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Israel-Gaza cease-fire doesn't mean the IDF should be excused for striking health facilities

Even if the fighting soon stops, not holding Israel to account for potential war crimes greenlights future heinous attacks.
The Palestinian Ministry of Health in Gaza City, which was heavily damaged by an Israeli bombardment on Wednesday.Anas Baba / AFP - Getty Images

In any war, the need for a safe humanitarian space is paramount. Not only are innocent civilians injured in the crossfire of violence they are not party to, but preventing them from receiving effective care for their wounds compounds their suffering.

Even if Hamas militants were “in the unit for medical reasons” or “small arms and ammunition” are found on the premises, the targeting of the clinic would still be considered a war crime.

Having worked as a doctor on the front lines during the war on the Islamic State militant group in Iraq, I have witnessed firsthand the necessity of having a safe space to tend to patients fleeing war. The sound of U.S. airstrikes, resonating across the camp as regularly as a beating drum, would shake the ground of our clinic on the outskirts of Mosul. Clouds of smoke from the explosions would cover the skies like an ominous storm, serving as an overshadowing reminder that we were in a war zone as well as a health care facility.

It was harrowing, but being in regular contact with U.S. and Iraqi military forces, medical camps were able to set up and be protected, operating with minimal risk of being attacked. Giving GPS coordinates to the military forces on a daily basis prevented any accidental attacks on the camps.

So we operated on faith that the U.S. fighter pilots respected the coordinates we had provided. We had no shelter or defense. I still remember hearing the initial bombs drop, and fear and anxiety rapidly permeating my emotions. But as soon as the first casualties arrived, adrenaline took over and I learned to ignore the emotions to help those in need. Thankfully, we were never hit by U.S. bombs.

Image: IDPs setting up shelter just outside of a medical clinic in a camp on the outskirts of Tal Afar, Iraq, a city occupied by ISIS.
Internally displace persons setting up shelter just outside a medical clinic in a camp on the outskirts of Tal Afar, Iraq, a city occupied by ISIS.Courtesy Ahmed Twaij

Knowing there can be an effective system for protecting medical facilities during wartime, it was particularly troubling to see earlier this week that a clinic run by Médecins Sans Frontières (Doctors Without Borders), providing trauma and burn treatment to victims of the recent fighting in the Gaza Strip, announced it had been struck by an Israeli aerial bombardment.

The targeting of health care facilities such as this one is a potential war crime. Beyond the humanitarian tragedy the situation poses for Palestinians on the ground, understanding why this constitutes a war crime is vital for assessing the true scope of the damage Israel has inflicted. Protected from United Nations Security Council criticism by the Biden administration, Israel has conducted airstrikes across Gaza with impunity. Even if the fighting soon stops under an expected cease-fire, not holding Israel to account for potential war crimes greenlights future heinous attacks.

Like my clinic in Iraq, MSF regularly updates the Israel Defense Forces with the GPS coordinates of its clinics, as well as clearly marking its buildings with medical symbols. I don’t believe it’s possible that Israeli forces didn’t know the location of the clinic. Particularly as Israel routinely uses precision-guided missiles, the attack on the health care facility must be questioned.

International law specifically addresses this type of circumstance, making very clear what’s allowed — and what’s so problematic about Israel’s behavior. According to the Geneva Conventions, the only circumstance in which health centers may lose their protection and become a legal target (though one limited to a proportionate response) is when they are used “to commit, outside their humanitarian duties, acts harmful to the enemy.”

Israel has yet to answer for the attack on the MSF clinic, which comes as part of a barrage of strikes the country has launched in response to rocket fire aimed at Israeli cities by the Palestinian militant group Hamas. In a previous round of fighting in which Israel attacked a hospital in Gaza, however, Israeli officials claimed the hospital had been turned into a “missile-launching site.”

Indeed, if Hamas was using the clinic as a kind of human shield, it would then be guilty of conducting a war crime and must be held accountable. But since virtually no one, including journalists and human rights observers, has been allowed access to Gaza from Israel or Egypt since the fighting began and borders were sealed, the onus is on Israel to provide sufficient evidence that the clinic was a legitimate target.

Importantly, even if Hamas was using the medical clinic to conduct military operations, Israel must still meet certain conditions prior to any attack. Under international law, protection of medical centers ends “only after a due warning has been given, naming, in all appropriate cases, a reasonable time limit and after such warning has remained unheeded.” MSF has stated it didn’t receive any prior warning about last week’s strikes, raising more questions about the legality of the attack.

Medical neutrality, the concept of providing equal access to health care even in times of war as outlined in international law, goes further to suggest that even if Hamas militants were “in the unit for medical reasons” or “small arms and ammunition” are found on the premises, the targeting of the clinic would still be considered a war crime.

The situation is particularly perilous given that the Palestinians who rely on the clinic often have nowhere else to go. During times of war, humanitarian corridors are often created to allow safe pathways for civilians seeking security. Throughout my time in Iraq, for instance, those fleeing Mosul, Tikrit, Fallujah or other regions were able to enter camps where multiple international human rights observers and journalists could ensure that the rights of each internally displaced person were upheld. But in Gaza, civilians are trapped by Egypt’s and Israel’s restrictions on freedom of movement. The only health care facilities the civilians have access to are often the very ones targeted.

Sadly, health care facilities have increasingly found themselves under fire in recent years. Syrian President Bashar al-Assad has often deliberately targeted health centers in Syria, Saudi Arabia bombed MSF hospitals in Yemen and the United States destroyed an MSF hospital in Kunduz, Afghanistan, in 2015.

At the time of the U.S. attack, MSF demanded that the International Humanitarian Fact-Finding Mission conduct an independent review of the incident, but instead an internal U.S. military investigation was conducted. The Pentagon report declared the attack wasn’t a war crime, but reparations were provided to the victims and 16 military personnel were disciplined.

Israel shouldn’t be allowed to escape with similar impunity. Not only should its leaders be held accountable, but they should pay for the damage caused. Beyond the MSF facility, in the past two weeks of fighting, Israeli airstrikes have reportedly killed senior doctors, among an already thinly stretched workforce, and damaged Gaza’s Ministry of Health.

The bombing of roads leading to Gaza’s main hospital, Al-Shifa Hospital, has further cut access to health care for the victims of violence. Already suffering from as much as $16.7 billion worth of economic devastation as a consequence of the Israeli and Egyptian blockade, the siege on Gaza has severely limited access to life-saving medications for Gaza’s health care providers.

This all comes amid a global pandemic in which Gaza is suffering from a second wave of Covid-19 cases. Gaza’s only Covid-19 testing lab was also damaged by airstrikes earlier this week.

Israel cannot continually destroy Gaza’s health care infrastructure and remain unaccountable. It’s time global pressure was applied and independent investigations conducted, with those responsible tried at the International Criminal Court. Israel seems to be conducting war crimes in plain sight and, in the name of self-defense, getting away with it.