An article by The Conversation written by Shannon Bosch – Associate Professor (Law), Edith Cowan University
Pakistan claims it did not deliberately target this medical facility. In a statement posted on X social media, the Pakistani Ministry of Information and Broadcasting stated that these “precision airstrikes” targeted “military facilities of the Afghan Taliban regime used to support terrorist activities,” including “technical support infrastructure and ammunition storage facilities.”
Globally, attacks on healthcare facilities are on the rise. On March 14, 2026, an Israeli airstrike hit a health center in Lebanon, killing 12 doctors, nurses, and rescuers. This attack brings the total number of healthcare professionals killed in the country to 31 on that date.
Since the beginning of March, the World Health Organization (WHO) has recorded 27 attacks on healthcare facilities in Lebanon alone, while Israeli strikes in the country and joint American-Israeli operations in Iran have intensified. The Office of the High Commissioner for Human Rights (OHCHR) and WHO have condemned these aggressions, calling them violations of international law.
What laws protect medical facilities, personnel, and patients during conflicts? Do these protections become void if the infrastructure is used as a refuge for combatants?
The “law of war” on hospital protection
International humanitarian law consists of detailed rules aimed at protecting medical personnel, facilities, and patients during armed conflicts.
This “law of war” specifies that:
– Medical personnel, including doctors, nurses, and rescuers, must be respected and protected in the exercise of their functions. – Special protections exist for ambulances and transportation vehicles solely dedicated to medical purposes. – These protections extend to the wounded and sick under their care. This includes enemy combatants needing care and no longer participating in hostilities. – Impartial humanitarian organizations must be authorized to provide medical assistance. Consent to their actions cannot be arbitrarily denied. – Medical facilities must display the distinctive protective emblems of the Red Cross, Red Crescent, or Red Crystal. Medical staff must carry identity documents and armbands displaying these emblems.
The origin of these rules
Laws protecting medical services in wartime were born in response to the unspeakable suffering observed during the conflicts of the 19th and 20th 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 corpus of customary international law, form an almost universal legal framework binding all parties to the conflict, including non-state armed groups.
These rules compel belligerents to respect and protect healthcare personnel, facilities, and the wounded in all circumstances.
Why are attacks on healthcare facilities increasing?
In January, Doctors Without Borders (MSF) reported that attacks on medical facilities and personnel had reached unprecedented levels worldwide. For the year 2025 alone, there were 1,348 attacks on healthcare structures, double the number recorded in 2024.
While the law remains unchanged, the nature of war has evolved. Recent conflicts in South Sudan, Ukraine, Gaza, Iran, and Lebanon take place in densely populated urban environments. Armed groups operate in complex civilian contexts, often near hospitals and clinics.
This has changed the discourse of some belligerents. What was once termed “errors” is now frequently justified by military necessity imperatives. States often claim that insurgents use hospitals or ambulances to gain a military advantage. Israeli authorities, for example, accused Hezbollah and Hamas of using medical infrastructure for military purposes.
Can a hospital lose its protection if combatants hide there?
Yes. Hospitals can lose their special protection if they are used outside their humanitarian mission to harm the enemy.
However, according to international law, the level of activities that could result in the loss of hospital protection must be very high. Thus, medical personnel are allowed to carry light weapons for self-defense. Armed guards may be present to ensure site security. The presence of wounded combatants receiving care does not change the situation: the protections remain valid.
These protections can only be lifted if hospitals are used for activities such as launching attacks, using medical infrastructure as observation posts, storing weapons, using medical facilities as command or liaison centers, or hosting active combatants.
Even in such cases, if doubts persist, the hospital should be presumed protected. It is also crucial to note that verifying misuse does not give a blank check for attack.
Before launching an offensive against a medical facility involved in such activities, international humanitarian law requires a warning to be issued and a reasonable deadline given to end the abusive usage.
If the warning has no effect, the attacking party must continue to adhere to the fundamental principles of international humanitarian law, including:
– Proportionality: the anticipated military advantage must be weighed against the humanitarian consequences of the attack. This includes the long-term impact on health services. If the visible civilian damages are excessive, the attack must be canceled. – Precaution: all possible precautions must be taken to minimize harm to patients and healthcare personnel. This can include organizing evacuations, planning for care interruptions, and assisting in the restoration of medical capacities post-assault.
Even when a facility loses its protection, the wounded and sick must continue to be respected and protected.
Are attacks on healthcare facilities becoming normalized?
The UN Security Council, WHO, MSF, and OHCHR have expressed deep concern: attacks on medical personnel and infrastructure – as well as the fact that attackers are not being held accountable – are dangerously becoming normalized.
The legal framework protecting hospitals and healthcare providers already exists. It is the responsibility of states and armed groups to disseminate this right and train their military forces.
National judicial 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 misuse protective emblems for military purposes.
In practice, however, investigating such attacks during an ongoing conflict proves extremely challenging. In reality, states are often unwilling or unable to prosecute.
How to reverse this trend?
Specialized open-source investigation 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 networks. When independent investigative missions are conducted, their managers can rely on these different elements to establish the occurrence of events. Such missions contribute to the manifestation of truth, even when states are unwilling or unable to fulfill their role.
