Can hospitals be bombed? Navigating the IDF’s assault on Gaza’s health sector

In mid-June this year, Israel condemned the Iranian strike on the Beersheba Soroka hospital in Southern Israel as a war crime.  Iran, however, claimed that they were targeting a military intelligence camp situated nearby. Some international organisations have called out Israel’s double standards in its reactions towards this bombing as the IDF continues to attack hospitals in Gaza in the last 20 months. If attacking a hospital is crossing a red line, would it not be true for all hospitals including those in Gaza?

The clarity of the special status of hospitals and its workers in armed conflicts becomes hazy when the bombing of hospitals in Gaza is allowed to continue, despite Israeli Prime Minister Benjamin Netanyahu’s claim that “Israel’s commitment to international law is unwavering”. This article aims to explore the following three questions 1. Are hospitals always protected under international law? 2. How can we verify the narrative that hospitals in Gaza have lost its protected status? 3. Why should we stand in support of the healthcare workers in Gaza?

Al-Ahli hospital: The first hospital bombed after 7 October 2023

On 18th October 2023, an explosion took place outside the Al-Ahli hospital in Gaza City, killing more than 400 civilians. Against a backdrop of conflicting online narratives, Israeli authorities immediately denied responsibility. A digital aide of Israeli Prime Minister Benjamin Netanyahu even stated on social media that “IDF (Israel Defence Forces) does not bomb hospitals”. Fast forward to April 2025, Israel bombed this same Al-Ahli hospital which at this time, was the last functioning hospital in the northern part of the Gaza Strip. As of May 2025, WHO reported a record of 697 attacks on healthcare facilities in Gaza since October 2023. At least 94 per cent of all hospitals in the Gaza Strip are damaged or destroyed due to Israel’s military operations.

Hospitals in armed conflict: Must it always be protected?

The WHO director-general had earlier posted in October 2024 that: “Any attack of healthcare facilities is a violation of international humanitarian law”. While specific protection of hospitals is the general rule under International Humanitarian Law (IHL), Maarten van der Heijden, a global health lawyer, clarified that international law does not in fact impose an absolute ban on attacks against healthcare facilities. There is an exception to this rule as stated in article 19 of the Fourth Geneva Convention on Civilians:

The protection to which civilian hospitals are entitled shall not cease unless they are used to commit, outside their humanitarian duties, acts harmful to the enemy. Protection may, however, cease only after due warning has been given, naming, in all appropriate cases, a reasonable time limit, and after such warning has remained unheeded.

This means that the specific protection to which hospitals are entitled shall not cease unless they are used to commit an “act harmful to the enemy”. While the expression “act harmful to the enemy” is not defined under IHL, the bar for losing protected status is set very high. The International Committee of the Red Cross states that, “In case of doubt as to whether medical units of establishments are used to commit an ‘act harmful to the enemy’, they should be presumed not to be so used”. Moreover, the burden of proof that a hospital has been converted into a military object is on the party attacking the hospital and should be provided before the attack is executed, as emphasised by Ardi Imseis, an international law expert. Lastly, even after providing sufficient evidence to show that the hospital is being used as a military object that is harmful to its enemy, the attacking party remains bound by the fundamental principles of distinction, proportionality, and precautions, ensuring that harm to patients and healthcare workers who may have nothing to do with those acts is avoided – or at the very least, minimised.

It is also important to highlight that the protection of hospitals under IHL extends to all aspects of the hospital including the medical equipment within it. This is relevant because a United Nations (UN)-led mission to Gaza in April 2024, had discovered that medical equipment such as ultrasound machines in a hospital have been “purposefully broken” by IDF soldiers during a military raid.

What does the IDF say about their attacks on hospitals?

The IDF has claimed that hospitals in Gaza are being used by Hamas for military purposes that are harmful to Israel. This narrative has thus been repeatedly used by the IDF to demonstrate how their bombings, sieges and raids on the hospitals in Gaza are well within the boundaries of international law. The obvious strength of the Israeli narrative lies in the fact that their reports are expected to come from IDF soldiers who are on the ground in Gaza, thereby providing first-hand eye-witness accounts of what was actually happening in these hospitals. However, the reliability of these claims has been questioned by many including the UN High Commissioner for Human Rights who stated that Israel has not provided sufficient information to substantiate many of them. Andrew Cayley, the senior ICC prosecutor from the UK who leads the investigation into alleged war crimes in Palestinian territories has questioned Israeli claims about Hamas using hospitals in the Gaza Strip as bases of operation, stating that they have been “grossly exaggerated”.

The IDF has made it challenging to verify the accuracy of its reports  by refusing to allow foreign journalists entry to Gaza since 7 October 2023, except for limited military-controlled visits. They have also disproportionately killed the Palestinian journalists, with some of them alleged to be Hamas militants or just unfortunate collateral damage, making this one of the deadliest conflicts for journalists ever recorded.

Testimonies of foreign healthcare workers in Gaza

Healthcare workers form another group of first-hand eyewitnesses on the ground. In particular, foreign doctors and nurses who would clearly have no ties with Hamas and have volunteered to assist in treating the injured in Gaza’s hospitals since October 2023. In October 2024, about a hundred of these healthcare workers from the US wrote an open letter to then President Joe Biden. On the claim that Hamas was using hospitals for military purposes, the signatories to the letter, who spent a combined 254 weeks inside Gaza’s largest hospitals and clinics, wished to be absolutely clear, that “none of them saw any type of Palestinian militant activity in any of Gaza’s hospitals or other healthcare facilities”. This testimony was also supported by testimonies of many other international healthcare workers.

Media investigations that dispute IDF’s claims of Al-Shifa hospital

The IDF had initially unveiled a video showing a detailed 3D-model of the hospital with a series of underground installations that it said was part of an elaborate Hamas command-and-control centre under Al-Shifa hospital. The IDF then bombed an ambulance outside of Al-Shifa hospital which it said was being used by Hamas, before raiding the hospital with tanks.

After seizing Al-Shifa hospital, the IDF revealed a video of small arms in a bag recovered from the hospital. This finding only suggested an armed presence, which by itself is not enough to be considered as ‘acts harmful to the enemy’. Furthermore, a CNN analysis revealed that in another video that was later released by the IDF, the number of guns in the bag had increased compared to the first video. The IDF also claimed that its video of what it found at the hospital was unedited and filmed in a single take, but an analysis by the BBC  found that it had actually been edited. Finally, an investigation by The Washington Post found that the evidence presented by the Israeli government after seizing the Al-Shifa hospital fell short of confirming their initial claims that Hamas had been using the hospital as a command-and-control centre where they planned their attacks. Yet, despite these discrepancies, the IDF went on to conduct a two-week siege on Al-Shifa hospital four months later, leaving it completely non-functional.

Targeting of healthcare workers in Gaza

Perhaps the clearest example since October 2023 that showed an inconsistency in the IDF’s account of an event related to their attack on Gaza’s healthcare, was the killing of 15 Palestinian emergency aid workers by IDF soldiers who later buried them. The IDF had initially asserted repeatedly that these workers were targeted because their vehicles were “advancing suspiciously” toward IDF troops “without headlights or emergency signals.” However, the video obtained by the Palestine Red Cross Society shows that the approaching ambulances and fire truck were clearly marked and had their emergency signal lights on when Israeli troops hit them with a barrage of gunfire. It was only then that the IDF acknowledged that their initial accounts had been partially “mistaken.” Clearly, this was more than just a “partial mistake” and this was astutely understood by the Singapore Law and Home Affairs Minister who stated, in relation to this incident, that “the Army seems to have tried to cover up the solders’ illegal actions” and that their actions “deserve universal condemnation.” Had the video footage not been found, it would not be unrealistic to assume that the IDF would maintain their false account of the merciless killing of these rescue workers.

Similar to hospitals, all healthcare and humanitarian workers must be protected in times of armed conflict, unless they commit acts that are “harmful to the enemy”. Still, the number of aid workers killed in Gaza in the past year is the highest ever in a single crisis. In addition, more than 1400 health workers have been killed with at least 160 medics unlawfully detained in Israeli detention facilities in February this year. There is also growing evidence of inhumane treatment and abuse of healthcare workers in Israeli detention. The deaths and detention of healthcare workers have caused a strain in manpower at the hospitals. Dr Victoria Rose, an NHS plastic surgeon who just returned from her second medical mission in Gaza reported that in addition to having a shortage of medical supplies including essential drugs, the healthcare staff in the hospital she was working in were “really really depleted”.

IDF’s practice of disinformation

Now, there are a couple of questions that would naturally follow these inconsistent reports by the IDF. Firstly, are these “errors” or inaccuracies in reporting limited to healthcare-related matters? The short answer is no. The IDF has repeatedly stated that they do not target civilians. However, every single signatory to the Gaza Healthcare Letters had seen children in Gaza who suffered “violence that (they thought) must have been deliberately directed at them” based on the fact that “every one of us who worked in an emergency, intensive care, or surgical setting treated pre-teen children who were shot in the head or chest on a regular or even a daily basis”. Most recently, the IDF has denied that its troops deliberately fire at aid recipients around the Gaza Humanitarian Foundation (GHF) distribution sites, even though more than 500 Gazans have been reportedly killed in the vicinity. Not long after this denial, some IDF soldiers operating near GHF food distribution sites have disclosed that they were “ordered” to deliberately shoot at Gazan civilians seeking aid there, even if they pose no threat.

The second question is whether this practice of disinformation is a recent phenomenon. The sobering fact is, even before 7 October, Israel had contradictions in their reporting of incidents including the killing of US journalist Shireen Abu Akleh and the Gazan medic Razan Al-Najjar. With a multitude of evidence showing the IDF’s practice of disinformation even before October 2023, but especially during this current conflict, it would be reasonable to suggest that the reports coming from the IDF should not be taken at face value, especially when it involves potentially criminal acts such as their attacks on Gaza’s healthcare.

Final note: Do not abandon the healthcare workers in Gaza

The first two lines in the Physician’s Pledge, drafted by the World Medical Association in 1948, states that members of the medical profession shall “dedicate my life to the service of humanity” and that the “health and well-being of my patient will be my first consideration”. In recent history, one can confidently assert that there is no better personification of these qualities than the healthcare workers in Gaza. They chose not to leave their patients’ side when asked to evacuate from the hospitals before being raided or bombed by the IDF. When asked about why he refused to leave his patients, Dr. Hammam Alloh from Al-Shifa Hospital responded, “You think I went to medical school and for my postgraduate degrees for a total of 14 years so I think only about my life and not my patients?” Dr. Hussam Abu Safiya, who is currently still detained by the IDF, refused to leave Kamal Adwan hospital before the final assault on the hospital happened. “Forgive me, mother. This is the path I chose – to help people,” were the final words of Rifaat Radwan, one of the paramedics who was killed by the IDF.

As responsible and empathetic global citizens, we must continue to emphasize the need to protect Gaza’s hospitals including its workers and patients, and act meaningfully to ensure that the international humanitarian laws that protect them are upheld. Any attempt to justify breaching these laws by any party should be seriously scrutinized and not accepted without question. We should stand in solidarity with these extraordinary healthcare heroes, continue to speak out for them and advocate for their protection. Those in positions of influence should take concrete actions to stop the indiscriminate attacks on Gaza’s hospitals and its workers. The healthcare workers in Gaza did not abandon their patients, please, do not abandon them. Their patients include thousands of injured children, universally regarded as innocent. As dire as the situation appears, there is still no place for hopelessness here. The admirable Dr Ang Swee Chai, a Singaporean orthopaedic surgeon who co-founded the charity Medical Aid for Palestinians aptly reminds us: Do not despair, as this is the moment we must all stand firm and speak up to protect Gaza and its people.

The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.