Israel’s attacks on Gaza hospitals – Letter from Palestine (A/ES-10/968–S/2023/864)

13 November 2023

                     Identical letters dated 13 November 2023 from the Permanent Observer of the State of Palestine to the United Nations addressed to the Secretary-General, the President of the General Assembly and the President of the Security Council

Article 18 of the Fourth Geneva Convention stipulates: “Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack, but shall at all times be respected and protected by the Parties to the conflict”.

Yet, in the 48 hours since the Directors-General of the World Health Organization (WHO) and Palestine Red Crescent Society addressed the Security Council, warning of a health catastrophe in the besieged Gaza Strip and appealing for a ceasefire and the protection of civilians and civilian objects, including health-care sites, Israel has attacked more hospitals and killed more health workers, alongside other civilians. As of this morning, the casualty toll in Gaza was 11,180 Palestinians killed, among them 4,609 children and 3,100 women, and 28,200 injured.

By violating article 18 of the Fourth Geneva Convention and all other relevant norms of international law and ignoring appeals to halt the bloodshed, Israel, the occupying Power, is endangering the lives of thousands more Palestinians civilians, including sick and wounded patients, newborns in incubators, families sheltering on hospital grounds and doctors, nurses and paramedics.

WHO has recorded at least 137 attacks by Israel on health care in Gaza in the past 36 days, but there have certainly been more, causing 521 deaths and 686 injuries, among which 16 deaths and 38 injuries of health workers on duty. In the past 48 hours, Israel murdered another five Palestinian doctors: Dr. Israa Al-Ashqar, a young female doctor of resuscitation and anaesthesia at the Indonesian hospital; Dr. Basel Mehdi, an obstetrician; Dr. Hammam Ellouh, a kidney specialist; Dr. Raed Mahdi, an obstetrician; and Dr. Mohammed Adwan, a gastroenterologist.

Health workers face an impossible choice of leaving to try to save themselves, or staying to care for patients whose lives depend on them. Doctors describe an apocalyptic situation at Al-Shifa hospital, which is under siege by Israel, left without power, fuel or water and repeatedly targeted, including by drone strikes and firing at patients and staff who are trying to flee. Intensive care unit patients are dying, three premature babies have died, the morgue is overflowing with hundreds of decomposing bodies, and 3,000 patients and medical staff and 15,000 displaced persons sheltering there are in imminent danger. Médecins sans frontières has denounced “the death warrant of civilians currently trapped in Al-Shifa Hospital signed by the Israeli military”.

In addition to Al-Shifa, Al-Rantissi hospital, Naser paediatric hospital, Al‑Mahdi hospital and Al-Quds hospital in northern Gaza have come under attack by Israel, which also destroyed the Swedish clinic in Al-Shati refugee camp in an air strike on 11 November. Out of the 35 hospitals in Gaza, 20 have ceased functioning, including Al-Quds hospital as of 12 November, due to Israel’s attacks and blocking of fuel, medicines, electricity and other humanitarian supplies, adding immense pressure on remaining hospitals, which continue to be bombarded.

In this regard, claims that patients, doctors and other civilians at hospitals are being used as human shields by Palestinian fighters are false and dangerous. Israel has brought this aggression to them, encircling and striking at hospitals, ambulances and all civilian structures, wantonly and deliberately. Health workers trying to save lives do not serve as human shields; they are doing their duty, refusing to abandon patients they are sworn to care for, for whom no place in Gaza is safe, as conceded by United Nations officials, from the Secretary-General on down.

The Director-General of WHO, Tedros Adhanom Ghebreyesus, warns: “The situation is dire and perilous …. The world cannot be silent while hospitals, which should be safe havens, are transformed into scenes of death, devastation and despair. Ceasefire. NOW”. His call is being echoed by all other United Nations agencies and humanitarian organizations on the ground, and by countries the world over that are calling for a halt to the violence, including in the General Assembly, on 27 October, with the adoption of resolution ES-10/21.

Nevertheless, Israel carries on with its genocidal aggression on the Palestinian people, breaching every law of war and openly declaring its intentions to continue doing so, no doubt emboldened by the Security Council’s failure to demand a ceasefire, respect for international law, including humanitarian and human rights law, and protection of civilians, even as children, women and men, doctors and yet another journalist in Gaza are killed.

The situation in Gaza thus remains in free fall, provoking unprecedented levels of human suffering. In addition to 11,078 killed, another 2,700 victims, half of them children, are feared to be either dead or struggling to survive under the ruins of pulverized homes and refugee camps, waiting to be rescued or buried. The casualty toll in the West Bank, including East Jerusalem, has also climbed as Israeli occupying forces and settlers ratchet up their violence on Palestinian civilians, with, at the time of writing, 186 killed, including 46 children, and 2,400 injured.

The number of Palestinians displaced has also increased, with the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) reporting 778,000 civilians now sheltering in 154 facilities, and another struck by Israel today in Rafah in the south. The public health crisis is also worsening as humanitarian aid remains far below the magnitude of needs and malnutrition and dehydration spread, along with respiratory illness, skin infections, and other diseases spread by unsanitary health conditions. Without fuel, UNRWA is warning that its vital humanitarian operations will come to a halt in two days.

The rest of the 1.6 million displaced are sheltering in the homes of other families and other public facilities, including schools, hospitals, mosques and churches, mostly in southern Gaza, as Israel’s attacks and military orders have driven the majority of people from the north. We reiterate our demands for a halt to forced displacement of the Palestinian civilian population, including our firm rejection of attempts to forcibly transfer them to Egypt.

This criminal aggression on our people must be immediately stopped. The Security Council must unify to demand a ceasefire and an end to Israel’s forced displacement and collective punishment of the Palestinian people, and it must demand full compliance with international law, including humanitarian and human rights law.

In this regard, accountability is urgent to pursue – by the Council, by the International Criminal Court, by the International Court of Justice and by all States, in line with international legal obligations, including under the Fourth Geneva Convention obligation to respect and ensure respect in all circumstances, including in the Occupied Palestinian Territory, including East Jerusalem. Israel cannot remain a State above the law. Only such serious action can stop its war crimes, crimes against humanity and State terrorism against the Palestinian people, saving lives and our region from implosion.

The present letter is in follow-up to our 813 previous letters on the ongoing crisis in the Occupied Palestinian Territory, including East Jerusalem, which constitutes the territory of the State of Palestine. These letters, dated from 29 September 2000 (A/55/432-S/2000/921) to 10 November 2023 (A/ES-10/967-S/2023/857), constitute a basic record of the crimes being committed by Israel, the occupying Power, against the Palestinian people since September 2000. For all of these war crimes, acts of State terrorism and systematic human rights violations against our people, Israel, the occupying Power, must be held accountable and the perpetrators must be brought to justice.

I should be grateful if you would arrange to have the present letter distributed as a document of the tenth emergency special session of the General Assembly, under agenda item 5, and of the Security Council.

(Signed) Riyad Mansour

Minister

Permanent Observer