The bombing of hospitals in armed conflicts raises complex international law questions, as these facilities enjoy special protection. International humanitarian law, particularly the Geneva Conventions, sets clear rules to protect civilians and medical infrastructure in times of war. Nevertheless, in conflicts like the Gaza Strip or the recent Iran-Israel conflict in 2025, attacks on hospitals repeatedly occur, triggering both legal and ethical debates. This article examines the principles of international law, analyzes the situation in Gaza and the Iranian attack on a hospital in Israel, and discusses the challenges in enforcing international law.
International Law and the Protection of Hospitals
International humanitarian law, a central component of international law, governs the conduct of states and non-state actors in armed conflicts. The four Geneva Conventions of 1949 and their Additional Protocols of 1977 form the basis for the protection of civilians, the wounded, and medical facilities. Hospitals enjoy a special status, as they are essential for the care of the injured, regardless of whether they are civilians or combatants.
Protective Status of Hospitals
According to Article 8(e) of the First Geneva Convention and Article 8(c) of Additional Protocol I, hospitals, as well as medical personnel and transport, are expressly protected from attack. This protection applies to both civilian and military hospitals, as long as they exclusively serve humanitarian functions. Hospitals may not be attacked unless they are demonstrably misused for military purposes, such as weapons depots or command centers. Even in such cases, international law requires a proportionality assessment: the military advantage of an attack must clearly outweigh the expected civilian harm (Article 51(5)(b) Additional Protocol I).
The principle of distinction obliges parties to a conflict to distinguish between military and civilian objectives. Hospitals are considered protected objects, and their destruction can be prosecuted as a war crime under the Rome Statute of the International Criminal Court (ICC) (Article 8(2)(b)(ix)). Furthermore, international law prohibits attacks that are "indiscriminate," meaning they do not make a clear distinction between military and civilian targets.
Exceptions and Challenges
The protection of hospitals can be lost if they are used for "acts that may harm the enemy" (Article 8(f) Additional Protocol I). However, this requires clear evidence, and the attacker must issue a warning before an attack and set a reasonable period for the abuse to cease. In practice, providing evidence is difficult, as parties to a conflict often provide conflicting accounts. Furthermore, the dynamics of modern warfare, such as the use of drones or cyberattacks, make compliance with these rules more challenging.
The enforcement of international law remains a challenge. The International Criminal Court (ICC) and ad hoc tribunals can prosecute war crimes, but state cooperation is often limited. Sanctions or diplomatic measures by the UN Security Council are frequently blocked by vetoes, which weakens accountability.
Bombings of hospitals in the Gaza Strip
The Gaza Strip has been the scene of recurring conflicts between Israel and Palestinian groups, particularly Hamas, for decades. Since the Hamas attack on October 7, 2023, which killed 1,195 people and took 251 hostages, Israel has launched a comprehensive military operation in Gaza. These operations have resulted in numerous civilian casualties, including attacks on hospitals that have been sharply criticized internationally.
Examples and Allegations
Reports from human rights organizations like Human Rights Watch (HRW) document repeated attacks on medical facilities in Gaza. A prominent case was the attack on an ambulance in front of Al-Shifa Hospital in Gaza City on November 3, 2023, which was classified as "potentially unlawful." A UN report from December 2024 pointed to a "pattern of attacks" on hospitals that could potentially constitute war crimes. In April 2025, the Gaza Ministry of Health reported that at least 52,243 people had been killed since the start of the war, many by attacks on civilian infrastructure, including medical facilities.
Another incident occurred in October 2024 in Beit Lahiya, where the Indonesian Hospital came under fire, leading to power outages and patient deaths. Palestinian authorities accused Israel of deliberately targeting hospitals to destroy the healthcare system. Israel, on the other hand, claims that Hamas misuses hospitals for military purposes, such as command centers or weapons depots. These allegations are difficult to verify independently, as access for international investigators is restricted.
International Law Assessment
The attacks on hospitals in Gaza raise several international law questions:
- Misuse of Hospitals: Israel must prove that attacked hospitals were actively used for military purposes. Even then, an attack would only be permissible if it is proportionate and does not cause disproportionate civilian harm.
- Indiscriminate Attacks: Attacks that hit hospitals and surrounding civilian areas indiscriminately violate the principle of distinction. Reports suggest many attacks occurred in densely populated areas, disproportionately endangering the civilian population.
- Humanitarian Crisis: The destruction of hospitals exacerbates the humanitarian crisis in Gaza, where over 129,000 people have been injured and the healthcare system is on the verge of collapse, according to UN figures. This could be considered a violation of the obligation to minimize civilian harm.
The international community, including the EU, has called on Israel to comply with international humanitarian law. EU High Representative for Foreign Affairs Kaja Kallas is examining whether Israel is violating agreements that protect human rights and international law. Nevertheless, prosecuting those responsible remains difficult, as Israel rejects the jurisdiction of the ICC.
The Iranian attack on Soroka Hospital in Israel (2025)
In the context of the escalating Israel-Iran conflict in 2025, which began on June 13, 2025, with Israeli attacks on Iranian nuclear facilities, Iran carried out retaliatory strikes that also hit civilian targets in Israel. A significant incident was the missile attack on Soroka Hospital in Beersheba in southern Israel, which took place on June 19, 2025.
Details of the attack
According to the hospital, the Iranian missile caused significant damage, particularly to an old operating building that had previously been evacuated. 32 people were injured, and there was considerable property damage. The Iranian Revolutionary Guard stated that the attack targeted military facilities near the hospital, but Israeli authorities classified the attack as a "war crime" because a hospital was hit. Prime Minister Benjamin Netanyahu and other government officials strongly condemned the attack and threatened retaliation.
International Law Assessment
The attack on Soroka Hospital raises several questions of international law:
- Precision: International humanitarian law requires that attacks be directed exclusively at military objectives. Iran claims to have attacked military facilities, but the damage to the hospital suggests a possible violation of the principle of distinction. International law experts like Adil Haque emphasize that attacks in civilian areas must avoid disproportionate harm.
- Proportionality: Even if military objectives were present near the hospital, the military advantage must outweigh civilian harm. Attacking a hospital serving a million people could be deemed disproportionate.
- Right to Self-Defense: Iran invokes its right to self-defense under Article 51 of the UN Charter in response to Israel's attacks on Iranian nuclear facilities. However, even within self-defense, attacks must adhere to the rules of international humanitarian law, which is questionable in the case of the hospital attack.
The international reaction was muted. UN Secretary-General António Guterres called for de-escalation without explicitly condemning the attack. This reflects the political complexity, as both sides – Israel and Iran – are accused of violating international law.
Comparison of Cases: Gaza vs. Soroka Hospital
The attacks on hospitals in Gaza and Soroka Hospital show both parallels and differences:
- Frequency and Context: In Gaza, attacks on hospitals are part of a long-standing conflict with repeated incidents, whereas the attack on Soroka Hospital is an isolated event within a new escalation. The high number of attacks in Gaza has nearly destroyed the healthcare system, while the damage in Beersheba was limited.
- Justification: Israel claims Hamas misused hospitals, while Iran asserts it attacked military targets near Soroka Hospital. In both cases, independent evidence is lacking, complicating legal assessment.
- International Reaction: Attacks in Gaza have drawn stronger international criticism, including from human rights organizations and the UN, while the Iranian attack received less attention. An X post points out that the outrage over the Soroka attack was disproportionately strong compared to Gaza.
Challenges in Enforcing International Law
The cases in Gaza and Israel highlight the difficulties in enforcing international law:
- Evidence Gathering: Independent investigations are difficult in war zones. Both Israel and Iran restrict access for international investigators, making it hard to verify allegations.
- Political Interests: Veto powers in the UN Security Council, such as the USA or Russia, often block resolutions condemning one side. This leads to a selective application of international law.
- Asymmetric conflicts: In Gaza, a state (Israel) faces a non-state actor (Hamas), complicating the application of international law. In the Iran-Israel conflict, both are recognized state actors, but enforcing international legal responsibility remains difficult.
Approaches and Outlook
Several measures can be considered to improve the protection of hospitals:
- Increased international monitoring: The International Atomic Energy Agency (IAEA) and UN missions could play a more active role in monitoring hospitals to prevent misuse and document attacks.
- Sanctions and prosecution: The ICC should be strengthened to prosecute war crimes more consistently. States could also impose targeted sanctions against those responsible.
- Diplomatic initiatives: Negotiations, such as the planned talks between the E3 states (Germany, France, United Kingdom) and Iran, could contribute to de-escalation.
Conclusion
The bombing of hospitals in Gaza and the attack on Soroka Hospital in Israel likely violate international humanitarian law, which calls for the protection of medical facilities. While Israel cites the misuse of hospitals by Hamas in Gaza, Iran justifies its attack as self-defense. In both cases, independent evidence is lacking, and the international community faces the challenge of enforcing international law. The cases show that political interests and the dynamics of modern conflicts make the application of international law difficult. Only through increased international cooperation, independent investigations, and diplomatic efforts can the protection of hospitals be guaranteed in the future.
