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Credit to Author: Vittoria Elliott| Date: Mon, 12 Feb 2024 13:34:34 +0000<\/strong><\/p>\n Vittoria Elliott<\/a><\/span><\/span><\/p>\n The world has witnessed a near-unprecedented and ongoing humanitarian crisis in Gaza during the first 129 days of the Israel-Hamas war<\/a>. Despite their critical role in saving lives, hospitals and other health care facilities\u2014which are protected under international law\u2014have not been spared the widespread destruction in the Palestinian territory, according to new research.<\/p>\n A study published Monday in the British Medical Journal Global Health<\/em><\/a> from researchers at the Yale School of Public Health found that from October 7\u2014the day Hamas launched an unexpected attack on Israel that left some 1,200 Israelis dead\u2014to November 7, 2023, hospitals and health care facilities were damaged at the same rate as other buildings. The paper\u2019s authors suggest that the Israel Defense Forces (IDF) did not take measures to ensure it did not strike these facilities, despite their protected status.<\/p>\n \u201cThis pattern of war, at least in this first month, looks like it was not really aligned with international humanitarian law,\u201d says Danielle Poole, an associate research scientist at the Yale School of Public Health and lead author on the paper.<\/p>\n The United Nations Relief and Works Agency for Palestine Refugees in the Near East estimates<\/a> that at the start of 2024, 85 percent of Gaza\u2019s population, or some 1.9 million people, had been displaced by the conflict, and the Gaza Ministry of Health reports<\/a> that at least 28,064 Palestinians were killed between October 7, 2023, and February 10, 2024. Human Rights Watch, a nonprofit watchdog organization, has characterized<\/a> Israel\u2019s attacks on health care facilities in Gaza as \u201capparently unlawful.\u201d<\/p>\n Using high-resolution satellite imagery from the United Nations, data from the open source mapping platform OpenStreetMap, and known locations of medical facilities listed by the World Health Organization (WHO) and the United Nations Office for Coordination of Humanitarian Assistance, the researchers were able to identify damage to over 167,000 buildings during the first month of the conflict. Poole and her team found that 15,768 nonmedical structures and nine health care\u2013related facilities suffered damage\u2014about 9 percent in each case. The analysis also found that health care facilities were more likely than other buildings to have sustained severe damage or to have been destroyed completely.<\/p>\n \u201cAlready in this first month, their health system was severely compromised due to the conflict,\u201d says Poole. As the researchers note in their report, the attacks on medical facilities \u201cwill undoubtedly have long-term effects on the health system through the severely decreased ability to provide necessary medical care to the population.\u201d<\/p>\n Researchers ranked the damage done to buildings in four ascending categories: \u201cpossible damage,\u201d \u201cmoderate damage,\u201d \u201csevere damage,\u201d and \u201cdestroyed.\u201d Poole says the numbers noted in her team\u2019s report are conservative because they don\u2019t count smaller medical facilities, like pharmacies or small clinics. \u201cYou wouldn't expect an artillery officer to know about the little pharmacy in the strip mall, even though those things are still protected\u201d under international humanitarian law, she says.<\/p>\n Matt Simon<\/span><\/span><\/p>\n Jaina Grey<\/span><\/span><\/p>\n Amit Katwala<\/span><\/span><\/p>\n Emily Mullin<\/span><\/span><\/p>\n International humanitarian law prohibits attacks<\/a> on hospitals and health care facilities, or against patients, doctors, and their means of transport, during a conflict. A health care facility can lose its protected status if it is used to \u201ccommit acts that are harmful to the enemy,\u201d according to the International Committee of the Red Cross (ICRC).<\/p>\n \u201cHospitals have special protection status underneath the Geneva Conventions and the Law of Armed Conflict,\u201d says Nathaniel Raymond, a human rights investigator and a coauthor of the study. \u201cTo intentionally strike a hospital, the protocol required is the most restrictive for any type of civilian infrastructure. An armed party to a conflict must ensure that the hospital is notified that it has lost protected status, and efforts are made to ensure the evacuation of those facilities prior to any kinetic strike. That is what the law requires.\u201d<\/p>\n In a lengthy response to WIRED\u2019s questions about what measures it has taken to prevent damage to health care facilities, the IDF defended its military operations. \u201cA central feature of Hamas\u2019 strategy is the exploitation of civilian structures for terror purposes,\u201d says an IDF spokesperson. \u201cIt is against this context of widespread exploitation of medical facilities and intelligence indicating their knowledge and even participation in terror activities that Israel has apprehended and questioned individuals in Gaza, including medical staff. We reiterate that individuals found not to have been involved in terrorist activity are released after questioning.\u201d<\/p>\n The IDF has alleged<\/a> that Hamas was operating out of tunnels underneath Al-Shifa, the largest hospital in Gaza, thereby making it a legitimate target. IDF forces raided the hospital on November 15. The tunnels have not been proven to have had a military function, and the legality of that IDF military operation remains in dispute<\/a>.<\/p>\n Even in cases where the military has leveraged civilian structures, combatants are expected to exercise what IHL dubs \u201cproportionality\u201d and \u201cprecaution,\u201d meaning that any attack should be done such that civilian harms do not outweigh the military benefit. \u201cThis does not mean there\u2019s free license to attack,\u201d ICRC chief legal officer Cordula Droege said<\/a> in an ICRC video posted November 2 on X. \u201cThe party to the conflict has to do everything feasible in order to avoid or at least minimize harm to patients and medical staff.\u201d<\/p>\n Although the destruction of health care facilities in Gaza is far more extensive, the WHO also recorded<\/a> \u201c33 attacks on health care in Israel during the violent events of October 7.\u201d The WHO cautioned Hamas and Israel to remember \u201ctheir obligation under international humanitarian law to respect the sanctity of, and actively protect, health facilities.\u201d An independent UN Human Rights Council commission also says it is \u201ccollecting and preserving evidence of war crimes committed by all sides since 7 October 2023.\u201d<\/p>\n The implications for Gaza\u2019s health system have been disastrous. Even in the earliest weeks of the conflict, doctors warned<\/a> that hospitals were running out of space to treat the wounded and were operating without access to anesthetics or even clean water. Hospitals and the health care system have also seen continued destruction. On January 3, the WHO estimated that only 13 of the 36 hospitals<\/a> in Gaza remained operational. The WHO also says<\/a> that instances of disease in Gaza have skyrocketed as access to health care, food, and clean water has plummeted.<\/p>\n Poole says she hopes the research leads to further investigations to \u201cascertain whether or not the medical complexes were getting distinction, proportionality, and precaution principles that protects them through IHL\u201d throughout the course of the conflict.<\/p>\n \u201cIf the principle of distinction was being respected in this conflict, there would be a stark difference in our findings between special protected infrastructure\u2014in this case, health facilities\u2014and non-health facility infrastructure,\u201d Raymond says. \u201cWhat we find instead is that there is no difference.\u201d<\/p>\n