The Legalities Of Bombing Hospitals: Understanding The Laws Of War

Bombing a hospital is generally considered illegal under international humanitarian law, which grants special protections to hospitals, ambulances, and other medical facilities. However, there are exceptions to this rule. If a hospital is being used for military purposes, such as shielding combatants or storing ammunition, it can lose its protected status. Even in such cases, the response must adhere to the laws of armed conflict, including the principle of proportionality, which weighs the military advantage gained against the civilian harm caused. Notably, the presence of weapons or soldiers within a hospital does not automatically justify an attack, as the potential harm to civilians must still be carefully considered.

Hospitals have protections under international humanitarian law

According to IHL, all wounded and sick individuals, regardless of their affiliation, have general rights to be respected, protected, searched for, collected, and cared for without distinction based on non-medical grounds. This protection would be meaningless if medical personnel and facilities were subject to attack, so IHL extends specific protections to them. Parties to a conflict must respect and not interfere with the work of medical establishments and units so that they can treat the wounded and sick.

The specific protection of hospitals is outlined in the Four Geneva Conventions of 1949 and the Two Additional Protocols of 1977. The protection of medical services in war zones is also part of International Humanitarian Customary Rules and is reflected in the domestic law and military code of all countries.

A hospital can lose its protection under IHL if it is used for a military purpose that is "harmful to the enemy," rather than just for medical care. For example, if an armed group uses a hospital building as a headquarters, it cannot use the special hospital protection as a shield. However, the interpretation of "act harmful to the enemy" is not defined under IHL, and there is a narrow range of acts that are expressly recognized as not being harmful, such as the presence of weapons for self-defense or the defense of wounded and sick individuals.

In summary, hospitals generally have strong protections under international humanitarian law, and attacking them is considered a serious violation that can constitute a war crime. However, in specific circumstances where hospitals are utilized for military purposes, their protected status may be revoked. Even in such cases, measures must be taken to minimize the impact on healthcare services and ensure the safety of civilians.

Using hospitals for military purposes is illegal

Hospitals have special protections under international humanitarian law (IHL). It is illegal in nearly all circumstances to attack hospitals, ambulances, or other medical facilities, or to interfere with their ability to provide care to the wounded and sick. Attacking a protected hospital is a war crime that can be prosecuted at the International Criminal Court (ICC).

However, a hospital can lose its protected status if it is used for military purposes. For instance, if a hospital is used as a headquarters for a military operation, it cannot use its special protection as a shield. This is a narrow exception and, even in such cases, the attacking force must still take steps to spare and protect patients, medical staff, and other civilians. They must also give civilians a chance to evacuate, and the Red Cross states that if there is doubt about whether a hospital is being used for military purposes, it should be presumed not to be.

The presence of weapons and soldiers in a hospital does not automatically make it a military target. Even if a hospital loses its protected status, the civilians inside are still protected by the rule of proportionality. This means that if the civilian harm caused by an attack is disproportionate to the military advantage gained, then it is illegal. This is a stringent test when the target is a medical facility, as the likely harm includes the loss of medical care for the civilian community.

In summary, using hospitals for military purposes is illegal, and even if weapons and soldiers are discovered to be present, an attack must still avoid excessive civilian harm.

Hospitals can lose legal protection if used for military purposes

Hospitals are protected under international humanitarian law, and it is illegal in nearly all circumstances to attack them. However, this protection is not absolute and hospitals can lose their legal immunity if they are used for military purposes. This exception to the general protection of hospitals under international law is important to prevent the perception that hospitals are completely immune to military action, which could encourage their use as military bases or propaganda tools.

The exception is narrow and must be interpreted cautiously. According to the Red Cross, a leading authority on humanitarian law, if there is any doubt about whether a hospital is being used for military purposes, it should be presumed that it is not. Even if a hospital is used for military purposes, it does not automatically mean that patients and staff lose their civilian status and protection under the laws of armed conflict. The attacking force must still follow rules of proportionality and take feasible precautions to mitigate civilian harm.

A hospital can lose its protected status if it is used for "interference, direct or indirect, in military operations", such as sheltering able-bodied combatants or fugitives, storing arms or ammunition, serving as a military observation post, or facilitating liaison with combat forces. For example, if an armed group uses a hospital building as its headquarters, it cannot use the special protection afforded to hospitals as a shield for that military operation. In such cases, the hospital may become a legitimate military target.

There are documented instances where hospitals have been attacked by military forces due to their perceived use for military purposes. During the 2016-17 Battle of Mosul, Iraqi Security Forces raided Mosul's As Salam hospital because ISIS was allegedly using it as their "tactical center of gravity". In another instance, during the Second Battle of Fallujah in 2004, the U.S. military and Iraqi forces assaulted Fallujah General Hospital to remove enemy forces and prevent its use as a propaganda tool by insurgents.

Attacking a hospital is a war crime

Hospitals are protected by international humanitarian law, which prohibits attacks on buildings dedicated to charitable or medical purposes. Article 8 of the Rome Statute, which established the International Criminal Court (ICC), defines war crimes, including "intentionally directing attacks" against hospitals. Therefore, attacking a hospital is a war crime.

International humanitarian law, as well as the Geneva Conventions, protects civilian objects like schools and hospitals. Direct attacks on these institutions are considered grave violations by the UN Security Council, and the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) mandates that any military operation near hospitals must take steps to protect patients, medical staff, and civilians. Additionally, the Red Cross, a leading authority on humanitarian law, emphasizes that if there is doubt about a hospital's military use, it should be presumed as non-military.

However, there is an exception to these protections. A hospital can lose its legal status as a protected entity if it is utilized for military purposes "harmful to the enemy." For instance, if a hospital building serves as the headquarters for an armed group, it cannot claim special protection. Nevertheless, even in such cases, the attacking force must adhere to proportionality requirements and take precautions to avoid excessive civilian harm. They must also provide advance warning to the hospital and allow reasonable time for doctors and patients to evacuate safely.

Despite these exceptions, attacking a hospital remains a serious issue, and the international community has taken steps to address it. The Security Council Resolution 1998 mandates the identification and listing of armed forces or groups that attack hospitals in the Secretary-General's annual report. This resolution aims to hold violators accountable and ensure children's rights to education and health are protected. Additionally, the Special Representative for Children and Armed Conflict launched a Guidance Note in 2014 to provide tools for monitoring, reporting, and preventing attacks on hospitals.

The US and Israel have attacked hospitals

Under international humanitarian law, hospitals have special protections. It is illegal in nearly all circumstances to attack hospitals, and doing so can be prosecuted as a war crime. However, a hospital can lose this protection if it is used for military purposes that are "harmful to the enemy". Even in such cases, the attacking force must give civilians a chance to evacuate, and the harm caused to civilians must not outweigh the military advantage of the attack.

Israel has been accused of repeatedly attacking hospitals in Gaza. Between October 2023 and September 2024, there were 492 attacks on healthcare in Gaza, resulting in 492 deaths. Only 17 of 36 hospitals in Gaza are partially functioning, and 19 are out of service. Israel has defended these attacks by claiming that Hamas was using hospitals for military operations, such as holding Israeli hostages and storing weapons. However, these claims have been disputed by journalists and the International Criminal Court, which found that Israeli claims were "grossly exaggerated".

In February, Israeli ground troops forced thousands of displaced people sheltering in Nasser Hospital, the largest in southern Gaza, to evacuate the premises. During the week-long incursion, Israeli spokespeople claimed that the hospital continued to treat patients. In December 2023, Israeli soldiers attacked al-Ahli Arab Hospital, arresting doctors and patients and partially destroying the building. In May 2024, Israel bombed Al-Shifa Hospital, the largest in the Gaza Strip, seizing control of it to destroy alleged Hamas command centers and underground facilities. Hamas and doctors at Al-Shifa deny these allegations.

In June 2025, Iran struck Soroka Hospital in Israel with ballistic missiles, injuring at least 65 people. This attack was in retaliation for an alleged Israeli strike on Iran's Arak heavy water reactor.

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