmeyah, director of Al-Shifa hospital, said last week.

Israeli attacks have targeted medical centres such as Al-Quds hospital, the second largest in Gaza, Al-Ahli hospital, the Al-Nasr and Al-Rantisi hospitals for children, and the Indonesian hospital, among others.

“We are completely surrounded, there are tanks outside the hospital, and we cannot leave”, said Mustafa al-Kahlout, who heads the Al-Nasr and Al-Rantisi hospitals which were both bombed and forcibly evacuated earlier this month.

The Al-Ahli hospital, which was one of the last medical centres in the north still functioning, was besieged and bombed last week before it was declared out of service. Dr Ghassan Abu-Sittah, a British Palestinian surgeon, spoke about the “most heartbreaking thing” he had to do as he was forced to leave the hospital. “It has been a living nightmare, leaving 500 wounded knowing that there’s nothing left for you to be able to do for them,” he said.

Al-Quds hospital also came under attack last week. Thousands of displaced people and dozens of injured were forced to evacuate the establishment and move to the south, partly on foot, allegedly due to ongoing Israeli shelling around the hospital.

The Indonesian hospital, the only facility in northern Gaza still treating patients, was struck by artillery and sniper fire on Monday, reportedly killing 12 people and wounding dozens more.

One medical worker, Marwan Abdallah, told the Associated Press tanks were clearly visible from the windows, and that snipers could be seen on nearby rooftops as Israel laid siege to the hospital. “You can see them moving around and firing,” he said. “Women and children are terrified. There are constant sounds of explosions and gunfire.”

"Israel's brazen, repeated targeting of hospitals has led to the complete breakdown of a healthcare system already battered by the 16-year blockade of the Gaza Strip"

"Hospitals are not battlegrounds," the UN's undersecretary-general for humanitarian affairs and emergency relief coordinator, Martin Griffiths, posted on X last Wednesday.

Hospitals and medical personnel are protected under international humanitarian law and direct attacks against civilians and civilian objects are prohibited.

“As long as they operate to provide medical services, hospitals are protected in all circumstances for their life-saving function,” Dalia Qumsieh, lawyer and founder of the Balasan Initiative for Human Rights, a Palestinian legal advocacy group, told The New Arab, stressing how they play an even more vital role during times of war.

“Most importantly, any attack that puts civilians at high risk must be aborted,” she added.

The advocate pointed out that even if there is doubt as to whether a hospital is being used for a military purpose, the presumption that it is a civilian structure that provides a medical service must prevail, unless there is “compelling evidence” to the contrary.

Even in the exceptional cases where hospitals lose their protection under international law, attacks must adhere to strict rules of precaution, necessity, and proportionality “to avoid or minimise civilian harm”.

Israeli forces have also struck ambulances marked with the Red Cross or Red Crescent emblem, often in the proximity of hospitals. As of 20 November, more than 60 ambulances have been attacked, with 55 damaged or out of service, based on data from the Palestinian health ministry. The Palestine Red Crescent Society (PRCS) announced that six of its ambulances are inoperative due to a lack of fuel while 10 were destroyed by Israeli bombing.

In addition, Israeli authorities ordered the evacuation last month of 23 hospitals in Gaza City and northern Gaza, despite medical professionals saying it was “impossible” to carry out safely. The WHO called the order “a death sentence” for the sick and injured, with operational hospitals in the south already running at full capacity.

"What we're witnessing now is the very result of a chronic culture of impunity that Israel has been enjoying for the past decades even with meticulous evidence of its systematic breaches of international law"

“Since the beginning of the war, Israel has been strategically attacking healthcare facilities,” Nebal Farsakh, a spokesperson for Red Crescent, told TNA, expressing serious alarm. She explained that, as a humanitarian organisation, they are facing an “extreme challenge” in providing emergency services as there are few ambulances operating and highly restricted movement in northern Gaza.

“Israel has been preventing aid from particularly getting to northern Gaza. We feel helpless because we can’t access many areas,” the PRCS spokesperson stated, raising attention to an urgent need for the continuity of health services in the north, where thousands of people are still trapped in their homes under continuous bombardment, many of whom are elderly and with chronic diseases and cannot evacuate to the south.

Israel’s brazen, repeated targeting of hospitals has led to the complete breakdown of a healthcare system already battered by the 16-year blockade of the Gaza Strip, which itself amounted to a war crime of collective punishment.

“Israeli attacks and the siege have forced the near-total collapse of Gaza's health system,” Fikr Shalltoot, Medical Aid for Palestinians (MAP) Gaza director, told TNA, warning that with Israel's “indiscriminate bombardment continuing across all areas” civilians cannot receive desperately needed medical treatment or find any safe spaces.

MAP, among the first responders since Israel unleashed its assault on Gaza, is one of the last remaining relief organisations inside the blockaded territory. It is working to distribute medical supplies, aid, food, and other essentials, and is now coordinating with local partners to distribute hot meals to thousands of forcibly displaced families.

Under the Fourth Geneva Convention, during military occupations the occupying power has a duty to the fullest extent of the means available to it of “ensuring the food and medical supplies” of the population.

"26 out of the 35 hospitals across Gaza are non-functional because of damage sustained during the Israeli military assault or a lack of power"

“What’s been getting into Gaza is a drop in the ocean. Non-stop, safe entry of aid must be allowed to fulfil the humanitarian needs of over 2 million civilians who lacking literally everything,” Farsakh said, remarking that the global community has failed to pressure Israel to comply with its international obligations.

Qumsieh noted that attacking hospital infrastructure and targeting medical personnel on duty are among many well-documented systematic and grave breaches of international law committed by Israel in Gaza. She underlined that such attacks on hospitals cannot be perceived separate from the context of forcible displacement, another grave breach of international law that amounts to war crimes.

“What we’re witnessing now is the very result of a chronic culture of impunity that Israel has been enjoying for the past decades even with meticulous evidence of its systematic breaches of international law,” Balasan’s founder argued.

The lawyer affirmed that while the law is clear, the major problem lies in the “politicisation” of international law whereby states’ political stances eventually influence the implementation of the law.

“When demanding accountability for war crimes, as stipulated in international law, members of the international community must act according to legal obligations not to render aid or assistance to the offending state, and not to recognise as lawful a situation created by war crimes or other breaches of international law,” she said.

“States are also required to take measures that would bring the grave breaches to an end, such as suspension of diplomatic relations.”

Shalltoot, MAP’s Gaza director, maintained that such serious violations will end only when those responsible “fear the consequences” of their actions. “States must ensure that attacks on healthcare are independently investigated and perpetrators held to account.”

Alessandra Bajec is a freelance journalist currently based in Tunis.

Follow her on Twitter: @AlessandraBajec