A global failure to uphold the International Humanitarian Law

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Gaza's healthcare collapse: A global failure to uphold the International Humanitarian Law

One of the greatest achievements of international diplomacy is the unequivocal commitment of states to safeguard healthcare amidst the pandemonium of war and conflict. In the midst of chaos and hostilities, International Humanitarian Law (IHL) reiterates this consensus through its mandate to protect healthcare systems and medical missions to help those caught in the crossfires. Yet, the current realities in the Gaza enclave present a disconcerting picture.

The relentless bombardment and attacks have pushed nearly all healthcare facilities in the beleaguered Gaza Strip into make-shift battlegrounds. This is a distressing erosion of humanitarian values. The healthcare system has been shattered; as per UN data (as of 11 April 2024), with a staggering 804 recorded attacks on healthcare facilities, leaving only 10 out of 36 hospitals partially operational. These facilities have been overwhelmed by relentless demand and depleted resources. Targeted assaults on medical establishments and personnel, compounded by intentional throttling of aid, have aggravated an already dire situation. The health crisis gripping Gaza paints a picture of sheer catastrophe, spotlighting the broader assault on medical services in conflict zones worldwide.

The healthcare system has been shattered; as per UN data (as of 11 April 2024), with a staggering 804 recorded attacks on healthcare facilities, leaving only 10 out of 36 hospitals partially operational.

This article argues that the Gaza crisis transcends mere geopolitical impasses. It serves as a testament to the shortcomings of international mechanisms tasked with upholding human rights and dignity and, at the very least, the principle of humanitarian law. This grim reality underscores the urgent need for a nuanced legal discourse to confront the pervasive pattern of healthcare assaults in conflict zones worldwide.

Wider health consequences in Gaza-Palestine 

As Gaza rages into the month of what many describe as one of the deadliest and most devastating military campaigns of the 21st century, the impact on human life and health is deplorable. Over 34,900 lives have been lost since the conflict broke out, with casualty figures surpassing those from previous conflicts in the region. However, the health crisis in Gaza extends far beyond the immediate casualties of war.

Chronic shortages of medical supplies, electricity, and clean water, coupled with restricted access to essential health services, have created an extreme situation. Recent reports indicate that millions face the threat of starvation and malnutrition, with the entire population in the Gaza Strip confronting acute food insecurity, and as per UN reports, the risk of famine is imminent in Gaza. This crisis has left the entire population vulnerable to a range of health challenges, including non-communicable diseases, mental health disorders, and infectious disease outbreaks.

The already fragile healthcare system in Gaza is on the brink of collapse, threatening not only immediate medical care but also the long-term ability to respond to the health needs of the population.

The continued targeting of health facilities and aid workers has only exacerbated the situation, pushing Gaza towards what could soon become the worst humanitarian crisis in recent memory. As a result, the already fragile healthcare system in Gaza is on the brink of collapse, threatening not only immediate medical care but also the long-term ability to respond to the health needs of the population.

The role of International Humanitarian Law

IHL sets forth meticulous regulations to alleviate the impact of armed conflicts for humanitarian purposes. It comprises a universal framework of rules, including international treaties and customary rules, tailored to address humanitarian challenges arising from armed conflicts. At its core lies a set of four Geneva Conventions, adopted between 1864 and 1949 to ameliorate the effects of war on soldiers and civilians, and three Additional Protocols adopted in 1977 and 2005.

The Geneva Convention (IV) mandates that conflicting parties ensure the protection of civilians, particularly those who are wounded and sick, as well as individuals in need of medical assistance, such as maternity cases, disease sufferers, new-borns, and anyone requiring immediate medical care, as specified under Article 8(a) of the Additional Protocol I. The law also comprehensively extends this protection to health facilities and personnel. As per Article 24 of the Geneva Convention (I), medical personnel exclusively engaged in providing medical care, preventing disease, or transporting the sick and wounded are required to be respected and protected, paralleling the protection afforded to the sick and wounded themselves.

The deliberate targeting of medical facilities and personnel, coupled with constraints on ambulance movements and blockades impeding access to medical supplies represent egregious violations of the universal humanitarian rules.

Article 19 of the First Geneva Convention emphasises that fixed establishments and mobile medical units may under no circumstances be attacked but shall at all times be respected and protected by the Parties to the conflict. Similarly, Articles 18 and 19 of the Fourth Geneva Convention explicitly prohibit targeting civilian hospitals, emphasising their perpetual respect and protection, except when used for acts harmful to the enemy, respectively.

Despite these provisions, recent events in Gaza starkly illustrate the disregard for upholding these principles. The deliberate targeting of medical facilities and personnel, coupled with constraints on ambulance movements and blockades impeding access to medical supplies represent egregious violations of the universal humanitarian rules.

Israel’s defence, which invokes the principles of proportionality and harm minimisation, raises critical questions about the intentional targeting of civilians and civilian infrastructure. This rationale extends to Israel’s interpretation of legal obligations, notably the duty of proportionality enshrined in Article 57(2)(a)(iii) of Additional Protocol I. However, doubts arise concerning the extent to which feasible precautions were taken to mitigate civilian harm, particularly in targeting hospitals, highlighting the lack of clarity in the exemption clause under Article 19.

The widespread attacks not only raise concerns about Israel’s disregard for essential humanitarian principles but also breach obligations outlined in various international agreements. For instance, the UNGA Resolution on Protection of Civilians in Armed Conflict emphasises the imperative to safeguard civilians and healthcare workers. Additionally, UN Security Council Resolution 2286 underscores the importance of International Humanitarian Law (IHL) and urges all parties involved in conflicts to fully adhere to it, particularly in ensuring the safety of medical personnel and facilities.

The UNGA Resolution on Protection of Civilians in Armed Conflict emphasises the imperative to safeguard civilians and healthcare workers.

Given the escalating humanitarian crisis, calls to designate attacks on medical facilities as war crimes have gained traction. Under the Rome Statute of the International Criminal Court, intentional attacks on medical facilities, as well as transport and civilian structures, neighbourhoods, and populations, also constitute war crimes. Article 8 of the Rome Statute defines a long list of war crimes, including “intentionally directing attacks against buildings dedicated to religion, education, art, science or charitable purposes, historic monuments, hospitals and places where the sick and wounded are collected”. In Gaza, the ongoing military operations by Israeli forces, characterised by bombings and a continued siege, underscore the imperative for a thorough examination of accountability mechanisms for those responsible for the devastation. The systematic dismantling of healthcare infrastructure, particularly in Gaza, draws attention to revisiting the enforcement of humanitarian norms. 

Failure of accountability and its consequences

The stark failure to ameliorate the situation in Gaza and create accountability is prolonging unmitigated suffering, perpetuating a cycle of impunity and injustice. Despite clear violations of IHL, international mechanisms and state parties have consistently failed to hold perpetrators accountable through investigation and prosecution. This absence of accountability not only undermines the rule of law but also emboldens further violations, creating a dangerous precedent.

One striking example of this failure is the blatant disregard for the ruling of the International Court of Justice (ICJ) passed on 26 January 2024 in a case brought by South Africa. In its directive to Israel under Article II of the Genocide Convention, the ICJ explicitly ordered the cessation of actions causing harm to Palestinians in Gaza. However, bombardments continued even after this directive, demonstrating a flagrant disregard for international legal obligations. Recent incidents, including Israeli airstrikes killing aid workers and halting humanitarian aid, highlight the consequences of this accountability vacuum. Israel’s attempts to justify these actions as unintentional intensify scrutiny and raise questions about the threshold of negligence acceptable under international law.

In December 2023, the WHO Executive Board addressed an active conflict for the first time, endorsing, after intense negotiations, a resolution to uphold IH obligations and support the UNGA’s call for a humanitarian ceasefire under Article 99 of the UN Charter’s Article.

Israel’s attempts to justify these actions as unintentional intensify scrutiny and raise questions about the threshold of negligence acceptable under international law.

To address the failure of accountability and the health crisis in Gaza, several urgent measures are necessary. Firstly, the international community must recommit to upholding and enforcing IHL, particularly regarding the provision of healthcare during the conflict. Secondly, independent and transparent investigations into violations of international law must be conducted to break the cycle of impunity. Thirdly, efforts should focus on strengthening Gaza’s healthcare system through capacity-building initiatives and ensuring the unhindered delivery of essential services to the population.

Lastly, states must resolve to cooperate by providing financial and humanitarian aid. The resolutions passed by the World Health Assembly in May 2006 and 2012 underscore the collective responsibility of states to provide assistance in humanitarian emergencies and to facilitate the work of humanitarian agencies. These resolutions emphasise the imperative of cooperation to ensure the efficient delivery of aid to affected populations.

The case of Gaza exemplifies the pressing need for a coordinated international response to health crises in humanitarian settings. By addressing failures of accountability and reaffirming legal obligations, we can work towards a future where the dignity and health of all individuals are respected, even amidst the most challenging circumstances.


Nishant Sirohi is a Health & Human Rights Fellow at Geneva Health Files

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