Israel-Hamas war: What protection do hospitals have in wartime and how does that apply in Gaza?
Gaza’s hospitals have been a flashpoint of fighting, claims and counterclaims.
Tens of thousands of people sought shelter in medical facilities after being driven from their homes by the risk of airstrikes.
But many have fled elsewhere as hospitals ran out of fuel and power and the fighting circled closer.
Al Shifa, the largest hospital in Gaza, is now surrounded by Israeli troops as gunfire and explosions rage around it.
The hospital’s last generator ran out of fuel at the weekend, leading to the deaths of at least 32 patients, including three babies, according to the Hamas-run Gaza health ministry.
Al Quds hospital is also now also closed to new patients. The Red Cross tried to evacuate about 6,000 people from the hospital but said its convoy had to turn back because of shelling and fighting.
Hospitals have protected status in wartime – but there are caveats to when this applies.
Here Sky News looks at what the rules are, and what both sides are saying.
Follow Israel-Gaza latest: Communications in Gaza could fail in two days
What are the rules on the protection of hospitals?
The International Criminal Court’s Rome Statute states it is a war crime for combatants to “intentionally direct attacks against… hospitals and places where the sick and wounded are collected, provided they are not military objectives”.
Under international humanitarian law (IHL) hospitals have protected status during war.
This means they cannot be attacked or otherwise prevented from performing their medical functions, according to the International Committee of the Red Cross (ICRC).
However, hospitals can lose those protections if they are used in a way that is harmful to the enemy – this includes being used to hide fighters or store weapons, the ICRC said.
But this does not give the other party free licence to attack, ICRC legal officer Cordula Droege said.
A warning must be given – first to stop the misuse of the hospital and then to allow evacuation of staff and patients if the misuse continues.
Any attack must be proportionate, Ms Droege added. If harm to civilians from an attack is disproportionate to the military objective, it is illegal under international law.
Also, using hospitals for military purposes is a violation of international humanitarian law, according to Amnesty International.
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What status do hospitals have in war? Sky military analyst Sean Bell explains
What does Israel say?
Israel claims Hamas uses hospitals for military purposes – but has not provided verified visual evidence of this.
It says Hamas has built a vast underground command complex centre below al Shifa hospital, connected by tunnels.
Israel also claims hundreds of Hamas fighters sought shelter at al Shifa after the 7 October attack.
The IDF released footage on Monday of a children’s hospital that its forces entered over the weekend, showing weapons it said it found inside, as well as rooms in the basement where it believes Hamas was holding hostages.
“Hamas uses hospitals as an instrument of war,” said Israel’s chief military spokesman Rear Admiral Daniel Hagari from a room at the Rantisi Children’s Hospital where explosive vests, grenades and RPGs were displayed on the floor.
Israel also accuses Hamas of using ambulances to carry fighters, using this as justification for a strike on an ambulance convoy that officials in the Hamas-run health ministry said killed and injured scores of people.
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Ambulance convoy hit by airstrike
What does Hamas say?
Both Hamas and al Shifa hospital staff deny Israeli allegations militants are operating a command centre from within its grounds.
Ghazi Hamad, a senior Hamas official, rejected the Israeli claims about al Shifa as “false and misleading propaganda”.
“The occupying forces have no evidence to prove it,” he said. “We have never used civilians as human shields because it goes against our religion, morality and principles.”
In a statement on its Telegram channel, Hamas said the video of Rantisi hospital showed “fabricated scenes that misled public opinion”, adding that it was a “failed attempt” by Israel to justify the targeting of hospitals.
At al Shifa, spokesperson for the health ministry Ashraf al Qidra said Israeli snipers and drones were firing into the hospital, making it impossible for medics and patients to move around.
Israel said the east side of the hospital was a safe passage for people to leave al Shifa, but people who tried to leave said Israeli forces had fired at evacuees and that it was too dangerous to move the most vulnerable patients.
The World Health Organisation said there was “no safe passage out of the hospital”.
Goudhat Samy al Madhoun, a healthcare worker, told the AP news agency that about 50 people left on Monday and were fired at several times, wounding one man who had to be left behind.
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Premature babies share a bed at Shifa hospital. Pic: Dr Marawan Abu Saada via AP
What has the international response been?
The international NGO Human Rights Watch has called for the attacks on “medical facilities, personnel, and transport” to be investigated as war crimes.
Israel’s claims about Hamas activity in hospitals are contested, Human Rights Watch said.
“Human Rights Watch has not been able to corroborate them, nor seen any information that would justify attacks on Gaza hospitals,” it said.
It added that Israel’s general evacuation warning to hospitals in northern Gaza was “not an effective warning” because it did not account for the safety needs of patients and medical staff.
The 27 European Union nations have jointly condemned Hamas for what they described as the use of hospitals and civilians as “human shields”.
US president Joe Biden said hospitals “must be protected” as he called for “less intrusive action” in relation to hospitals.
Insecurity Insight collects data on attacks on healthcare in Israel and Gaza. Its data – which it notes is not complete – from 7 October to 5 November records 219 incidents of violence against or obstruction of access to healthcare facilities in Gaza and 10 in Israel.
Pakistan has launched attacks on “multiple targets” across India, according to the media wing of Pakistan’s military.
Pakistan said in a statement that retaliatory attacks are underway in response to what it called “continuous provocation” by India, which fired missiles at three air bases inside Pakistan.
“Multiple targets in this operation are being engaged all across India,” the statement from Pakistan Armed Forces (PAF) said.
Pakistan’s military said it used medium-range Fateh missiles to strike more than 25 military sites, including airbases and weapons depots in the Indian states of Gujarat, Punjab and Rajasthan, as well as locations in India-administered Kashmir.
Pakistan’s military posted footage on X showing missiles being fired from what appeared to be a mobile launcher.
Pic: MilitaryPakISPR
The AP news agency also said loud explosions have been heard in India-administered Kashmir, in the disputed region’s two big cities of Srinagar and Jammu, and the garrison town of Udhampur.
Meanwhile, an Indian military source told Reuters that India has launched air operations in Pakistan, although no further details were given.
The operations mark the latest escalation in a conflict between the two nuclear-armed rivals, triggered by a deadly attack last month in India-administered Kashmir.
Most of the 26 civilians killed were Hindu Indian tourists. India blames Pakistan for backing the assault, an accusation Islamabad rejects.
Pakistan’s Prime Minister Shehbaz Sharif has called a meeting of the National Command Authority, the body which takes security decisions, including those related to the country’s nuclear arsenal.
State-run Pakistan television said three air bases were struck by India on Friday, although Pakistan insisted most of the missiles had been intercepted.
Despite the military offensive, PAF also posted a message on X in what appeared to represent an opportunity to de-escalate the situation.
“Now that a response has been given we hope the neighbour [India] will move to dialogue and diplomacy like Civilized Nations,” it said.
In recent days, both countries have launched a series of missile and drone strikes, although the scale and impact have been consistently questioned by each other.
On Wednesday, India conducted airstrikes on several sites in Pakistani territory. Pakistan said it shot down five Indian fighter jets.
On Thursday, India claimed to have repelled drone and missile attacks at military targets in more than a dozen cities and towns, including Jammu in India-administered Kashmir. Meanwhile, India claimed it struck Pakistan’s air defence systems and radars close to the city of Lahore.
A damaged house in Jammu, in Indian-administered Kashmir, after a Pakistani drone attack. Pic: AP
The Indian army said on Friday that Pakistan fired about 300 to 400 drones, targeting military installations along the western borders – a claim strongly denied by Pakistan.
The G7 group of advanced economies, which includes Canada, France, Germany, Italy, Japan, the US and Britain, urged maximum restraint from both India and Pakistan.
“We call for immediate de-escalation and encourage both countries to engage in direct dialogue towards a peaceful outcome,” a statement issued on Friday said.
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World
European leaders to meet in Ukraine for ‘coalition of the willing’ talks – and issue call to Russia
Sir Keir Starmer will join other European leaders in Kyiv on Saturday for talks on the “coalition of the willing”.
The prime minister is attending the event alongside French President Emmanuel Macron, recently-elected German Chancellor Friedrich Merz and Polish Prime Minister Donald Tusk.
It will be the first time the leaders of the four countries will travel to Ukraine at the same time – on board a train to Kyiv – with their meeting hosted by President Volodymyr Zelenskyy.
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Sir Keir Starmer, Emmanuel Macron and Friedrich Merz travelling in the saloon car of a special train to Kiev. Pic: Reuters
Military officers from around 30 countries have been involved in drawing up plans for the coalition, which would provide a peacekeeping force in the event of a ceasefire being agreed between Russia and Ukraine.
Ahead of the meeting on Saturday, Sir Keir, Mr Macron, Mr Tusk and Mr Merz released a joint statement voicing support for Ukraine and calling on Russia to agree to a 30-day ceasefire.
Sir Keir and Volodymyr Zelenskyy during a meeting in March. Pic: AP
“We reiterate our backing for President Trump’s calls for a peace deal and call on Russia to stop obstructing efforts to secure an enduring peace,” they said.
“Alongside the US, we call on Russia to agree a full and unconditional 30-day ceasefire to create the space for talks on a just and lasting peace.”
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The leaders said they were “ready to support peace talks as soon as possible”.
But they warned that they would continue to “ratchet up pressure on Russia’s war machine” until Moscow agrees to a lasting ceasefire.
“We are clear the bloodshed must end, Russia must stop its illegal invasion, and Ukraine must be able to prosper as a safe, secure and sovereign nation within its internationally recognised borders for generations to come,” their statement added.
“We will continue to increase our support for Ukraine.”
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The European leaders are set to visit the Maidan, a central square in Ukraine’s capital where flags represent those who died in the war.
They are also expected to host a virtual meeting for other leaders in the “coalition of the willing” to update them on progress towards a peacekeeping force.
This force “would help regenerate Ukraine’s armed forces after any peace deal and strengthen confidence in any future peace”, according to Number 10.
World
Ten explosions near international airport in India-administered part of Kashmir, officials say
Ten explosions have been heard near Srinagar International Airport in India-administered parts of Kashmir, officials have told Reuters news agency.
The blasts followed blackouts caused by multiple projectiles, which were seen in the sky above the city of Jammu earlier on Friday.
Explosions were also heard in the Sikh holy city of Amritsar, in the neighbouring Punjab state, according to Reuters.
An Indian military official told the agency that “drones have been sighted” and “they are being engaged”.
It comes as tensions between India and Pakistan across the line of control around the region of Kashmir have boiled over this week, leading to fears of a wider conflict.
On Wednesday morning, India carried out missile strikes in Pakistan and Pakistan-administered parts of the disputed region.
The retaliation came weeks after 26 people, mainly Indian tourists, were shot dead by gunmen in an India-administered part of Kashmir last month.
The government in India said it hit nine “terrorist infrastructure” sites, while Pakistan said it was not involved in the April attack and the sites were not militant bases.
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Explained: India-Pakistan conflict
Around 48 people have been killed since Wednesday, according to casualty estimates on both sides – which have not been independently verified.
India also suspended its top cricket tournament, the Indian Premier League, as a result of rising tensions, while the Pakistan Super League moved the remainder of its season to the United Arab Emirates.
Meanwhile, White House press secretary Karoline Leavitt said at a conference on Friday that the US is in constant contact with both India and Pakistan.
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