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.
World
‘At least 798 killed’ at Gaza aid points – as medical charity warns acute malnutrition at all-time high
At least 798 people in Gaza have reportedly been killed while receiving aid in the past six weeks – while acute malnutrition is said to have reached an all-time high.
The UN human rights office said 615 of the deaths – between 27 May and 7 July – were “in the vicinity” of sites run by the controversial US and Israel-backed Gaza Humanitarian Foundation (GHF).
A further 183 people killed were “presumably on the route of aid convoys,” said Ravina Shamdasani, from the Office of the UN High Commissioner for Human Rights.
Its figures are based on a range of sources, including hospitals, cemeteries, and families in the Gaza Strip, as well as non-governmental organisations (NGOs), its partners on the ground, and Hamas-run health authorities.
Aid agency Project Hope said on Thursday that 10 children were among at least 15 people killed as they waited for its clinic in Deir al Balah to open.
Ten children were reportedly killed when Israel attacked near a clinic on Thursday. Pic: AP
The GHF has claimed the UN figures are “false and misleading” and has repeatedly denied any violence at or around its sites.
Meanwhile, Medecins Sans Frontieres (MSF) – also known as Doctors Without Borders – said two of its sites were seeing their worst-ever levels of severe malnutrition.
Cases at its Gaza City clinic are said to have tripled from 293 in May to 983 in early July.
“Over 700 pregnant or breastfeeding women and nearly 500 children are now receiving emergency nutritional care,” MSF said.
The humanitarian medical charity said food prices were at extreme levels, with sugar at $766 (£567) per kilo and flour $30 (£22) per kilo, and many families surviving on one meal of rice or lentils a day.
It’s a major concern for the estimated 55,000 pregnant women in Gaza, who risk miscarriage, stillbirth and malnourished infants because of the shortages.
The GHF began distributing food packages in Gaza at the end of May, after Israel eased its 11-week blockade of aid into the coastal territory.
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It has four distribution centres, three of which are in the southern Gaza Strip.
The sites, kept off-limits to independent media, are guarded by private security contractors and located in zones where the Israeli military operates.
Palestinian witnesses say Israeli forces have repeatedly opened fire towards crowds of people going to receive aid.
The Israeli military says it has fired warning shots at people who have behaved in what it says is a suspicious manner.
It says its forces operate near the aid sites to stop supplies from falling into the hands of militants.
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GHF aid distribution linked to increased deaths
Gaza situation ‘apocalyptic’, says UN expert
After the deaths of hundreds of Palestinians trying to reach the aid hubs, the United Nations has called the GHF’s aid model “inherently unsafe” and a violation of humanitarian impartiality standards.
Listen to The World with Richard Engel and Yalda Hakim every Wednesday
In response, a GHF spokesperson said: “The fact is the most deadly attacks on aid sites have been linked to UN convoys.”
The GHF says it has delivered more than 70 million meals to Gazans in five weeks and claims other humanitarian groups had “nearly all of their aid looted” by Hamas or criminal gangs.
At least 798 people in Gaza have been killed while receiving aid in six weeks, the UN human rights office has said.
A spokesperson for the Office of the United Nations High Commissioner for Human Rights said 615 of the killings were “in the vicinity” of sites run by the controversial US and Israel-backed Gaza Humanitarian Foundation (GHF).
A further 183 people killed were “presumably on the route of aid convoys,” Ravina Shamdasani told reporters in Geneva.
The office said its figures are based on numbers from a range of sources, including hospitals, cemeteries and families in the Gaza Strip, as well as NGOs, its partners on the ground and the Hamas-run health authorities.
The GHF has claimed the figures are “false and misleading”. It has repeatedly denied there has been any violence at or around its sites.
The organisation began distributing food packages in Gaza at the end of May, after Israel eased its 11-week blockade of aid into the enclave.
It has four distribution centres, three of which are in the southern Gaza Strip. The sites, kept off-limits to independent media, are guarded by private security contractors and located in zones where the Israeli military operates.
Palestinian witnesses say Israeli forces have repeatedly opened fire towards crowds of people going to receive aid.
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US aid contractors claim live ammo fired at Palestinians
The Israeli military says it has fired warning shots at people who have behaved in what they say is a suspicious manner.
It says its forces operate near the aid sites to stop supplies falling into the hands of militants.
Read more:
GHF aid distribution linked to increased deaths
Gaza situation ‘apocalyptic’, says UN expert
After the deaths of hundreds of Palestinians trying to reach the aid hubs, the United Nations has called the GHF’s aid model “inherently unsafe” and a violation of humanitarian impartiality standards.
Listen to The World with Richard Engel and Yalda Hakim every Wednesday
In response, a GHF spokesperson told the Reuters news agency: “The fact is the most deadly attacks on aid sites have been linked to UN convoys.”
The GHF says it has delivered more than 70 million meals to Gazans in five weeks and claims other humanitarian groups had “nearly all of their aid looted” by Hamas or criminal gangs.
Ten children and two women are among at least 15 killed in an airstrike near a Gaza health clinic, according to an aid organisation.
Project Hope said it happened this morning near Altayara Junction, in Deir al Balah, as patients waited for the clinic to open.
The organisation’s president called it a “blatant violation of international humanitarian law, and a stark reminder that no one and no place is safe in Gaza“.
“No child waiting for food and medicine should face the risk of being bombed,” added the group’s project manager, Dr Mithqal Abutaha.
“It was a horrific scene. People had to come seeking health and support, instead they faced death.”
Operations at the clinic – which provides a range of health and maternity services – have been suspended.
Some of the children were reportedly waiting to receive nutritional supplements, necessary due to the dire shortage of food being allowed into Gaza.
Israel‘s military is investigating and said it was targeting a militant who took part in the 7 October terror attack.
“The IDF [Israel Defence Force] regrets any harm to uninvolved individuals and operates to minimize harm as much as possible,” added.
The deaths come as an agreement over a 60-day truce hangs in the balance – with President Trump cautiously saying it could happen “this week, or next week”.
Elsewhere in Gaza, the Nasser Hospital reported another 21 deaths in airstrikes in Khan Younis and in the nearby coastal area of Muwasi.
It said three children and their mother were among the dead.
Israel said its troops have been dismantling more than 130 Hamas infrastructure sites in Khan Younis over the past week, including missile launch sites, weapons storage facilities and a 500m tunnel.
On Wednesday, a soldier was shot dead when militants burst out of a tunnel and tried to abduct him, the military added.
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Do Trump and Netanyahu really get along?
Eighteen soldiers have been killed in the past three weeks – one of the deadliest periods for the Israeli army in months.
A 22-year-old Israeli man was also killed on Thursday by two attackers in a supermarket in the Israeli-occupied West Bank, said the Magen David Adom emergency service.
People on site reportedly shot and killed the attackers but information on their identity has so far not been released.
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IDF chief says conditions ‘created’ for Gaza ceasefire
What is the possible Gaza hostage and ceasefire deal ?
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Lack of food and water ‘lethal’ for Gaza children
Negotiations over a proposed 60-day ceasefire are ongoing and President Trump reportedly put “heavy” pressure on Israel’s leader, who visited the US this week.
A major sticking point is said to be the status of the Israel Defence Forces (IDF) inside Gaza during the 60-day ceasefire and beyond, should it last longer.
However, Sky News understands the Israeli government thinks the chances of a permanent truce are “questionable”.
Listen to The World with Richard Engel and Yalda Hakim every Wednesday
More than 57,000 Palestinians have been killed in the war – more than half are women and children, according to Gaza’s Hamas-controlled health ministry.
Its figure does not differentiate between civilians and fighters.
The war began in October 2023 after Hamas killed around 1,200 people in Israel and kidnapped 251 others.
Some of them remain In Gaza and are a crucial part of ceasefire negotiations, which also include a planned surge in humanitarian aid into the strip.
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