Israel attacks push Gaza healthcare ‘to brink of collapse’

This article is published in association with United Nations.

Israel’s pattern of deadly attacks on and near hospitals in Gaza, and associated combat, have pushed the healthcare system to the brink of total collapse, with catastrophic effect on Palestinians’ access to health and medical care, the UN Human Rights Office (OHCHR) said on Tuesday.

A report published by the Office documents attacks carried out between 12 October 2023 and 30 June 2024, raises serious concerns about Israel’s compliance with international law. Medical personnel and hospitals are specifically protected under international humanitarian law, provided they do not commit – or are not used to commit, outside their humanitarian function – acts harmful to the enemy.

“As if the relentless bombing and the dire humanitarian situation in Gaza were not enough, the one sanctuary where Palestinians should have felt safe in fact became a death trap,” said UN High Commissioner for Human Rights Volker Türk. “The protection of hospitals during warfare is paramount and must be respected by all sides, at all times,”.

The study has been released just days after the last functioning major healthcare facility in northern Gaza, Kama Adwan Hospital, was taken out of service after a raid by Israeli military forces, leaving the population of North Gaza with almost no access to adequate health care.

Staff and patients were forced to flee or were taken into custody, with many reports of torture and ill-treatment. The director of the hospital was taken into custody and his fate and whereabouts are unknown.

© WHO

Airstrikes cause destruction in the area surrounding Kamal Adwan hospital in northern Gaza on 25 October 2024.

Possible war crimes, crimes against humanity

During the period covered by the report, there were at least 136 strikes on at least 27 hospitals and 12 other medical facilities, claiming significant casualties among doctors, nurses, medics and other civilians, and causing significant damage, if not complete destruction of civilian infrastructure.

The report explains that, in the exceptional circumstances when medical personnel, ambulances, and hospitals lose their special protection because they fulfil the strict criteria to be considered military objectives, any attack on them must still comply with the fundamental principles of distinction, proportionality and precautions in attack. Failure to respect any of these principles constitutes a breach of international humanitarian law.

Intentionally directing attacks against hospitals and places where the sick and wounded are treated, provided they are not military objectives; intentionally directing attacks against the civilian population as such, or against individual civilians not taking direct part in hostilities, including the launching of an indiscriminate attack resulting in death or injury to civilians; and intentionally launching disproportionate attacks, are also war crimes, the report adds.

Under certain circumstances, the deliberate destruction of healthcare facilities may amount to a form of collective punishment, which would also constitute a war crime.

The report also notes that several of these acts, if committed as part of a widespread or systematic attack directed against a civilian population, further to a State or, in case of non-State actor, organizational policy, may also amount to crimes against humanity.

Were hospitals being used for military purposes?

In most instances, Israel alleges that the hospitals were being improperly used for military purposes by Palestinian armed groups, the report states. However, insufficient information has so far been made available to substantiate these allegations, which have remained vague and broad, and in some cases appear contradicted by publicly available information.

If these allegations were verified, this would raise serious concerns that Palestinian armed groups were using the presence of civilians to intentionally shield themselves from attack, which would amount to a war crime.

500 medical professionals reported killed, mass graves found

The impacts of the Israeli military’s operations in and around hospitals, and associated combat, extend far beyond the physical structures, the report finds.

Women, especially pregnant women, have suffered gravely. Many women have given birth with no or minimal pre- and post-natal care, increasing the risk of preventable maternal and child mortality. The UN Human Rights Office received reports that newborns had died because their mothers were unable to attend postnatal check-ups or reach medical facilities to give birth.

The increasingly limited healthcare system prevented many of those who had sustained trauma injuries from receiving timely and possibly life-saving treatment. By the end of April 2024, according to the Ministry of Health of the State of Palestine (Palestinian MOH), 77,704 Palestinians were injured. Many injured reportedly died while waiting to be hospitalized or treated. According to the Palestinian MOH, by the end of June 2024, more than 500 medical professionals had been killed in Gaza since 7 October.

The Israeli military’s first major operation against a hospital involved Al Shifa Medical Complex in November 2023. It raided the facility a second time in March 2024, leaving it in complete ruin by 1 April. Subsequent to the withdrawal by the Israeli military, three mass graves were reportedly found at the hospital, with at least 80 corpses retrieved, raising serious concerns that crimes under international law may have been committed. Some of these bodies were reportedly found with catheters and cannulas still attached, suggesting they had been patients.

© UN Women/Samar Abu Elouf

A woman carries the body of a newborn killed in an attack on Nasser Hospital in Khan Younis, Gaza.

Possible targeting of medical staff and patients

In some of the attacks, the Israeli military likely used both heavy weapons and air dropped munitions with wide area effects, the report finds. It appears that an MK 83 munition was used in the 10 January airstrike in front of Al Aqsa Martyrs Hospital in Deir Al-Balah, Middle Gaza. Reportedly, at least 12 people were killed, including a journalist and several internally displaced persons (IDPs), and 35 people were injured. The use of explosive weapons with wide-area effects in a densely populated area raises serious concerns of an indiscriminate attack.

The report finds that another feature of such attacks has been the apparent targeting of people inside hospitals, but that in most of these cases it was difficult to determine attribution. The UN Human Rights Office verified multiple cases of people being shot dead at Al Awda Hospital in Jabalya, including a volunteer nurse who was fatally shot in the chest while looking out of a window on 7 December 2023.

“It is essential that there be independent, thorough and transparent investigations of all of these incidents, and full accountability for all violations of international humanitarian and human rights law which have taken place,” said Mr. Türk. “All medical workers arbitrarily detained must be immediately released.”

“It must also be a priority for Israel, as the occupying power, to ensure and facilitate access to adequate healthcare for the Palestinian population, and for future recovery and reconstruction efforts to prioritise the restoration of the medical capacity which has been destroyed over the last 14 months of intense conflict.”