Health facilities and ambulances have protected status under international humanitarian law, Human Rights Watch affirms.

Israel’s repeated attacks on medical facilities, health personnel and ambulances in Gaza should be “investigated as war crimes”, international NGO Human Rights Watch has said.

The Israeli military’s “apparently unlawful attacks” are further destroying Gaza’s healthcare system at a time when medics have unprecedented numbers of severely injured patients, and hospitals have run out of medicine and basic equipment, the group said on Tuesday.

“Despite the Israeli military’s claims on November 5, 2023, of ‘Hamas’s cynical use of hospitals’, no evidence put forward would justify depriving hospitals and ambulances of their protected status under international humanitarian law,” HRW added.

A war crime is a serious violation of international humanitarian law, committed with criminal intent. HRW urged the Independent International Commission of Inquiry on the Occupied Palestinian Territory and the International Criminal Court (ICC) to investigate Israel’s actions.

Healthcare system ‘devastated’

As of November 10, two-thirds of primary healthcare facilities and half of all hospitals in Gaza are not functioning, according to the United Nations. And as of November 12, at least 521 people, including 16 medical workers, have been killed in 137 “attacks on health care” in Gaza, the World Health Organization said.

“Israel’s repeated attacks damaging hospitals and harming healthcare workers, already hard hit by an unlawful blockade, have devastated Gaza’s healthcare infrastructure,” said A Kayum Ahmed, special adviser on the right to health at HRW. “The strikes on hospitals have killed hundreds of people and put many patients at grave risk because they’re unable to receive proper medical care.”

Between October 7 and November 7, HRW said it investigated attacks on or near five healthcare facilities in Gaza.

It found that Israeli forces struck the Indonesian Hospital multiple times between October 7 and 28, killing at least two civilians; the International Eye Hospital was struck repeatedly and completely destroyed on October 10 or 11;  the Turkish-Palestinian Friendship Hospital was forced to close on November 1, days after air raids on or near the facility; a man and a child were injured after repeated attacks on the al-Quds Hospital; and Israeli forces struck well-marked ambulances on several occasions – at least a dozen people were killed or wounded in one incident outside al-Shifa Hospital on November 3.

“These ongoing attacks are not isolated. Israeli forces have also carried out scores of strikes damaging several other hospitals across Gaza,” HRW said.

‘Special protections’

“Intentionally directing attacks against … medical units and transport” is prohibited as a war crime under the ICC’s Rome Statute, HRW noted.

“Hospitals and other medical facilities are civilian objects that have special protections under international humanitarian law, or the laws of war. Hospitals only lose their protection from attack if they are being used to commit ‘acts harmful to the enemy’, and after a required warning,” it said.

Israel claims that Hamas fighters have set up command centres beneath hospitals like al-Shifa and the Indonesian Hospital – claims Hamas and the hospital staff deny.

“These claims are contested,” HRW said. “Human Rights Watch has not been able to corroborate them, nor seen any information that would justify attacks on Gaza hospitals.”

HRW also criticised the “sweeping nature” of Israel’s evacuation orders, which did not take into account specific requirements for hospitals and patients. The group said there was no way to ensure safe compliance as “there is no reliably secure way to flee or safe place to go in Gaza”, which raised concerns that “the purpose was not to protect civilians, but to terrify them into leaving”.

“The Israeli government should immediately end unlawful attacks on hospitals, ambulances, and other civilian objects, as well as its total blockade of the Gaza Strip, which amounts to the war crime of collective punishment,” HRW said.

It added that Hamas and other Palestinian armed groups should also take feasible precautions to protect civilians under their control.