Hailey Tran
The bombing of hospitals is a highly contentious issue that has sparked widespread debate and condemnation. Under international humanitarian law (IHL), hospitals are generally considered protected civilian objects due to their life-saving function for the wounded and sick. However, there are exceptions where hospitals can lose their protected status if they are used for acts considered harmful to the enemy, such as serving as a base for attacks or sheltering combatants. Despite legal ambiguities, the international medical and global health community advocates for stronger protections, arguing that attacks on hospitals violate humanitarian principles and constitute war crimes. The UN Security Council has identified attacks on hospitals as one of the six grave violations against children in armed conflict, emphasizing the need to safeguard these institutions even during warfare.
| Characteristics | Values |
|---|---|
| International laws protecting hospitals | International humanitarian law, Geneva conventions |
| Hospitals' status as protected civilian objects | Hospitals are protected because of their life-saving function for the wounded and sick |
| Hospitals' loss of protection | Hospitals can lose protection if they are used for acts considered "harmful to the enemy", such as a base for launching attacks, an observation post, a weapons depot, a center for liaison with troops, or a shelter for combatants |
| Rules for attacking legitimate military targets | The principle of proportionality, which prohibits excessive incidental loss of civilian life or damage to civilian objects, and the principle of precaution in attack, which requires constant care to spare and minimize harm to civilians and civilian objects |
| Examples of hospitals attacked | Gaza's al-Shifa hospital, Al Ahli Arab Hospital in Gaza |
| Reactions to hospital attacks | UN experts have condemned hospital attacks as crimes against humanity and called for the protection of humanitarian workers; media outlets and public health publications have labeled hospital attacks as breaches of international law and war crimes |
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What You'll Learn
Hospitals are protected under international humanitarian law
Under IHL, all wounded and sick individuals—no matter what party they belong to—have the right to be respected, protected, searched for and collected, and cared for without distinction based on grounds other than medical ones. This protection extends to medical staff and means of transport.
Medical units, which include hospitals, clinics, pharmacies, laboratories, and other medical centers, are protected under IHL from destruction, attacks, and requisitions. They are also entitled to the protection provided by the use of the distinctive emblem of the Red Cross.
Civilian hospitals that are organized to provide care for the wounded, sick, infirm, and maternity cases may under no circumstances be the object of attacks. States Parties to a conflict are required to provide all civilian hospitals with certificates confirming their civilian status and their entitlement to protection.
However, it is important to note that hospitals can lose their protection under IHL if they are used to commit "acts harmful to the enemy." For example, a hospital can lose its protected status if it is used as a base to launch attacks, as a weapons depot, or as a shelter for able-bodied combatants. If there is doubt about whether a hospital has lost its protective status, the presumption is that it retains this status and is not a legitimate target.
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Hospitals can lose protection if used for military purposes
Under international humanitarian law (IHL), health establishments and units, including hospitals, are protected and should not be attacked. This protection extends to the wounded and sick, medical staff, and means of transport. However, hospitals can lose their protection under specific circumstances.
According to the International Committee of the Red Cross (ICRC), a person or object is considered "civilian" if they do not have a direct role in hostilities. An attack against a civilian person or object is a violation of IHL and may constitute a war crime. However, a person or object can lose its civilian status if it contributes to military action. In such cases, it becomes a legitimate military objective or target. This determination must be unequivocal, and when in doubt, there is a presumption that a hospital retains its civilian status.
Hospitals can lose their protection if they are used for military purposes or acts harmful to the enemy. For example, if a hospital is used as a base to launch attacks, an observation post for military intelligence, a weapons depot, a liaison center with fighting troops, or a shelter for able-bodied combatants, it may lose its protected status. Even then, the attacking party must follow the principles of proportionality and precaution, carefully weighing the military advantage against the humanitarian consequences of attacking a medical facility.
Before attacking a hospital that has lost its protected status, certain measures must be taken. These include issuing a warning, allowing for the evacuation of patients and medical personnel, and interrupting the attack if the hospital no longer meets the criteria for losing protection, such as combatants fleeing the facility. Additionally, the attacking party must provide advance warning and facilitate the rapid restoration of healthcare services after the attack.
While hospitals generally enjoy protected status under international law, they can lose this protection if they are used for military purposes. Even in such cases, the response must be proportional, and precautions must be taken to minimize harm to civilians and medical personnel.
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Attacking a hospital may be a war crime
International humanitarian law (IHL) maintains that schools and hospitals are protected civilian objects and benefit from the humanitarian principles of distinction and proportionality. Under IHL, health establishments and units, including hospitals, should not be attacked. This protection extends to the wounded and sick, medical staff, and means of transport.
However, a hospital can lose its protection if it is used for acts considered "harmful to the enemy". This includes using the hospital as a base to launch attacks, an observation post to transmit information of military value, a weapons depot, a centre for liaison with fighting troops, or a shelter for able-bodied combatants. In such cases, the military advantage gained from attacking these establishments must be carefully weighed against the humanitarian consequences of doing so.
Attacks on hospitals are widely condemned as breaches of international law and war crimes. The UN Security Council has identified attacks on schools and hospitals as one of six grave violations of children's rights in times of war. The Geneva Conventions, adopted after World War II, are particularly protective of civilian hospitals, forbidding their transformation into conflict zones or the use of sick or injured people as human shields. Article 8 of the Rome Statute, which established the International Criminal Court (ICC), defines war crimes as including "intentionally directing attacks against buildings dedicated to...charitable purposes, historic monuments, hospitals and places where the sick and wounded are collected".
Despite this, there is no categorical prohibition of attacks on hospitals in international law. Military and armed groups often deny responsibility, claim ignorance, or assert that the strike was unintentional. They may also accuse the other party of violating international law by using hospitals for military purposes. The broad exceptions in the current legal framework allow states and armed groups to justify attacks based on flexible interpretations.
To address this issue, there are calls for a total and unequivocal prohibition of attacks on healthcare facilities, with additional international legislation adopted by the UN and WHO to strengthen protections.
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The UN has condemned hospital attacks as crimes against humanity
Hospitals are protected under international humanitarian law (IHL) because of their life-saving function for the wounded and sick. This protection extends to the wounded and sick, medical staff, and means of transport. According to the Geneva Conventions, it is forbidden to turn recognised civilian hospitals into conflict zones or to use civilian populations, the sick, or the injured as human shields. Article 8 of the Rome Statute, which established the International Criminal Court (ICC), defines a long list of war crimes, including "intentionally directing attacks" against hospitals.
However, a hospital can lose its protected status if it is used for acts considered "harmful to the enemy", such as serving as a base for launching attacks, an observation post, a weapons depot, a center for liaison with fighting troops, or a shelter for able-bodied combatants. Even in such cases, humanitarian considerations relating to the welfare of the wounded and sick must be taken into account, and the military advantage of attacking such facilities must be carefully weighed against the potential humanitarian consequences.
Despite these protections, hospitals continue to be attacked during conflicts, with detrimental effects on civilians. The United Nations (UN) has identified attacks on schools and hospitals as one of the six grave violations of children's rights in times of war. The UN has also condemned the bombing of hospitals and schools as crimes against humanity, calling for the protection of humanitarian workers.
In 2023, UN experts expressed outrage over the deadly strike on the Al Ahli Arab Hospital in Gaza, which resulted in the death of at least 16 health workers. They raised serious humanitarian and legal concerns over Israel's actions in the region, including the tightening of its siege on the enclave and the long-standing occupation, which has deprived 2.2 million people of essential food, fuel, water, electricity, and medicine. The UN experts also recalled that the willful and systematic destruction of civilian homes and infrastructure, known as 'domicide', and cutting off access to drinking water, medicine, and other essential services are violations of international humanitarian and criminal law.
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Current legal protections are insufficient
International humanitarian law (IHL) is clear that hospitals are protected because of their life-saving function for the wounded and sick. However, hospitals can lose their protected status if they are used for acts considered "harmful to the enemy". This includes using hospitals as a base to launch attacks, as an observation post, as a weapons depot, as a centre for liaison with fighting troops, or as a shelter for able-bodied combatants.
While IHL provides important protections for hospitals, current legal protections are insufficient. There is a growing consensus in the international medical and global health community that stronger protections are needed. The broad exceptions in the current legal framework allow states and armed groups to use the fog of war and flexibility in their targeting assessments to justify attacks on hospitals. For example, military and armed groups often claim that a bombed hospital was used as a command centre, for shielding fighters, or for storing weapons.
The International Committee of the Red Cross (ICRC) found that attacks with explosive weapons are the leading cause of damage to healthcare facilities. Despite this, there is currently no prohibition on the use of explosive weapons in and around healthcare structures. The use of explosive weapons in populated areas can have devastating consequences for civilians, including long-term effects on the delivery of healthcare.
In addition to stronger legal protections, there is a need for better monitoring, reporting, and advocacy to prevent and respond to attacks on hospitals. The UN Security Council has a mandate to identify and list armed forces and groups that attack hospitals in its annual report on Children and Armed Conflict. However, more needs to be done to hold perpetrators accountable and prevent future attacks.
One solution proposed by the health-care community is a total and unequivocal prohibition of attacks on healthcare facilities. At the very least, a strict prohibition could be adopted prohibiting explosive weapons in and around such structures.
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Frequently asked questions
Yes, under international humanitarian law (IHL), hospitals are protected because of their life-saving function for the wounded and sick. However, hospitals can lose their protection if they are used for acts considered "harmful to the enemy", such as a base for launching attacks, an observation post, or a weapons depot.
If a hospital is used for military purposes, it can become a legitimate military objective or target. However, even attacks against legitimate military targets must follow the principles of proportionality and precaution, which aim to minimize harm to civilians and civilian objects.
Bombing a hospital can result in serious legal and humanitarian consequences. It may be considered a war crime or a crime against humanity under international law. It can also have detrimental effects on the delivery of healthcare and the welfare of those being cared for in the facility.
