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

The international law aims to protect medical personnel and facilities, as well as patients and the wounded in times of armed conflict. It also strictly regulates the conditions under which combatants are allowed to attack health infrastructures suspected of being used by certain parties.

On the night of Monday, March 16 to Tuesday, March 17, 2026, a Pakistani airstrike hit a detox center in Kabul, Afghanistan. Afghan authorities reported that at least 400 people died and hundreds were injured as a result of the bombings.

Pakistan denied intentionally targeting the medical facility. In a statement on the social network X, the Pakistani Ministry of Information and Broadcasting claimed that the “precision airstrikes” targeted the “military installations of the Afghan Taliban regime used to support terrorist activities”, including “technical support infrastructures and ammunition storage warehouses”.

Globally, attacks on health infrastructures are on the rise. On March 14, 2026, an Israeli airstrike hit a care center in Lebanon, killing 12 doctors, nurses, and paramedics. This attack brought the number of healthcare professionals killed in the country to 31.

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

What laws protect medical facilities, personnel, and patients in times of conflict? Do these protections become void if the infrastructures are used as shelters for combatants?

What the “laws of war” say about hospital protection

International humanitarian law consists of detailed rules aiming to protect medical personnel, facilities, patients, and the wounded during armed conflicts.

This “laws of war” specify that:

• Medical personnel, including doctors, nurses, and paramedics, must be respected and protected in the performance of their duties.
• There are special protections for ambulances and means of transportation solely dedicated to medical purposes.
• These protections extend to the wounded and sick under their care, including enemy combatants needing 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 protective symbols of the Red Cross, Red Crescent, or Red Crystal. Medical personnel must carry identification documents and armbands displaying these symbols.

The misuse of these symbols to cover military operations is prohibited. Deliberately attacking personnel or medical facilities displaying these symbols can also constitute a war crime.

Origins of these rules

Laws protecting medical services in times of war originate from the unbearable suffering observed during conflicts of the 19th and 20th centuries. The first treaty protecting wounded soldiers and medical personnel dates back to 1864 with the adoption of 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 oblige the belligerents to respect and protect healthcare personnel, facilities, and the wounded in all circumstances.

Why are attacks on medical facilities increasing?

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

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

This has altered the discourse of some belligerents. What was once labeled as “mistakes” is now frequently justified by military imperatives. States often claim that insurgents use hospitals or ambulances for military advantage. Israeli authorities, for example, accused Hezbollah and Hamas of using medical infrastructures 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 their humanitarian mission to commit acts harming the enemy.

However, according to international law, the level of activities that could lead to the loss of protections for hospitals must be very high. Medical personnel are allowed to carry light arms for self-defense. Armed guards can 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 infrastructures as observation posts, storing weapons, using medical infrastructures as command or liaison centers, or hosting able-bodied combatants.

Even in such cases, if doubts persist, the hospital must be presumed protected. It is also crucial to note that verifying an abuse of protection does not justify an attack.

Before launching an offensive against a medical facility engaged in such activities, international humanitarian law requires a warning to be issued and a reasonable time given to end this abusive use.

If the warning remains ineffective, the attacking party must continue to comply with the fundamental principles of international humanitarian law, including:

• Proportionality: the anticipated military advantage must be balanced with the humanitarian consequences of the attack. This includes long-term repercussions on healthcare services. If foreseeable civilian harm is excessive, the attack must be canceled.
• Precaution: all possible precautions must be taken to minimize harm to patients and medical personnel. This can include organizing evacuations, planning ahead to anticipate care interruptions, and assisting in restoring medical capacities after the assault.

Even when an establishment loses its protection, the injured 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 – as well as the lack of accountability from the attackers – are dangerously becoming normalized.

The legal framework protecting hospitals and healthcare workers already exists. It is the responsibility of states and armed groups to promote 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.

In practice, however, investigating such attacks in the midst of an ongoing conflict proves extremely challenging. In reality, states are often reluctant or unable to prosecute.

How to reverse this trend?

Specialized investigative groups in open sources, such as Forensic Architecture, Bellingcat, Mnemonics, and Airwars, play an increasingly important role in preserving satellite images, geolocation data, and videos posted on social networks. When independent investigative missions are conducted, their leaders can rely on these various elements to establish the occurrence of events. Such missions contribute to revealing the truth, even when states are unwilling or unable to play their role.

This point is particularly crucial because if belligerents are not held accountable, places meant to save lives in times of conflict are at risk of increasingly becoming targets.