Israel’s strikes on a major hospital in southern Gaza on Tuesday, in a bid to kill a top Hamas commander, have drawn new attention to one of the war’s most contentious issues: Israeli attacks on medical facilities, and Hamas’s use of such sites for military purposes.
The attack on the European Gaza Hospital complex near Khan Younis killed at least six people, according to the Gazan medical authorities, and left several deep craters in and around the hospital grounds, according to video filmed at the site and verified by The New York Times.
In a separate set of attacks, Israeli strikes killed dozens of people in northern Gaza overnight, Palestinian health officials said on Wednesday.
Even in a war that has decimated Gaza’s health sector, Israel has rarely launched as powerful an attack on a health complex as the one that damaged the European Gaza Hospital on Tuesday.
The Israeli military said it had been targeting a Hamas command center underneath the complex, and Israeli officials who spoke on condition of anonymity to divulge sensitive details said the specific target was Muhammad Sinwar, the senior Hamas commander.
Imad al-Hout, the hospital’s director, said in a phone interview that the strikes — which he said were conducted without warning — had damaged walls and pipes, cut off the water supply, put the hospital out of service, and forced most of the 200 patients to evacuate. Dr. al-Hout denied that Hamas fighters operated inside the hospital complex, adding that he did not believe the group had dug tunnels beneath it, though he could not definitively rule it out.
For human rights campaigners and international watchdogs, attacks on medical facilities have fueled accusations that Israel is conducting a genocide against Palestinians in Gaza, in part by wrecking their health system.
By early May, the World Health Organization had recorded 686 attacks on health facilities in Gaza since the start of the war. Those attacks have damaged at least 33 of Gaza’s 36 hospitals, according to the W.H.O., and at one point had rendered at least 19 of them inoperable; five have since returned to service.
A United Nations committee of inquiry concluded last September that such attacks collectively constituted “a concerted policy to destroy the health-care system of Gaza.”
For Israel and its defenders, who strongly deny the claims of genocide, such attacks are a necessary and legal response to Hamas’s use of hospitals for military purposes. Israel says that Hamas routinely uses hospitals, and tunnels and shelters beneath them, as command centers, hiding places and weapons stores.
Hamas strongly denies it does so, but Israeli officials say the group has essentially turned Gaza’s health sector into a civilian shield for military activity.
“The use of hospitals for terror purposes is one of Hamas’ core operating methods,” the Israeli military said in a post on its website, which a spokesman cited in lieu of a comment for this article. “The terror infrastructure in the hospitals is meant to ensure optimal protection for Hamas terrorists during times of war,” it added.
Interviews with Hamas members and Israeli soldiers operating in Gaza, along with other evidence, have shown that Hamas has used some medical facilities to conceal entrances leading to its vast military tunnel network, store weapons and station militants. Palestinians have also reported seeing Hamas fighters operating within health facilities, both in this war and in previous conflicts.
In March, 2024, a group of militants made a last stand inside Al-Shifa, a major hospital in Gaza City, leading to a days-long battle with the Israeli military.
Under the international rules of conflict, hospitals are considered protected sites that should not be attacked except in rare circumstances. The use of a hospital for military purposes may make it a legitimate target, but only if the risk to civilians is proportional to the military advantage created by the attack. In addition, the law states that the attacking force must give advance warning of a strike on a hospital, which the Israeli military did not do before its strike at the European Gaza hospital.
“If Hamas uses a hospital to shield a military command and control center, that is a violation of international humanitarian law, and it can in principle mean that the hospital loses its automatic protection from attack,” said Lawrence Hill-Cawthorne, an expert on the laws of armed conflict at the University of Bristol in England.
“But Israel is obligated under the Fourth Geneva Convention to give a warning before attacking the hospital to allow civilians to evacuate,” Professor Hill-Cawthorne said. “And an attack would still be unlawful if it causes disproportionate civilian harm.”
International law experts say that assessments of likely civilian harm must consider a strike’s effect on a region’s wider health system, rather than on only the affected hospital. In Gaza, where so many health centers are damaged or out of use, that makes it much harder to find legal justification for attacks on hospitals, according to Janina Dill, an expert on the laws of armed conflict at the University of Oxford.
“I struggle to see what anticipated military advantage could render any attack against a hospital in Gaza right now proportionate,” Professor Dill said.
The Israeli military declined to comment on the lack of a warning before the strike on the European Gaza hospital. An Israeli military official, speaking on the condition of anonymity because he was not authorized to discuss the matter publicly, said that the military had assessed the legality of the strike and concluded that it was acting according to international law.
Aaron Boxerman, Aric Toler and Rawan Sheikh Ahmad contributed reporting.
Patrick Kingsley is The Times’s Jerusalem bureau chief, leading coverage of Israel, Gaza and the West Bank.
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