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.
Read more:
Gaza surgeon gives harrowing account of child amputation
Palestinians stream onto Gaza highway as Israeli forces strike near hospitals
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.
One of the alleged gunmen in the killing of 15 people on Bondi Beach has been charged.
Naveed Akram, 24, faces 59 counts, including 15 of murder and a terror charge.
The other alleged attacker, his 50-year-old father Sajid, died at the scene in Sydney.
The charges came as people gathered for funerals three days after Sunday’s terror attack shocked Australia and intensified concerns about rising antisemitism.
Some 22 victims remain in hospital following the shooting, carried out at an event marking the start of the Jewish celebration of Hanukkah.
People look at flowers laid out for the victims. Pic: Reuters
At the first of the funerals, relatives mourned the death of British-born Rabbi Eli Schlanger, a 41-year-old father of five, who organised the Chanukah by the Sea event.
Often speaking through tears, his father-in-law, Rabbi Yehoram Ulman, expressed his “biggest regret” that he “could have done more” to tell him “how much we love him”.
“I hope he knew that. I’m sure he knew it,” he added. “But I think it should’ve been said more often.”
Relatives of Rabbi Eli Schlanger next to his coffin during his funeral. Pic: Reuters
The father of 10-year-old victim Matilda, whose surname has been withheld at her family’s request, spoke at a vigil on Tuesday night.
Local media reported him as saying: “We came here from Ukraine… and I thought that Matilda is the most Australian name that can ever exist.
“So just remember the name, remember her.”
A photo of Matilda. Pic: Reuters
Read more: Who were the suspected gunmen?
Police have said the two alleged gunmen – who were shot by officers – were motivated by Islamic State ideology.
A recent trip to the Philippines is under investigation. The older Akram used an Indian passport to travel, while his son used an Australian one.
The Akrams stayed at the GV Hotel in Davao from 1 November to 28 November, according to a source, who said police had visited on Wednesday.
The pair are said to have only left their rooms for meals and no one was seen visiting them.
Davao is in an area associated with Islamic extremism but a spokesman for the president of the Philippines said he rejected the claim the country is an “ISIS training hotspot”.
New South Wales to debate gun reforms
The Australian government and intelligence services have come under pressure because the alleged attackers were legally able to acquire the high-powered rifles and shotguns used in the attack.
Prime Minister Anthony Albanese has vowed to toughen the country’s gun laws after its deadliest mass shooting in three decades, and the state parliament in New South Wales will reconvene next week to discuss reforms.
They include capping the number of guns allowed by a single person and making some shotguns harder to access.
State premier Chris Minns told a news conference: “We’ve got a monumental task in front of us. It’s huge.
“It’s a huge responsibility to pull the community together.
“We need a summer of calm and togetherness, not division.”
Mr Albanese has vowed to work with the Jewish community to “stamp out and eradicate antisemitism”. The prime minister has been accused of not doing enough to prevent its spread since the war in Gaza began two years ago.
Fellow world leaders have expressed their shock and anguish since the attack, including British Prime Minister Sir Keir Starmer, who hosted a Hanukkah event at Downing Street on Tuesday.
And speaking at the White House last night, US President Donald Trump said: “We join in mourning all of those who were killed, and we’re praying for the swift recovery of the wounded.”
A South African man, with eyes darkened by sleepless nights, tells us his older brother was lured into fighting for Russia on the frontline in Ukraine’s raging Donbas region.
“To them, it’s a suicide mission because they have never been trained for the military. They don’t have military training – they don’t have military experience,” says Bongani, whose name we have changed for his safety.
In the hidden back garden of a modest hotel in KwaZulu-Natal province, he continues: “They don’t have experience of any war. They are just bodyguards who want to get a job and provide for their families. That’s all.”
Bongani says his brother travelled to Russia on a flight via Dubai after being told he would be receiving bodyguard training along with at least 16 other South African men. After signing a contract in Russian, their fate was sealed.
Bongani, not his real name, tells Yousra his brother was on a ‘suicide mission’
“The problems started when they were moved from Russia to Ukraine, and they asked them: ‘Guys – where are we going now because we are here for training?’
“And then the Russians said: ‘Training for what? We don’t know anything about training – what we know is that you’ve signed the contract. You are under our command now – under the Russian army.'”
How is this happening?
Sky News has seen harrowing SOS video messages from South African men who describe entrapment and deployment to the frontline in Ukraine.
In one video, a man in military fatigues details the moment they signed their contracts. He claims Duduzile Zuma-Sambudla, the daughter of former South African President Jacob Zuma, encouraged them to sign away their lives.
“We refused to sign the contract forms because it was written in Russia, which we didn’t understand. We asked them for a translator – someone who can translate the language. They said there was no network,” he says in fluent English.
“That is when Duduzile came with a guy by the name of Khosa. She said we must sign the contract because it is the same thing they did. Duduzile said she is doing the same course we are doing, the same training, and that unfortunately she won’t be with us because she is training somewhere else.”
“Yes, we agreed. We did sign the forms because we trust the lady, Duduzile.”
South African men claim they were trafficked by Duduzile Zuma, daughter of the country’s former president – allegations she denies
Duduzile Zuma-Sambudla is accused of trafficking South African men – including eight of her own relatives – for mercenary recruitment by her half-sister Nkosazana Bonganini Zuma-Mncube, who has filed police charges against her.
She denies the allegations and says she was a victim of deception, misrepresentation, and manipulation.
The South African Police Service (SAPS) say they are currently investigating the charges. Duduzile Zuma-Sambudla has resigned as a member of parliament and has not responded to our request for comment.
Former president Jacob Zuma with his daughter Duduzile Zuma, wearing “I Stand With Russia” T-Shirt in 2023. Pic: @DZumaSambudla/X
Five hours away in Johannesburg’s Gauteng province, we watched as another case of suspected mercenary recruitment played out in a South African magistrate’s court.
Five suspects were ushered out into a crowded courtroom in Kempton Park after being arrested on their way out of Johannesburg’s Oliver R Tambo airport following a tip-off to the police that they were allegedly travelling to Russia via the United Arab Emirates.
Five people suspected of attempting to join Russia’s war effort in Ukraine appear in a Johannesburg court
Among the five suspects is Patricia Mantuala, 39, suspected of recruiting the men
The line-up is sullen as the three young men on one end of the stand look down at their hands. The youngest is only 21 years old.
At the other end of the stand is a 39-year-old woman called Patricia Mantuala, who stands accused of recruiting them. The five suspects were eventually granted bail by the court after a postponed hearing.
Read more from Sky News:
G20 overshadowed by Ukraine
Alleged mercenary arrested in London
Is time running out for Ukraine?
Colonel Katlego Mogale, a spokesperson for the Directorate for Priority Crime Investigation (DPCI), also known as the HAWKS, told Sky News and other journalists in a news conference that they are not ruling out the possibility that more suspects will be arrested.
South Africa’s specialised police unit is investigating a growing recruitment drive
Amid signs of a growing recruitment drive, the families of those who say they are trapped fighting for Russia in Ukraine are advocating for their loved ones to return home – against all odds.
“You are dealing with people who are well known in South Africa and in South Africa nobody’s safe and we may never know what’s going to happen next to us,” says Bongani.
“What’s going to happen to our family?”
World
Imran Khan’s sons ‘fear they may never see him again’ as former Pakistan PM ‘held in death cell’
The sons of former Pakistani prime minister Imran Khan have said they fear they might never see their father again as he is being “psychologically tortured” in a “death cell”.
Speaking to Sky News’ The World with Yalda Hakim, Kasim and Sulaiman Khan said they had not spoken to their father, who has been in prison since August 2023, for months.
Imran Khan’s sons being interviewed by Yalda Hakim
Kasim described the conditions the former Pakistani leader has been kept, saying: “He’s been in a solitary confinement cell for over two years where he’s had filthy water, he is around inmates who are dying of hepatitis, the conditions are disgusting and also he is completely isolated from any human contact.”
He continued: “It’s getting harder to see a route out at this point. We’re trying to have faith. But at the same time, right now, the conditions are getting worse.
“It’s very hard to see a way out… We’re now worried we might never see him again.”
Kasim said his father was being subjected to “psychological torture tactics” as even the prison guards weren’t allowed to communicate with the former Pakistani leader, who led the country between 2018 and 2022.
Imran Khan, pictured in March 2023 before his arrest on corruption charges. File pic: Reuters
Sulaiman said his father’s cell, where he allegedly spends 23 hours a day, has been described as a “death cell”.
He said an army spokesperson announced on Friday that Imran Khan, who has in the past been shot three times, was now officially in full isolation.
He added that Imran Khan was being kept in “completely substandard conditions that don’t meet international law for any sort of prisoner”.
The brothers’ words echo what one of Khan’s sisters reported after being allowed to meet the former cricketer in prison at the start of the month.
Uzma Khanum said at the time that Khan was facing isolation and psychological strain in prison following weeks in which his family said access had been blocked.
The former leader was jailed after being convicted in a string of cases that he says were politically driven following his ousting in a 2022 parliamentary vote.
Before launching his political career, Imran Khan was best known as a star of international cricket and for leading Pakistan to Cricket World Cup victory in 1992.
Kasim said his father would “never take a deal and leave all of his other party members in jail to die and fester in these jails…
“Instead he stays in those conditions, happy to rot and it means that he can move towards his goal of ridding Pakistan of corruption, a goal that he has stated to us a million times.”
Mosharraf Zaidi, a Pakistani government spokesperson, will be speaking to Yalda Hakim tonight on Sky News from 9pm.
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