Gaza’s Hospitals and the Laws of War, Daily Brief, 13 November 2023.

“Regrettably, the hospital is not functioning as a hospital anymore.”

These words from Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), last night have further concentrated the world’s focus on al-Shifa hospital in Gaza.

He said he had managed to get in touch with health professionals at the hospital, Gaza’s largest, who told him it had been three days (now four) with no electricity and no water. Gunfire and bombings around the hospital were making things even worse, and more and more patients were dying.

The Guardian this morning is reporting al-Shifa hospital, amid Israeli airstrikes, is without oxygen, medical supplies, and fuel to power incubators. An Israeli military strike on an ambulance just outside al-Shifa hospital ten days ago adds to fears of even worse to come.

The chief of the WHO was unequivocal: “The world cannot stand silent while hospitals, which should be safe havens, are transformed into scenes of death, devastation, and despair.”

For weeks, Israeli army statements about Gaza hospitals have been raising grave concerns for the safety of patients and medical workers. They accuse Palestinian armed groups of using medical facilities for military operations.

If true, this would endanger civilians and violate the laws of war. It would not, however, give the Israeli military free rein to do anything it wanted against the hospital.

Hospitals have special protections under the laws of war that they only lose if they are being used to “commit acts harmful to the enemy.” What’s more, any attacks on them can come only after due warning.

Such warnings should be clear and cannot be issued for the purpose of disrupting the functioning of the hospital or forcing an evacuation. Ordering patients, medical staff and others to evacuate should be used only as a last resort.

In its advance around al-Shifa, Israel’s military has called for evacuating the hospital, saying last week, “time is running out” for civilians to leave. However, there is no reliably safe route to evacuate. Satellite imagery confirms fires, military operations, and roadblocks on every conceivable route.

And many sick and injured people in the hospital wouldn’t be able to evacuate even if the roads were clear.

Here’s perhaps the most critical legal point right now: people unable to leave the hospital still have protections under the laws of war against indiscriminate or disproportionate attacks.

Gaza’s health care system is collapsing not just at al-Shifa, of course.

Israel’s cutting of basic services and blocking of all but a trickle of aid, including medicines, to enter Gaza, combined with attacks on health care facilities, have resulted in the shutdown of 23 out of 35 hospitals in the Gaza Strip, according to the Palestinian Authority Ministry of Health.

The situation of hospitals in northern Gaza is particularly acute, with some having evacuated and others not. Kamal Adwan Hospital in northern Gaza also suspended operations after its main generator ran out of fuel, the hospital’s director told Al Jazeera.

Israeli authorities should immediately allow fuel into Gaza via the Rafah crossing with Egypt and should take the steps needed to reopen their own commercial crossing into Gaza for humanitarian relief, as they have as done in previous hostilities. They cannot deprive Gaza’s 2.2 million people of the fuel needed to power hospital generators and pump water.

Willfully impeding the delivery of life-saving relief supplies is a war crime.

Hospitals provide care and shelter for the sick, injured, and displaced, and must be safeguarded, especially during times of war. Doctors, nurses, and ambulances have to be permitted to do their work and be protected in all circumstances.