Health crisis: Why hospital attacks are surging in warzone

The scale of modern warfare is increasingly measured by the destruction of the very places meant to offer sanctuary.

Afghanistan recently reported that at least 400 people were killed in a Pakistani airstrike on a drug rehabilitation hospital in Kabul, with potentially hundreds more wounded.

While Pakistan denied deliberately targeting the facility—claiming the strike precisely targeted military installations and terrorist support infrastructure—the incident highlights a grim global trend of targeting healthcare in conflict zones.

Attacks on healthcare facilities are surging worldwide. On March 14, an Israeli airstrike in Lebanon killed 12 medical professionals, bringing the recent death toll of healthcare workers in the region to 31. Since early March, the World Health Organisation (WHO) has verified 27 attacks on Lebanese medical facilities alone.

As operations in Lebanon and joint US–Israeli operations in Iran intensify, the WHO and the Office of the High Commissioner for Human Rights (OHCHR) have condemned these strikes as blatant violations of international law.

This raises a critical question: what laws protect medical facilities, staff, and patients during conflict, and do they lose this protection if facilities are used to shelter combatants?

Legal shields during warfare

International humanitarian law (IHL) contains detailed rules to protect medical personnel, facilities, and the wounded. Under these "laws of war," medical personnel, including doctors, nurses, and paramedics, must be respected and protected while performing their duties. These protections extend to special transport, such as ambulances used exclusively for medical purposes, and to the wounded and sick in their care. This includes enemy fighters who are hors de combat—those requiring treatment and no longer taking part in hostilities. Furthermore, impartial humanitarian organizations must be allowed to provide medical assistance, and consent to their work cannot be refused arbitrarily.

To ensure safety, medical facilities must display the distinctive protective emblems of the Red Cross, Red Crescent, or Red Crystal, and personnel must carry identification. Misusing these symbols to shield military operations is strictly prohibited; doing so may amount to perfidy, a type of deliberate deception which is a war crime under international law.

Deliberately attacking personnel or facilities displaying these emblems can similarly constitute a war crime.

These rules emerged from the enormous suffering of 19th and 20th-century conflicts, starting with the original Geneva Convention in 1864. Today, the 1949 Geneva Conventions and their Additional Protocols form a near-universal legal framework binding all parties to conflict, including non-state armed groups.

Drivers of recent violence

The law itself has not changed, but the nature of warfare has. In January, Médecins Sans Frontières (MSF) reported that attacks on healthcare reached unprecedented levels, with 1,348 attacks in 2025 alone—double the number reported in 2024. Recent conflicts in South Sudan, Ukraine, Gaza, Iran, and Lebanon are taking place in densely populated urban environments where armed groups operate within complex civilian settings, often near hospitals. This has shifted the narrative: what were once described as "mistaken attacks" are now frequently justified on grounds of military necessity. States often claim insurgents are exploiting hospitals or ambulances to gain a military advantage, a justification frequently cited by Israel regarding Hezbollah and Hamas.

Hospitals can lose their special protection if they are used, outside their humanitarian role, to harm the enemy. However, the law sets a very high threshold for this. Protection is not lost if medical personnel carry light weapons for self-defence, if armed guards are present for security, or if wounded fighters are receiving treatment. Protection may only be forfeited if a facility is used for launching attacks, storing weapons, serving as an observation post, or sheltering able-bodied combatants. Even in cases of doubt, hospitals must be presumed protected under international law.

Restraints on military action

Verifying that a hospital is being misused does not give parties a free license to attack. Before launching an assault, IHL requires a warning to be issued and a reasonable time allowed for the misuse to stop. If the warning is ignored, the attacker must still comply with the principle of proportionality, weighing the military advantage against the humanitarian consequences. 

The UN Security Council and the WHO have expressed deep concern that attacks on medical personnel — and the lack of accountability for them — are becoming dangerously normalised. While the legal framework exists, territorial states are often unwilling or unable to pursue prosecutions. However, open-source investigative groups such as Forensic Architecture and Bellingcat are now playing a growing role.  

The Conversation