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.
Britain plans to equip its armed forces with a homegrown hypersonic cruise missile by the end of the decade, according to a report.
Military chiefs are under pressure to catch up with China, Russia and the US by developing a weapon capable of flying at speeds higher than Mach 5 – five times the speed of sound, according to The Sunday Telegraph.
The Ministry of Defence wants the missile to be designed and built in the UK and to enter service by 2030.
Plans are at an early stage, the newspaper reported, although there is no decision on whether the missile will be launched from land, sea or air.
It comes after Prime Minister Rishi Sunak pledged to spend 2.5% of gross domestic product on defence by 2030.
Keep up with all the latest news from the UK and around the world by following Sky News
Ballistic weapons can also reach hypersonic speeds but the difference is in manoeuvrability – ballistic weapons generally have fixed paths but the path of a hypersonic weapon can be changed after launch, making it difficult to destroy.
The US, Russia and China are the main players in the hypersonic weapons race but other countries, such as North Korea, claim to have tested hypersonic weapons.
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The development of hypersonic capabilities is part of Pillar Two of AUKUS – a defence and security pact between the UK, Australia and the US.
Keep up with all the latest news from the UK and around the world by following Sky News
Last month the US tested a hypersonic cruise missile on an atoll in the Marshall Islands in a message to its rival in the Pacific – China. It is the latest in a number of hypersonic weapons tests the country has completed in recent years.
A spokesperson for the MoD would not comment in detail on the development of Britain’s hypersonic missile capability, citing national security, but confirmed “hypersonic technologies to further develop UK sovereign advanced capabilities” were being pursued.
“We continue to invest in our equipment to meet current and future threats,” they added.
World
Sudan: Civilians trapped as UN warns of possible imminent attack on city of al Fashir by Rapid Support Forces
The United Nations has expressed increasing concern over a potential imminent attack on al Fashir, the capital of North Darfur in Sudan.
It comes as residents describe the city as “seriously suffocated” and besieged by Sudanese paramilitary forces known as the Rapid Support Forces (RSF).
A spokesperson for the office of UN secretary general Antonio Guterres said in a statement that “an attack on the city would have devastating consequences for the civilian population”.
“The escalation of tensions is an area already on the brink of famine,” with the rival Sudanese Armed Forces (SAF) appearing to be “positioning themselves”.
The last of Darfur’s five state capitals not under full RSF control, al Fashir city and its 800,000 inhabitants face an uncertain fate as a local ceasefire negotiated in the early days of the conflict has collapsed.
Mr Guterres has reiterated his call on all parties to refrain from fighting in the area.
At least 43 people, including women and children, have reportedly been killed since the RSF began their push into al Fashir earlier this month, Friday’s UN statement continued, and civilians are trapped in the city.
The North Darfur capital and sprawling displacement camps in its suburbs have been a haven for thousands of people displaced by armed conflict and ethnic violence in the region since the early 2000s, including the last year of war between the RSF and SAF.
Sudan was plunged into chaos in mid-April 2023 when tensions between its military, headed by General Abdel Fattah Burhan who leads the SAF, and the RSF paramilitary, commanded by Mohammed Hamdan Dagalo, broke out into street battles in the capital Khartoum.
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Sudan’s health system crippled by conflict
Fighting has spread to other parts of the country, especially urban areas and the western Darfur region.
The conflict has left around 25 million people, or half the country’s population, needing humanitarian aid, with over eight million forced to flee their homes, said the UN.
More than 14,000 people have been killed and tens of thousands of others wounded.
Residents have told Sky News the RSF is blocking main arterial routes bringing in goods and fuel to al Fashir, leaving them with dwindling medicine, humanitarian aid and food supplies as increased army airstrikes have hit civilian homes in surrounding areas.
Many fear a telecoms blackout which marked the start of an RSF-led massacre last year in al Geneina, the capital of West Darfur, and December’s siege of Wad Madani, the capital of al Jazira state, as reports mount of an RSF advance.
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The orphaned and disabled children forced to flee fighting in Sudan
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Sudan: A year of war at home
An online video shows a large RSF convoy in the desert, with militiamen yelling “lift your head al Fashir, the steel is coming”.
“Al Fashir is unsafe and an attack is expected at any time. Three days ago, a shell fell into my uncle’s house – only 80 metres from my home. My uncle was injured and my cousin’s son died,” said Mohamed.
“The city is seriously suffocated.”
Fighting displaced 40,615 people in al Fashir between 1 and 16 April, according to the International Organisation for Migration (IOM).
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‘Where will people go?’
Aid organisation Medecins Sans Frontieres (MSF), also known as Doctors Without Borders, has said it has responded to three mass casualty events in al Fashir’s South Hospital over the past week and treated over 100 wounded patients.
“The situation is already catastrophic and we are very worried that the escalation in conflict is going to make it even worse,” said MSF spokesperson Kirsty Cameron.
Alarm bells are sounding with little hope of successful intervention.
“Where will people go? People have fled to al Fashir from surrounding areas that are still unsafe. There are no more options for refuge,” said Darfuri journalist and human rights monitor Ahmed Gouja.
“They are forced to surrender to their death.”
Hamas has released a new video that appears to show two hostages who have been held in Gaza since the 7 October assault on southern Israel.
The two men, Keith Siegel, 64, and Omri Miran, 47, speak in the video against an empty background, sending their love to relatives and asking to be released.
The video was released during the Passover holiday, when Jews celebrate the biblical story of gaining freedom from slavery in Egypt.
Sky News has decided not to show the video online.
In the footage, Mr Siegel breaks down in tears as he recalls spending last year’s Passover with his family, saying he hoped they would be reunited.
Mr Miran was taken from his home in Nahal Oz in front of his wife and two daughters, while Siegel, who is a dual US citizen, was abducted with his wife, although she was released during the brief truce in November.
Keith Siegel
Omri Miran
Some 250 Israelis and foreigners were taken hostage during the 7 October Hamas attack, which killed around 1,200 people.
It prompted Israel’s assault on Gaza, as it pledged to destroy Hamas and bring the hostages home.
Some 34,000 Palestinians have been killed in the conflict so far, according to the Hamas-run Gaza health ministry.
Also on Saturday, Hamas said it was reviewing a new Israeli ceasefire proposal.
Hamas senior official Khalil al Hayya did not share details of Israel’s offer but said it was in response to a Hamas proposal made two weeks ago.
This included a six-week ceasefire, release of 40 civilian and sick hostages, in exchange for the release of Palestinian prisoners in Israeli jails.
Israel’s foreign minister said on Saturday that the country’s planned incursion into the southern Gaza city of Rafah could be put on hold if a deal is struck to secure the release of Israeli hostages.
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The hostage situation is putting pressure on Israeli leader Benjamin Netanyahu. Pic: Reuters
The prospect of an attack on Rafah has prompted concern from various countries, including Israel’s staunchest ally, the US.
Meanwhile, Egypt also ramped up its efforts to broker a deal that could end the war.
An Egyptian delegation left Israel on Saturday after talks there about a “new vision” for a ceasefire in Gaza.
This would include the release of some hostages and Palestinian prisoners and the return of many displaced Palestinians to their homes in northern Gaza with “minimum restrictions”, according to an Egyptian official.
Hamas still wants a permanent ceasefire and full withdrawal of Israeli troops but Israel has rejected both of these, saying it will continue military operations until Hamas is defeated and it will maintain a security presence in Gaza.
It came as protests continued around the world calling for an end to the conflict, including pro-Palestinian demonstrations in London and at universities across the US.
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