Ethan Rhodes
Since the Russian invasion of Ukraine, there has been an increasing global awareness of war crimes, with reports of hospitals being targeted and attacked. Under the laws of war, targeting a hospital is a war crime, and conducting military operations inside a hospital is also a war crime. The UN Security Council identifies attacks on schools and hospitals as one of six grave violations, and the World Health Organization (WHO) is responsible for monitoring these attacks. Oxfam has also spoken out about the issue, stating that bombing a hospital is a war crime and urging humanitarian access to Gaza. With the prevalence of war crimes and the devastating impact on civilians, there is a growing need for a new approach to document, address, and prevent these crimes.
| Characteristics | Values |
|---|---|
| Under the laws of war | Targeting a hospital is a war crime |
| War Crime of Attacking Protected Objects | Article 8 (2) (b) (ix) |
| War Crime of Using Protected Persons as Shields | Article 8 (2) (b) (xxiii) |
| International Humanitarian Law | Hospitals are protected civilian objects |
| IHL Principle | Obligation of belligerents to distinguish civilians from military targets |
| IHL Principle of Precaution | Requires the attacker to take all feasible precautions to minimise or avoid loss of lives and injury in the civilian population |
| IHL Principle of Proportionality | Requires ensuring that the attack will not cause excessive harm to civilians, compared to the anticipated military advantage |
| UN Security Council | Attacks on schools and hospitals are one of the six grave violations identified and condemned |
| Geneva Conventions | Legal immunity of medical personnel, ambulances, and health facilities |
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What You'll Learn
Hospitals are protected civilian objects
However, there are exceptions to this rule. For example, if a hospital is being used for military purposes or as a base from which to launch an attack, it may lose its protected status. In such cases, the attacking party must first give an effective warning and set a time limit before the attack is permitted. Additionally, even if a hospital is being used for acts harmful to the enemy, the response must follow the laws of armed conflict, including proportionality and taking feasible precautions to mitigate civilian harm.
Despite these protections, there have been several instances of hospitals being targeted during armed conflicts. For example, in the Second Battle of Fallujah in 2004, the US military and Iraqi forces made the assault of the city's main hospital a preliminary objective. More recently, Israel's attack on Gaza's al-Shifa hospital has sparked accusations of war crimes, although Israel claims it acted within the boundaries of international law.
To prevent attacks on hospitals and ensure the protection of civilians, the United Nations Security Council has identified and condemned attacks on schools and hospitals as one of the six grave violations during conflict. The Special Representative for Children and Armed Conflict has also launched a Guidance Note on Attacks against schools and hospitals to help monitor, report, and prevent such incidents.
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Intentional attacks on hospitals are war crimes
Under the laws of war, intentional attacks on hospitals are war crimes. Hospitals are protected civilian objects and benefit from the humanitarian principles of distinction and proportionality. The principle of distinction requires belligerents to distinguish civilians from military targets at all times. If an attack is not directed at a military target, it is considered indiscriminate and is a violation of international humanitarian law (IHL). The principle of proportionality requires ensuring that an attack does not cause excessive harm to civilians compared to the anticipated military advantage.
The Geneva Conventions established the legal immunity of medical personnel, ambulances, and health facilities. Medical neutrality provides the humanitarian space required to treat the sick and wounded. However, unscrupulous warring parties sometimes violate this ban. For example, during the Russia-Ukraine conflict, there were widespread, indiscriminate attacks on Ukraine's healthcare system, with hospitals, clinics, and health workers targeted by Russian forces. Human rights organizations documented hundreds of cases where healthcare facilities and workers were attacked or cut off from essential resources.
The World Health Organization (WHO) reported that hospitals had been attacked but did not specify the perpetrators or provide details of the attacks. WHO called for accountability, referring to the attacks as "violations of international humanitarian law" rather than war crimes. However, systematic attacks on hospitals are considered war crimes. The International Criminal Court's prosecutor, Karim Khan, announced an investigation into possible war crimes committed on Ukrainian territory.
The United Nations Security Council has identified attacks on schools and hospitals as one of six grave violations. Resolution 1998 mandates the UN to identify and list armed forces and groups that attack these institutions in the annexes of the Secretary-General's annual report. This resolution aims to ensure that children can enjoy their rights to education and health and that violators are held accountable.
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Indiscriminate attacks on hospitals are war crimes
Despite this, hospitals continue to be targeted during conflicts. For example, during the Russian invasion of Ukraine, there were claims of airstrikes hitting hospitals or their surroundings. Human rights organizations documented evidence of deliberate, widespread, and indiscriminate attacks on Ukraine's healthcare system, including attacks on health workers and facilities, as well as cutting off access to electricity and clean water. These attacks have profoundly destabilizing effects on civilian populations, limiting access to care and creating fear among those seeking treatment.
International humanitarian law (IHL) protects hospitals and caregivers. The principle of distinction, a fundamental principle in IHL, states that belligerents must distinguish civilians from military targets at all times. An attack may be directed against combatants or military objectives but not against civilian persons or objects. If an attack is not directed at a military target, it is considered indiscriminate and may constitute a war crime.
The principle of precaution requires attackers to take all feasible precautions to minimize or avoid loss of life and injury in the civilian population, as well as damage to civilian objects. This can include using sufficiently accurate weapons and munitions. The principle of proportionality requires ensuring that an attack will not cause excessive harm to civilians compared to the anticipated military advantage.
Judges analyzing potential war crimes will consider the population density where the strike took place and the size of the military objective targeted. They will also bring in experts in military strategy to establish the expected military advantage of a particular attack and the resulting damage suffered by civilians.
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Military operations inside a hospital are war crimes
The International Criminal Court (ICC) defines the "War Crime of Attacking Protected Objects" as the intentional targeting of buildings dedicated to religious, educational, charitable, or scientific purposes, as well as hospitals or places where the sick and wounded are collected. The ICC further recognizes the "War Crime of Using Protected Persons as Shields." These definitions were negotiated by experts on the laws of war, such as Professor Michael Newton of Vanderbilt Law School.
Conducting military operations inside a hospital is a violation of these laws and principles. Hospitals are meant to be zones of peace, where civilians are granted protection even in times of conflict. Attacks on hospitals have been banned since 1863, when Henry Dunant, a Swiss banker, witnessed the visceral suffering of wounded soldiers left to die after the Battle of Solferino in 1859. Dunant's experiences led to the creation of the first Geneva Convention, which established the legal immunity of medical personnel and health facilities.
Despite these laws and principles, there have been numerous documented cases of military operations inside hospitals during conflicts. For example, during the Russia-Ukraine conflict, there were reports of Russian forces occupying and attacking hospitals in Ukrainian towns, such as Trostianets. Human rights organizations have also documented evidence of deliberate and widespread attacks on Ukraine's healthcare system, including cutting off electricity and clean water. These actions have profoundly destabilizing effects on civilian populations, limiting access to care and creating fear among those seeking treatment.
The international community has recognized the need for a new approach to document and address these war crimes. This includes identifying the attackers, pushing for special prosecutorial attention, and prioritizing the prosecution of those who deliberately target hospitals, as these actions amplify the suffering of civilians and drive forced displacement.
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The Geneva Conventions banned hospital attacks in 1863
The Geneva Conventions, established in 1863, outline the protection of civilian persons and properties in times of war. The conventions specifically address the protection of civilian hospitals and medical facilities, stating that they must be respected and protected by all parties involved in a conflict. This means that hospitals and medical units cannot be attacked under any circumstances and must be clearly marked and identifiable as civilian medical facilities.
The Geneva Conventions emphasize the importance of medical neutrality, which refers to the principle of non-interference with medical services during armed conflict or civil unrest. According to this principle, medical professionals must be allowed to care for the wounded and sick without obstruction, and all parties must refrain from attacking or misusing medical facilities, personnel, or transport.
The conventions also outline the establishment of hospital and safety zones during times of peace and at the outbreak of hostilities. These zones are designed to protect vulnerable individuals, including the wounded, sick, elderly, children, expectant mothers, and mothers with young children, from the effects of war.
The protection of hospitals and medical personnel is further emphasized in the Medical Neutrality Protection Act of 2011, which aims to make the protection of medical professionals and access to medical services a global policy priority. This act was introduced in response to violations of medical neutrality, such as attacks on hospitals and medical personnel, as well as the obstruction of access to medical treatment.
Overall, the Geneva Conventions of 1863 set a critical precedent for the protection of hospitals and medical facilities during times of war, ensuring that they remain safe spaces for those in need of medical attention and care.
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Frequently asked questions
Yes, under the laws of war, targeting a hospital is a war crime. Hospitals are protected civilian objects and benefit from the humanitarian principles of distinction and proportionality.
The international community needs a new approach to document these war crimes and identify the attackers. Leaders who deliberately compound the human suffering of war by attacking hospitals should be prosecuted with special attention.
During the Russia-Ukraine conflict, there were at least 707 attacks on Ukraine’s healthcare system, including the bombardment of Trostianets City Hospital. There have also been reports of hospitals being targeted in Syria, Chechnya, and Georgia.
