International law aims to protect medical personnel and facilities as well as the sick and injured in the event of armed conflict. It also very strictly regulates the conditions which authorize combatants to attack health infrastructures when they are suspected of being exploited by certain belligerents.
On the night of Monday March 16 to Tuesday March 17, 2026, a Pakistani airstrike hit a detoxification center located in Kabul, Afghanistan. According to the Afghan authorities, at least 400 people died, and the bombings left hundreds injured.
Pakistan has denied deliberately targeting the medical facility. In a statement published on the social network terrorist activities”, including “technical support infrastructure and ammunition storage warehouses”.
Globally, attacks on health infrastructure are on the rise. On March 14, 2026, an Israeli airstrike hit a health center in Lebanon, killing 12 doctors, nurses and rescue workers. This attack brings to 31 the number of health professionals killed in this country on this date.
Since the beginning of March, the World Health Organization (WHO) has recorded 27 attacks on health facilities in Lebanon alone, as Israeli strikes in the country and joint US-Israeli operations in Iran have intensified. The Office of the United Nations High Commissioner for Human Rights (OHCHR) and the WHO condemned these attacks, calling them violations of international law.
What laws protect medical facilities, staff and patients during times of conflict? Do these protections become obsolete if the infrastructure serves as a refuge for combatants?
What the “law of war” says about the protection of hospitals
International humanitarian law is a set of detailed rules aimed at protecting medical personnel, facilities, and the sick and wounded during armed conflicts.
This “law of war” specifies that:
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medical personnel, which includes doctors, nurses and first aiders, must be respected and protected in the exercise of their duties;
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there are special protections for ambulances and means of transport exclusively dedicated to medical purposes;
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these protections extend to the wounded and sick in their care. This includes enemy combatants requiring treatment and no longer participating in hostilities;
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Impartial humanitarian organizations must be allowed to provide medical assistance. Consent to their action cannot be arbitrarily withheld;
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medical facilities must display the distinctive protective emblems of the Red Cross, Red Crescent or Red Crystal. Medical personnel must be provided with identity documents and armbands displaying these emblems; (intended to free itself from the cultural, political or religious connotations of the other two emblems, the Red Crystal was adopted in December 2005 during a diplomatic conference of the States parties to the Geneva Conventions. It enjoys the same status as all emblems recognized by the Geneva Conventions.).
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the abusive use of these symbols to cover military operations is prohibited. Such an act may amount to perfidy, a form of deliberate deception that constitutes a war crime under international law;
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Deliberately attacking medical personnel or facilities displaying these emblems may also constitute a war crime;
What is the origin of these rules?
Laws protecting medical services in times of war arose in response to the untold suffering witnessed during the conflicts of the 19th century.eand 20e centuries. The first treaty protecting wounded soldiers and medical personnel dates back to 1864, when states adopted the original Geneva Convention.
Today, the Geneva Conventions of 1949 and their Additional Protocols, supplemented by a body of customary international law, form a near-universal legal framework binding all parties to the conflict, including non-state armed groups.
These rules require belligerents to respect and protect healthcare personnel, infrastructure and the wounded in all circumstances.
Why are attacks on medical facilities increasing?
In January, Doctors Without Borders (MSF) reported that attacks on medical facilities and personnel had reached unprecedented levels across the world. In 2025 alone, there were 1,348 attacks against healthcare structures, double the figure recorded in 2024.
The law itself has not changed, unlike the nature of war. Recent conflicts in South Sudan, Ukraine, Gaza, Iran and Lebanon are taking place in densely populated urban environments. Armed groups operate in complex civilian contexts, often near hospitals and clinics.
This has changed the discourse of certain belligerents. What were once called “errors” are now frequently justified by military necessity. Now, states often claim that insurgents use hospitals or ambulances to gain a military advantage. The Israeli authorities have, for example, accused Hezbollah and Hamas of exploiting medical infrastructures for military purposes.
Can a hospital lose its protection if fighters hide there?
Yes. Hospitals may lose their special protection if they are used outside of their humanitarian mission, to commit acts intended to harm the enemy.
However, under international law, the level of activities that could result in the loss of the protection enjoyed by hospitals must be very high. Thus, medical personnel are authorized to carry light weapons intended for their own defense. In addition, armed guards may be present to ensure the security of the site. The presence of injured combatants receiving treatment does not change the situation: the protections remain valid.
The latter can only be lifted if hospitals are used to carry out activities such as:
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launching attacks;
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the use of medical infrastructure as an observation post;
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weapons storage;
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the use of medical infrastructures as a command or liaison center;
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accommodation of able-bodied combatants.
Even in such cases, if doubts persist, the hospital must be presumed to be protected. It is also crucial to note that verifying misuse does not give carte blanche to attack.
Before launching an offensive against a medical facility involved in such activities, international humanitarian law requires that a summons be sent and that a reasonable period of time be granted for this abusive use to be put an end to.
If the summons remains ineffective, the attacking party must continue to comply with the fundamental principles of international humanitarian law, in particular:
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proportionality: the expected military advantage must be weighed against the humanitarian consequences of the attack. This includes long-term impacts on health services. If the foreseeable civilian damage is excessive, the attack must be canceled;
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precaution: all possible precautions must be taken to minimize harm caused to patients and nursing staff. This may include organizing evacuations, planning to anticipate interruption of care, and helping to restore medical capabilities after the assault.
Even when an establishment loses its protection, the injured and sick must continue to be respected and protected.
Are attacks on medical infrastructure becoming normalized?
The UN Security Council, WHO, MSF and OHCHR have expressed serious concern that attacks on medical personnel and infrastructure – and the lack of accountability from attackers – are becoming dangerously normalized.
The legal framework protecting hospitals and caregivers already exists. It is up to States and armed groups to disseminate this right and train their military forces.
National justice systems are supposed to investigate and prosecute perpetrators of war crimes against the wounded, sick, medical personnel and their facilities, as well as those who misappropriate protective emblems for military purposes.
In practice, however, investigating such attacks in the midst of an ongoing conflict is extremely difficult, with states often unwilling or unable to prosecute.
How can we reverse this trend?
Open source forensics groups, such as Forensic Architecture, Bellingcat, Mnemonics and Airwars, are playing an increasingly important role in preserving satellite images, geolocation data and videos posted on social media. When independent investigative missions are carried out, those responsible can rely on these different elements to establish the occurrence of the facts. Such missions contribute to the manifestation of the truth, even when States are unwilling or unable to play their role.
This point is all the more important because if belligerents are not held to account, places supposed to save lives during times of conflict risk being targeted more and more frequently.
