Hospitals enjoy special protection under the rules of war. Why are they in the crosshairs in Gaza?

Abu Sada described Shifa as a death trap for thousands of war wounded, medical personnel and displaced civilians sheltering there.

Jerusalem: The head of the operating room at Gaza’s largest and most advanced hospital held up his phone Saturday as gunfire and artillery shelling rang out. “Listen,” said Dr. Marwan Abu Sada as fighting raged around Shifa Hospital.

Grenades hissed through the hospital courtyard and crashed into wards as Israeli soldiers and Hamas militants clashed in close combat. Doctors tried to help patients even as they took cover.

Abu Sada described Shifa as a death trap for thousands of war wounded, medical personnel and displaced civilians sheltering there. The Israeli army denied carrying out direct attacks or besieging Shifa.

In this war between Israel and Hamas, hospitals in the main fighting zone of northern Gaza have increasingly found themselves in the crosshairs as Israeli tanks crunch through the hollowed-out heart of Gaza City. They have also become focal points for competing narratives.

Israel says Hamas militants use hospitals as shields for fighters but has provided no evidence, while Palestinians and rights groups accuse Israel of recklessly harming civilians seeking shelter.

The fighting around Shifa on Saturday raised an urgent question: when do medical facilities lose special protection under international humanitarian law?

WHAT DOES ISRAEL SAY?

Israel claims that Hamas locates military assets under hospitals and other sensitive locations such as schools and mosques. Bloodshed serves Hamas’s agenda, it says, and wins international attention and sympathy for the Palestinian cause.

Israel has singled out Shifa, claiming that Hamas operates its command headquarters beneath the hospital complex. The Israeli military released an illustrated map of Shifa showing the claimed locations of the underground militant installations, without providing further evidence. Hamas and the director of Shifa Hospital, Mohammed Abu Selmia, deny this.

Israel has said it will pursue Hamas fighters wherever they are as it tries to spare civilian lives.

“If we see Hamas terrorists shooting from hospitals, we will do what we have to do,” said Israeli army spokesman Lt. Col. Richard Hecht.

Last week, Israel defended its bombing of an ambulance convoy evacuating injured patients from Shifa, claiming it had Hamas fighters on board. At least 12 bystanders were killed in that attack, Abu Selmia said.

Asked about Saturday’s events in Shifa, Israel’s top military spokesman, Vice Admiral Daniel Hagari, said the forces did not besiege Shifa hospital but allowed a safe exit on the eastern side of the hospital. He said the military was in contact with hospital officials and would help move babies being treated there on Sunday to another hospital.

Israeli forces also battled Hamas militants in the rubble-filled streets outside Gaza’s Rantisi Hospital for Children, humanitarian officials said. The Israeli military claimed it had identified Hamas militants who were among civilians in Rantisi last week when they overran the area. Some militants fled after the military opened an evacuation corridor for civilians, the military said.

Rantisi Hospital was closed on Friday after running out of fuel, the World Health Organization said, and it is unclear how many people have been evacuated.

Amos Yadlin, former head of Israel’s military intelligence, told Israel’s Channel 12 that the intensifying battle for Shifa and other hospitals is creating moral and military dilemmas for commanders.

“Even though we plan to deal with these hospitals,” he added. “Today it is clear to everyone that they are Hamas’s main command centers.”

WHAT DO PALESTINIANS SAY?

Throughout the war, Palestinian families fleeing bombed homes took refuge in medical complexes, believing them to be safer than other alternatives.

Kamal Najar, a 35-year-old who sheltered in Shifa this week with his toddler son and daughter, said he believed the hospital would be “off-limits, even for Israel.”

“It was something that we somehow told ourselves wouldn’t happen,” he said by phone from the central city of Deir al-Balah, where he arrived on foot on Friday after escaping what he said was attacks on the hospital with dozens of people. thousands of others.

As of Saturday, some 1,500 patients, along with 1,500 medical workers and some 15,000 displaced people, were still stranded in Shifa, health authorities said. They said a power outage plunged Shifa Hospital into darkness and disabled life-saving equipment, killing several patients – including a newborn baby in an incubator.

Palestinian medical workers accuse Israel of launching a massive attack on infrastructure to punish the population and force a surrender. “It’s saying, ‘We won’t just kill and injure you, we’ll make sure you have nowhere to go to get treatment,’” says Dr. Ghassan Abu Sitta, a British-Palestinian surgeon working for Doctors Without Borders in Gaza City.

According to the Health Ministry in Gaza, about 190 medical workers were among the more than 11,000 Palestinians who have been killed since the war began. Ongoing Israeli bombardments have destroyed 31 ambulances and put 20 hospitals out of action, the ministry said. The war was sparked by Hamas’ brutal Oct. 7 attack on southern Israel, which killed about 1,200 people.

“Death always feels close,” said Naseem Hassan, a 48-year-old doctor in the southern city of Khan Younis. Too many colleagues, he said, have left the hospital only to return hours later in body bags. On Thursday he had a narrow escape when two rockets landed just meters from his ambulance.

“This is a war of total destruction and there is no protection anywhere,” he said. “Israel could be more precise, but it chooses not to be.”

Israel has said it is targeting Hamas fighters, not civilians. However, it has used powerful explosives in attacks on densely populated areas, killing large numbers of women and children.

WHAT DOES INTERNATIONAL HUMANITARIAN LAW SAID?

The claims and counterclaims over Gaza’s hospitals have raised pressing questions about what is permissible under the international laws of war.

International humanitarian law grants hospitals special protection during war. But hospitals could lose their protection if fighters use them to hide fighters or store weapons, the International Committee of the Red Cross said.

Nevertheless, there must be sufficient warning before the attacks to allow the safe evacuation of patients and medical staff, said ICRC lawyer Cordula Droege.

Even if Israel manages to prove that Shifa is hiding a Hamas command center, the principles of international law still apply, said Jessica Wolfendale, an expert in military ethics at Case Western Reserve University in Ohio.

“It doesn’t allow for an immediate attack,” she said. “Steps must be taken to protect the innocent as much as possible.”

If the damage to civilians is disproportionate to the military objective, the attack is illegal under international law.

In an editorial published Friday in the British newspaper The Guardian, International Criminal Court Prosecutor Karim Khan warned fighters that the burden of proof is on them if they claim that hospitals, schools or places of worship have lost their protected status because they are being used. for military purposes. And the bar for proof is very high.

“If there is any doubt that a civilian object has lost its protective status, the attacker should assume that it is protected,” Khan wrote. “The burden of demonstrating that this protective status is lost rests with those who fire the gun, missile or rocket in question.”