International law protects hospitals during war. Then why is Israel attacking them?

The moment the world was dreading has come. On Day 39 of the Israel-Hamas war, two of the main hospitals in the Gaza Strip, which is constantly being bombarded by airstrikes, has shut operations. The Al Shifa Hospital, the largest in the Palestinian enclave, and Al-Quds have shut down, making the situation even more perilous than before. On Monday (13 November), the World Health Organization (WHO) said that Shifa has been without water three days and “is not functioning as a hospital anymore.” This comes after the United Nations reported that 20 of Gaza’s 36 hospitals are “no longer functioning”. Here’s how the situation is unfolding and how hospitals have increasingly ended up in the crosshairs of this deadly war. Hospitals under attack When the Israel-Hamas war first broke out, several Gazans took shelter at the hospitals in the enclave, believing that they would be safe from the bombardment and airstrikes. However, as days passed by, they realised nowhere is safe in Gaza as hospitals also came under attack from the Israeli forces. Moreover, Israel has choked the entry of aid; until recently, food and water were also not being allowed in, but owing to international pressure, Tel Aviv allowed aid to be moved in. But fuel, which is necessary to generate power, is still being blocked. On Saturday, Israel offered fuel to Gaza’s Al-Shifa hospital, said Prime Minister Benjamin Netanyahu, but “it was “refused.” However, according to Dr Marwan Abusada, a surgeon at Al-Shifa hospital, Israel’s offer of fuel was only around two per cent of what the hospital needed to run in a single day. [caption id=“attachment_13382972” align=“alignnone” width=“640”] Newborns are placed on a bed after being taken off incubators in Gaza’s Al Shifa hospital after power outage, amid the ongoing conflict between Israel and the Palestinian Islamist group Hamas, in Gaza City. Reuters[/caption] As a result, hospital generators have run out of power, and gone dark. On Sunday, the officials at Al Shifa said that the last generator had run out of fuel, causing the death of a premature baby, another child in an incubator and four other patients. “There is no electricity. Medical devices stopped. Patients, especially those in intensive care, started to die,” said Mohammed Abu Selmia, the director of Shifa, speaking by phone over the sound of gunfire and explosions. Echoing the same anguish, Medhat Abbas, a spokesman for the Gaza Health Ministry, said that five patients had died at the hospital and intensive care units have stopped working. Doctors at the hospital also lament the shortage of anaesthesia. “We have no anaesthesia to treat patients with severe pain, patients with shrapnel in their head or abdomen, people whose arms or legs have been amputated,” Dr Mohammed Ghneim was quoted as telling CNN. **Also read: In Photos | How children have the most to lose in the Israel-Hamas War** The medical centre’s director Dr Muhammad Abu Salmiya further added, “Whoever needs surgery dies, and we cannot do anything for him.” Earlier, screams of pain and howls echoed from within the corridors of the hospital as doctors carried out surgery and treatment on patients without any anaesthesia. [caption id=“attachment_13383002” align=“alignnone” width=“640”] Palestinian girl Orheen Al-Dayah, who was injured on her forehead in an Israeli strike amid the ongoing conflict between Hamas and Israel is assisted after she had her wounds stitched without anaesthesia, at Al Shifa hospital in Gaza City. File image/Reuters[/caption] The situation at Al Quds hospital is also equally devastating. The medical facility has run out of power, putting patients’ lives at risk. The WHO director general, Tedros Adhanom Ghebreyesus said on X: “The constant gunfire and bombings in the area have exacerbated the already critical circumstances. Tragically, the number of patient fatalities has increased significantly. “The world cannot stand silent while hospitals, which should be safe havens, are transformed into scenes of death, devastation, and despair.”

Gaza’s Hamas-run health ministry says more than 2,000 people are inside Al-Shifa, including patients, medical staff and displaced people. A spokesperson also accused the Israeli forces of firing on people moving inside the hospital premises. Ashraf Al-Qidra, the spokesman for the health ministry, was quoted as telling Reuters, “The occupation forces are firing on people moving inside the complex, which is limiting our ability to move from one department to another. Some people tried to leave the hospital and they were fired at.” Israel speaks But why is it that Israel is striking hospitals in the Gaza Strip despite laws stating otherwise? Israel maintains that Hamas, the Palestinian militant group, has military assets under hospitals and other sensitive sites like schools and mosques. Bloodshed serves Hamas’ agenda, it says, winning international attention and sympathy for the Palestinian cause. Israel has continued its attacks on the Al-Shifa hospital as it claims that Hamas is operating its command headquarters beneath the complex. And to back their claims, they also released a map of Shifa marked with claimed locations of the underground militant installations. Lt Col Richard Hecht, an Israel Defence Forces (IDF) spokesperson, was also quoted as saying that they have opened “humanitarian corridors” for the doctors and patients to be evacuated through, but it is Hamas that is holding them back, causing more fatalities. “We understand it is very dire, and it is very very cynical on behalf of Hamas.” [caption id=“attachment_13383012” align=“alignnone” width=“640”] Palestinian wounded in an Israeli strike rest at Al Shifa hospital in Gaza City. Earlier, people believed they would be safe in hospitals. But Israel has attacked the medical facilities, stating that Hamas is hiding under the complexes. File image/AP[/caption] Furthermore, on claims that a siege had been laid around the hospital, the IDF refuted the charges. IDF’s Rear Admiral Daniel Hagari dismissed “false reports” that the IDF had hit Shifa Hospital and was surrounding and striking Gaza hospitals, saying that the IDF does not strike hospitals. Rather, he said, “We are fighting terrorists who are choosing to fight from close to Shifa Hospital.” “There has been a lot of misinformation from Gaza today. So I want to clarify the facts. There is no siege, I repeat no siege, on Shifa Hospital. The east side of the hospital is open for the safe passage of Gazans who wish to leave the hospital,” Hagari told Times of Israel, adding that the army would continue to allow patients and staff at Gaza’s hospitals, and all non-combatants in northern Gaza, to evacuate to the south. Israeli president Isaac Herzog has also denied that his country is striking the Al-Shifa hospital, adding that “everything is operating” at the centre. He asserted Israel’s right to defend itself after the attacks of 7 October. “We of course listen to our allies, but first and foremost, we defend ourselves,” he said, acknowledging that there had been civilian deaths in Gaza but blamed Hamas for many of the tragedies. **Also read: What happens once Israel dismantles Hamas in Gaza? The possibilities explained** International law and hospitals Israel has been receiving a lot of flak and pressure to stop their strikes around the hospital and allow for free passage of patients and medical staff, based on international laws. The Geneva Conventions of 1949 provide special protection, saying “civilian hospitals … may in no circumstances be the object of attack but shall at all times be respected and protected by the parties to the conflict.” [caption id=“attachment_13383032” align=“alignnone” width=“640”] Members of the Palestinian health sector take part in a rally to protest the collapse of the Palestinian health services in Gaza, in the West Bank city of Ramallah,. AP[/caption] However, this isn’t absolute. The Geneva Conventions go on to say that a hospital can lose this protected status if an armed group uses the hospital to carry out “acts harmful to the enemy”. Legal scholars say a Hamas attack from a hospital could make it a military target. However, the Geneva Conventions do state that the opposing side, in this case Israel, must give the facility “due warning” and allow a “reasonable time limit” to see if the attacks stop. Israel also has to ensure, by law, that the attacks are proportionate. For instance, a lone gunman’s attacks from the hospital don’t give Israel the right to bomb the building. International Criminal Court prosecutor Karim Khan also wrote in The Guardian that the law mandates that Israel has to prove their claims of hospitals being used by militants. “If there is a doubt that a civilian object has lost its protective status, the attacker must assume that it is protected,” Khan wrote. “The burden of demonstrating that this protective status is lost rests with those who fire the gun, the missile, or the rocket in question.” When confronted with allegations of violating the Geneva Conventions, Israeli prime minister Benjamin Netanyahu in an interview with NBC’s Meet the Press said: “We’re taking extraordinary efforts to achieve it, is to minimise civilian casualties. This is our ethos,” he said. “We’ll do everything we can to minimise civilian casualties, but you have to do everything in your power to lay the blame for the civilian casualties on where it belongs, on Hamas.” With inputs from agencies