Attacks on hospitals are increasing during armed conflicts: What does the law of war say?

An article by The Conversation written by Shannon Bosch – Associate Professor (Law), Edith Cowan University

Pakistan denies intentionally targeting this medical facility. In a statement posted on social media X, the Pakistani Ministry of Information and Broadcasting declared that these “precision airstrikes” targeted “Afghan Taliban regime military installations used to support terrorist activities,” including “technical support infrastructure and ammunition storage facilities.”

Globally, attacks on healthcare facilities are on the rise. On March 14, 2026, an Israeli airstrike hit a healthcare center in Lebanon, killing 12 doctors, nurses, and rescuers. This attack brings the number of healthcare professionals killed in the country to 31 as of that date.

Since the beginning of March, the World Health Organization (WHO) has documented 27 attacks on healthcare facilities in Lebanon alone, while Israeli strikes in the country and joint American-Israeli operations in Iran have intensified. The Office of the High Commissioner for Human Rights (OHCHR) and the WHO have condemned these aggressions, labeling them as violations of international law.

What laws protect medical facilities, personnel, and patients in times of conflict? Do these protections become void if the infrastructure is used as a refuge for combatants?

What does “the law of war” say about protecting hospitals

International humanitarian law comprises a set of detailed rules aimed at protecting medical personnel, facilities, as well as patients and the wounded during armed conflicts.

The “law of war” specifies that:

– Medical personnel, including doctors, nurses, and rescuers, must be respected and protected in the performance of their duties. – Special protections exist for ambulances and means of transport exclusively dedicated to medical purposes. – These protections extend to the wounded and sick under their care, including enemy combatants requiring care and no longer participating in hostilities. – Impartial humanitarian organizations must be allowed to provide medical assistance. Consent to their action cannot be arbitrarily denied. – Medical facilities must display the distinctive protective symbols of the Red Cross, Red Crescent, or Red Crystal. Medical personnel must carry identification documents and armbands with these symbols.

The abusive use of these symbols to cover military operations is prohibited. Such an act may constitute perfidy, a form of deliberate deception that is a war crime under international law.

Deliberately attacking personnel or medical facilities displaying these symbols can also constitute a war crime.

What is the origin of these rules?

Laws protecting medical services in times of war were established in response to the unspeakable suffering witnessed during the conflicts of the 19th and 20th centuries. The first treaty protecting wounded soldiers and medical personnel dates back to 1864 when States adopted the original Geneva Convention.

Today, the Geneva Conventions of 1949 and their Additional Protocols, supplemented by a body of customary international law, form an almost universal legal framework binding all parties to the conflict, including non-state armed groups.

These rules require belligerents to uphold and protect health personnel, facilities, and the injured under all circumstances.

Why are attacks on medical facilities increasing?

In January, Doctors Without Borders (MSF) reported that attacks on medical facilities and personnel had reached unprecedented levels worldwide. For the year 2025 alone, there were 1,348 attacks on healthcare structures, double the number recorded in 2024.

The legal framework has not changed, unlike the nature of war. Recent conflicts in South Sudan, Ukraine, Gaza, Iran, and Lebanon unfold in densely populated urban environments. Armed groups operate within complex civilian contexts, often in close proximity to hospitals and clinics.

This has changed the discourse of some belligerents. What was once deemed “errors” is now often justified by military necessity. States now frequently claim that insurgents use hospitals or ambulances to gain a military advantage. Israeli authorities, for example, have accused Hezbollah and Hamas of leveraging medical infrastructure for military purposes.

Can a hospital lose its protection if combatants hide there?

Yes. Hospitals can lose their special protection if they are used outside of their humanitarian mission to engage in activities harmful to the enemy.

However, according to international law, the level of activities that could result in hospitals losing their protective status must be very high. Therefore, medical personnel are allowed to carry light weapons for self-defense. Armed guards may also be present to ensure site security. The presence of wounded combatants receiving care does not change the situation: protections remain valid.

These protections can only be lifted if hospitals are used for activities such as launching attacks, using medical facilities as observation posts, storing weapons, using medical infrastructure as command or liaison centers, or accommodating combatants.

Even in such cases, if doubts persist, the hospital must be presumed protected. It is also crucial to note that uncovering wrongful use does not give a green light for an attack.

Before launching an offensive against a medical facility involved in such activities, international humanitarian law requires a warning to be issued and a reasonable period given to stop the abusive use.

If the warning is ineffective, the attacking party must continue to adhere to the fundamental principles of international humanitarian law, including:

– Proportionality: the military advantage sought must be weighed against the humanitarian consequences of the attack. – Precaution: all possible precautions must be taken to minimize harm to patients and healthcare personnel.

Even when a facility loses its protection, the wounded and sick must continue to be respected and protected.

Are attacks on medical infrastructures becoming normalized?

The UN Security Council, WHO, MSF, and OHCHR have expressed deep concern: attacks on medical personnel and facilities – and the fact that attackers are not being held accountable – are dangerously becoming normalized.

The legal framework protecting hospitals and caregivers already exists. It is the responsibility of states and armed groups to disseminate this right and train their military forces.

National judicial systems are supposed to investigate and prosecute perpetrators of war crimes against the wounded, sick, medical personnel, and their facilities, as well as those who misuse protective symbols for military purposes.

Investigative groups specializing in open-source investigations, such as Forensic Architecture, Bellingcat, Mnemonics, and Airwars, play an increasingly important role in preserving satellite images, geolocation data, and videos shared on social networks. When independent investigative missions are conducted, their leaders can rely on these various elements to establish the facts. Such missions contribute to the revelation of the truth, even when states do not want or cannot fulfill their role.