In a new Israeli war crime widely reported by the media, two airstrikes by the Israeli occupation army targeted the Nasser Medical Complex in Khan Younis, southern Gaza Strip, resulting in the death of at least 20 Palestinians, including five journalists. The first strike hit the upper floor of Nasser Hospital, and a live broadcast captured the second strike as civil defense members and journalists were present, causing a massacre witnessed live worldwide. Among the martyred journalists were Palestine TV cameraman Hussam Al-Masri, Al Jazeera cameraman Mohammed Salama, Arab Independent newspaper photographer Mariam Abu Dakka, and photographer Moaz Abu Taha.

This massacre represents a blatant violation of international law by the Israeli occupation army during its ongoing aggression and siege on Gaza since October 7, 2023. According to international humanitarian law, medical facilities and units, including hospitals, must not be attacked. This protection extends to the wounded, sick, medical staff, and means of transport. There are virtually no exceptions to this rule, as stated by the International Committee of the Red Cross (ICRC).

During armed conflict, the term ‘wounded and sick’ covers anyone, military or civilian, requiring medical care and not participating in hostilities or having ceased participation. Protecting medical services is essential to ensure the wounded and sick receive urgent care. The Geneva Conventions and their Additional Protocols impose obligations on warring parties to respect and protect healthcare services. Deliberate attacks on medical facilities, vehicles, and personnel constitute grave breaches of international humanitarian law and amount to war crimes.

Under the Rome Statute of the International Criminal Court, intentionally directing attacks against medical buildings, materials, units, transport, or personnel bearing distinctive emblems as per the Geneva Conventions is a war crime in both international and non-international armed conflicts.

Special protection of medical institutions and units, including hospitals, is the general rule under international humanitarian law. This protection ceases only if a party to the conflict uses them to commit ‘acts harmful to the enemy’ outside their humanitarian duties. In cases of doubt, medical units are presumed not to be used for such acts.

Although there is no agreed definition of ‘acts harmful to the enemy,’ the rationale for losing protection is clear when used for direct or indirect military operations, such as using a hospital as a base for attacks, observation post, weapons depot, communication center, or shelter for healthy combatants.

Before attacking a medical facility that has lost its protected status, a warning with a time limit must be issued to allow those committing harmful acts to cease or to permit safe evacuation of patients and wounded not responsible for such acts, according to the ICRC.

The attacking party remains bound by the principle of proportionality, carefully balancing the anticipated military advantage against the potential humanitarian consequences of damage or destruction. They must also take all feasible precautions to avoid or minimize harm to patients and medical personnel unrelated to hostile acts, whose suffering would be severe.

Legal advisers Subria Rao and Alex Pritiger of the ICRC emphasize that even when a hospital loses its special protection and becomes a legitimate military target, the parties remain obligated to collect and care for the wounded and sick, which is impossible without functioning medical facilities. They note that comprehensive care obligations impose an additional legal constraint beyond proportionality and precautions, tipping the balance toward preserving medical functions as much as possible even when hospitals are exposed to attack.