By: Lakshmi Sanmuganathan
Amidst Israel’s ongoing military campaign in Gaza, Palestinians continue to bear the brunt of civilian casualties. Since October 2023, more than 29,000 Palestinian civilians have been killed and another 70,000 injured. Further, systematic attacks on hospitals, limited humanitarian access, and blockades on vital medical supplies have significantly hindered the capacity of Gaza’s healthcare facilities to provide essential treatment to those in need.
As of March 2024, only 12 out of Gaza’s 36 hospitals are still partially functional, operating at 250% of their capacity. Since the outbreak of violence in October 2023, more than 600 attacks targeting healthcare facilities or obstructing access to healthcare services have been documented in Gaza. Due to these perilous conditions, at least 196 humanitarian workers have been killed—making Gaza the most dangerous place in the world for aid workers. Additionally, 2 million Palestinian civilians—half of whom are children—currently lack access to safe water, food, and vital medical services. As a consequence, 100% of the population of Gaza now stands at imminent risk of famine, further exacerbating the dire need for medical aid in the region.
The decimation of Gaza’s health system is a breach of international humanitarian law. Following the end of World War II the 1949 Geneva Conventions emerged, creating and governing internationally recognized rules of armed conflict. Ratified by all United Nations (UN) member states, including the State of Israel, the 1949 Geneva Conventions serve as the guiding international treaties governing the “law of armed conflict” or “international humanitarian law” (IHL). The four Geneva Conventions of 1949 serve to mitigate the horrors of warfare by establishing standards for the treatment of people who do not take part in combat such as civilians, medics, and aid workers as well as individuals who can no longer fight such as the wounded, sick, shipwrecked, and prisoners of war. Over time, the 1949 Geneva Conventions have been supplemented and reinforced by Additional Protocols and rulings at international war crimes tribunals further refining the understanding and application of international humanitarian law.
In addition to the Geneva Conventions, the Hague Conventions are a series of treaties and declarations adopted during international peace conferences in 1890 and 1907 that regulate the international laws of warfare. The Geneva Conventions and Hague Conventions are complementary bodies of international law. While the Geneva Conventions primarily focus on protecting individuals who are not participating in hostilities, the Hague Conventions focus on the conduct of warfare itself. The Hague Conventions outline international rules concerning the means and methods of warfare, conduct during hostilities and occupation, and the protection of cultural property in times of armed conflict. Together, the Geneva Conventions and Hague Conventions form the basis of IHL which collectively regulate armed conflict to limit the barbarity of war.
Israel ratified the Geneva Conventions on July 6, 1951 but has not signed or ratified the 1907 Hague Regulations. However, the Israeli High Court has recognized the 1907 Hague Regulations as part of customary international law, and thus binding them on all states including those not party to the treaty.
Under Article 19 of the First Geneva Convention, “medical units…may in no circumstances be attacked, but shall at all times be respected and protected by the Parties to the conflict.”. Additionally, Article 19 mandates that “the responsible authorities shall ensure…medical establishments and units are, as far as possible, situated in such a manner that attacks against military objectives cannot imperil their safety.” Moreover, under Article 12 of the Protocol (I) Additional to the Geneva Conventions, “[m]edical units shall be respected and protected at all times and shall not be the object of attack.” These protections extend to the wounded, sick, medical personnel, and means of transport such as ambulances.
Despite these express protections, relentless bombardments, power outages, and supply shortages have forced nearly every hospital in the besieged northern Gaza Strip out of service. Additionally, there is evidence of repeated attacks on and nearby medical facilities despite the presence of doctors, patients, and civilians inside. At least 20 out of the 22 hospitals identified in northern Gaza were damaged or destroyed in the first two months of Israel’s war against Hamas. The destruction of Gaza’s health system has impacted women and children in particular, with more than 52,000 pregnant women suffering as victims. The maternal mortality rate in Gaza has reached an all-time high as essential services for maternity, trauma, and emergency care are virtually non-existent. Childbirth complications have further skyrocketed in Gaza due to the ongoing consequences of war, malnutrition, and disease outbreaks.
The Geneva Conventions uphold that health facilities cannot be targeted under IHL unless these safeguards are exploited by a party to the conflict to harm the enemy. The Israel Defense Forces (IDF) says Hamas “systematically uses hospitals and medical centres for its terror activities;” however, Hamas has denied these claims. Nonetheless, international humanitarian law mandates that hospitals must be regarded as zones of peace, providing civilians with protection even in the midst of conflict. Furthermore, the Hague Convention IV (Hague IV) emphasizes the principle of distinguishing between combatants and civilians, mandating that the population of a territory under occupation should not be subjected to collective punishment or to attacks on their persons or property. Article 25 of the Hague IV expressly prohibits the “attack or bombardment” of undefended towns, villages, dwellings, or buildings, including hospitals. Additionally, attacking hospitals during armed conflict constitutes one of the six grave violations against children, condemned by the UN Security Council.
Attacks on healthcare systems and humanitarian workers endanger innocent lives and obstruct the delivery of services to those most in need. This is the devastating reality confronting civilians in Gaza at present. Consequently, international organizations have urged for a sustained ceasefire and immediate humanitarian relief in Gaza. On Monday, March 25, 2024, the UN Security Council passed Resolution 2728 which called for an immediate but temporary ceasefire in Gaza during Ramadan. The Resolution received 14 votes in favor, with the United States being the sole country to abstain. While the Resolution demands the immediate release of hostages and emphasizes the urgent need to increase humanitarian aid flow into Gaza, the Security Council rejected a proposed amendment that would call for a permanent ceasefire. In light of these fruitless efforts, the international human rights community has remained woefully inadequate in addressing the crushing magnitude of the humanitarian crisis in Gaza.
