OHCHR Thematic Report – Attacks on hospitals during the escalation of hostilities in Gaza (7 October 2023 – 30 June 2024)

Comments by Israel and the State of Palestine on the draft report shared on 16 December 2024. (source link is here)

العربية

31 December 2024

I. Introduction

1. This report presents grave concerns regarding attacks on hospitals, as well as operations within them and in their vicinity, in Gaza covering the period 7 October 2023 to 30 June 2024. In the context of the ongoing escalation of hostilities in Gaza, the Office of the United Nations High Commissioner for Human Rights (OHCHR) has since early October 2023 documented repeated attacks on hospitals and operations within and in the vicinity of hospitals, leading to sustained combat in and around many hospitals. This pattern has led to the destruction of most hospitals in Gaza, pushing the healthcare system to the point of almost complete collapse. Attacks on hospitals were reported in each of the areas in which the Israeli military conducted ground operations, starting in November 2023 with an attack on Al Shifa Medical Complex and other hospitals in Gaza City. At the end of June 2024, 22 out of 38 hospitals across Gaza had been rendered non-functional, according to the Ministry of Health of the State of Palestine (Palestinian MOH).

2. In gathering, assessing, and verifying the information contained in this report, and drawing conclusions based on international human rights law and international humanitarian law, OHCHR applied its standard methodology. The monitoring and verification of violations remained extremely challenging, including owing to access constraints, a high level of insecurity, and threats and direct attacks also on United Nations personnel, monitors and humanitarian actors. Nevertheless, verification work continued, and information was gathered from multiple independent sources, including victims and witnesses; military and weapons experts; open sources, including satellite imagery, videos and photos; credible organizations and individuals; official and other documentation. The analysis of the information involved legal and weapons expertise, including from independent experts. Findings are included in the report where the “reasonable grounds” standard of proof has been met, namely: based on a body of verified information, an objective and ordinarily prudent observer would have reasonable grounds to believe that the facts took place as described and, where legal conclusions are drawn, that these facts meet all the elements of a violation. On 16 December 2024, the report was shared with the Permanent Missions of Israel and the State of Palestine for factual comments. The State of Palestine and Israel responded with comments on 19 and 20 December, respectively. OHCHR welcomes receiving these comments, which can be read here.

3. The healthcare system in Gaza was grossly inadequate even before 7 October 2023. The 17-year blockade of Gaza in the context of Israel’s 57-year occupation, combined with the destruction caused by repeated escalations of hostilities since 2008, during which Israeli forces regularly bombed Gaza, had created broad dependence on external aid and heavily restricted access and movement of people and goods in and out of Gaza, including those essential for healthcare. This created the conditions for endemic shortcomings in healthcare provision and recurring violations of Palestinians’ human rights in Gaza, including their rights to life4 and health.

4. The situation has deteriorated to a catastrophic level since October 2023, as this already damaged health system has been targeted, resulting in the killing of hundreds of health and medical professionals. This report sets out patterns in the conduct of hostilities in relation to attacks on hospitals and in their vicinities, examining several cases which OHCHR has closely monitored. The attacks on hospitals often followed a similar pattern, involving missile strikes on hospital buildings, the destruction of hospital facilities, shooting of civilians, sieges, as well as temporarily taking over hospital buildings. The present report does not examine in detail the many cases of arbitrary detention, enforced disappearance, and ill-treatment of medical personnel and other Palestinians, including internally displaced persons (IDPs), taken into custody from inside hospitals, which has been reported on elsewhere. It is clear, however, that these losses of qualified personnel have contributed to the collapse of the healthcare system.

5. The impacts of the Israeli military’s operations in and around hospitals that led, in many instances, to combat in these areas have been significant, extending far beyond the physical structures. It has resulted in the loss of access to essential, life-saving treatment; loss of access to safe spaces, including desperately needed shelters; and loss of care for chronic illnesses, turning non-life-threatening conditions into potentially fatal ones. The destruction of Gaza’s healthcare system, along with Israel’s restrictions on the entry and distribution of medical supplies, has led to the drastic deterioration of health outcomes across the entire population and a health catastrophe, with the spread of infectious diseases including polio, Hepatatis A, acute diarrhea and jaundice. This has caused significant suffering among the population and thousands of Palestinian civilians have resultantly died and will continue to die until the health system is rebuilt.

6. A fundamental rule of international humanitarian law (IHL) is that the wounded and sick shall be collected and cared for. All wounded and sick persons, including civilians and persons hors de combat, are afforded protection. Furthermore, IHL provides specific protections to medical personnel and medical units where the wounded and sick are cared for, including hospitals.