On December 7, the US-led coalition’s Combined Joint Task Force, “Operation Inherent Resolve”, issued a statement that it had conducted a “precision airstrike” on al-Salam hospital in the east of Mosul city. The statement justified the December 6 strike by saying that Islamic State, also known as ISIS, fighters were attacking Iraqi Security Forces from the hospital complex, which they were using as a base of operations and command and control headquarters.

Despite a paragraph emphasizing the coalition’s commitment to the laws of war, the statement makes no mention of whether there were civilian casualties at the hospital that was, local residents told Human Rights Watch, still very much operational. Perhaps more disturbing, there is no mention of whether the coalition took a key measure required by international law – to issue an effective warning – so civilians could escape.

In October, the US Department of Defense published a memo reiterating its commitment to the special protections international humanitarian law provides to medical facilities in armed conflict, making specific mention of the requirement to give warning, with a reasonable time limit, when an adversary is using health facilities for military purposes.

About two weeks later, an airstrike by either Iraqi or US-led coalition warplanes, targeting ISIS fighters, hit a clinic south of Mosul. There was no warning, and the attack destroyed half the clinic, killing eight civilians and wounding at least two more.

Attacks on health facilities impede civilians’ ability to access life-saving health services, services that become even more vital in times of conflict. While it is deplorable that ISIS is violating the laws of war by using hospitals for military purposes, including at least three more in Mosul city, that does not give the US-led coalition or Iraqi forces an excuse to flout international law>

The US-led coalition and Iraqi forces should conduct an impartial, thorough, and transparent investigation into all airstrikes on healthcare facilities so far to establish whether they were lawful and, if they were not, to compensate victims and hold those responsible to account. They also need to fully respect the laws of war if they want to signal to Iraq’s civilians that they take those standards more seriously than ISIS does.