[News] Condemn Israel’s Targeting of Health Facilities and Workers in the Gaza Strip

Wed Jun 2 10:56:21 EDT 2021

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Special Focus: Al-Haq Condemns Israel’s Targeting of Health Facilities and
Workers in the Gaza Strip

02، Jun 2021

*Introduction*
The Gaza Strip has been suffering from 14 years of a brutal and inhumane
Israeli-imposed military land and sea closure, which has left its health
system with an inadequate health infrastructure, dearth of medicine, lack
of service capacity and electricity and fuel deficiencies, amounting to an
illegal collective punishment
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of
the civilian population. In 2018, the World Health Organization documented
that Gaza had only 23 primary health centers providing for emergency
medical services, for a total population of 1,899,291.[1]
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The
coronavirus pandemic is exacerbating the already concerning humanitarian
situation of the health sector in the Gaza Strip, now on the verge of
collapse due to shortage of medical materials, oxygen-generating machines
and ventilators, as well as intensive care beds.[2]
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The targeting of health facilities and health workers has been a recurring
pattern of Israel’s attacks on the Gaza Strip. Already during Israel’s 2014
military offensive on the Gaza Strip (‘Operation Protective Edge’), the
occupying forces damaged 17 of 32 hospitals, as well as 45 primary health
centers, causing respectively 6 out of the 17 of them to close during the
active hostilities.[3]
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At
the time, Al-Haq reported the direct targeting of health facilities, in
particular the Al-Rahma Association for the Disabled, and nine hospitals,
killing 6 civilians and injuring more than 70.[4]
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Continuing
its policy of targeting healthcare facilities Al-Haq documented substantial
damage to healthcare facilities, including coronavirus testing centers and
health administrative buildings, and the injury of dozens of health
workers, during Israel’s 10-21 May military offensive on the Gaza Strip.

*An ambulance was damaged in the bombing of Al-Batnji and Al-Badawi
buildings, northern Gaza © Al-Haq, 20 May 2021 *

*Indiscriminate Attacks on an Ambulance Post and Health Facilities,
including a Vaccination Center, Throughout the Offensive *
Throughout the hostilities, healthcare facilities, in addition to road
infrastructure essential to its proper functioning, have been
indiscriminately impacted. On 11 May 2021, the Israeli Occupying Forces
(IOF) severely damaged two health clinics north of Gaza City, the
Indonesian Hospital and Hala al-Shawa Health Center, forcing paramedics to
evacuate and causing the health center to stop services completely.[5]
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 The
administrative unit of the Indonesian hospital rattled and its ceilings
collapsed as a result of the explosion.[6]
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On
the same day, IOF targeted and attacked the 10-storey Al-Jawhara Tower,
Dabit Junction, Al-Rimal neighborhood in the center of Gaza City,
containing a number of health clinics.[7]
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Also on 11 May 2021, the IOF targeted empty land adjacent to the Hala Jamil
Al Shawa care center, Beit Lahia, severely damaging the building. The
center is devoted to mother and child health services, including children’s
vaccinations. The Ministry of Health announced that the center has to be
put completely out of service.[8]
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On 11 and 12 May 2021, Israeli warplanes bombed empty land in Izbt Abd
Rabbo, causing damage to the Palestine Red Crescent Society ambulance
station, located at the Izbt Abd  Rabbo roundabout.

*16 May 2021: Crippling Al-Shifaa Hospital’s Main Road Artery and Killing
of Two Paramedics *
On the night of 16 May 2021, the IOF targeted and completely destroyed,
with at least 50 missiles and without prior warning, several residential
buildings of Al-Rimal neighborhood, Gaza City,[9]
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causing
the death of 30 civilians, including 11 children. The headquarters of
Doctors Without Borders were also destroyed in the bombardment.[10]
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 The
bombing resulted in the killing of 30 civilians, including 11 children and
9 women.[11]
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 Two
doctors were killed in the strike: Doctor Ayman Tawfiq Abu Auf, 50, serving
as Director of Internal Medicine, and Doctor Moeen Ahmed Hassan al-Aloul,
67, a specialist in neurosurgery.[12]
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The
bombardment caused severe damage to Al-Wehda street, the main road leading
to Al-Shifaa hospital, the largest medical facility in Gaza. It also
impaired the Churches Union junction, severely damaging the main roads
leading to Al-Wehda street, blocking the road connection between Abu Talal
junction and Dabit junction.[13]
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The
missiles created a massive crater destroying the entire road. The crater
has prevented ambulances from leaving or reaching the hospital, prevented
patients’ movement to and from the hospital, and prevented the wounded from
accessing emergency health care services.

*Al-Wehda Street, leading to Al-Shifaa hospital © Al-Haq, May 2021*
*17 May 2021: Targeting of Palestinian Health Ministry Buildings and of the
Only Coronavirus Test Center*
At approximately 6:45 pm on 17 May 2021, Israeli warplanes targeted,
without prior warning, the last three floors of the Ghazi Shawa six-floor
building, located opposite to the Rimal Martyrs Center, known as Al-Rimal
Clinic, and to the administrative building of the Palestinian Ministry of
Health, in the middle of Al-Wehda Street, Al-Rimal neighborhood, Gaza City.
[14]
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The
Ghazi Shawa building notably contained the Dakhhani laboratory, the Basma
Clinic for medicine and dental implants, as well as a number of doctors’
clinics. [15]
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The
bombardment killed two civilians, including *Rafif Murshed Kamel Abu Dyer,
10,*and his uncle, *Ziad Kamel Abdullah Abu Dayer, 54,* and injured 10
others.[16]
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The
shelling extensively damaged the Al-Rimal Clinic and the administrative
building of the Ministry of Health in Gaza, shattering a large number of
windows, doors and offices, and some health rooms, leaving the building
courtyard replete with rubble and broken glass.[17]
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*Ministry of Health Building © Al-Haq, May 2021*
During a press conference, the Under Secretary of the Ministry of Health,
Dr. Youssef Abu Al-Rish, denounced the devastating effect the shelling had
on the delivery of coronavirus-related health care. The bombing injured 103
medical staff members working in the central laboratory, in telemedicine,
and medical services. The central laboratory, the only functioning
coronavirus test center in the Gaza Strip, was forced to close, the
Ministry of Health ceased its direct contact service, and a number of
doctors stopped providing medical consultations to patients.[18]
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*Legal Analysis: Sweeping Violations of General Principles of IHL, in
addition to the Protected Status of Health Workers and Health Facilities  *
*Violations of the General Customary Principles of Distinction,
Proportionality and Prohibition of Indiscriminate Attack against Civilians
and Civilian Facilities *
As civilians and civilian objects, paramedics, health workers, health
centers and health ministry buildings are protected under the customary
principles of distinction, proportionality, and the prohibition of
indiscriminate attack.

   - Article 48 of the First Additional Protocol to the Geneva Conventions
   stipulates that “the Parties to the conflict shall at all times distinguish
   between the civilian population and combatants […]”.[19]
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   - In addition, Article 51(4) prohibits indiscriminate attacks, that “are
   not directed at a specific military objective [or] employ a method or means
   of combat which cannot be directed at a specific military objective […] and
   consequently, in each such case, are of a nature to strike military
   objectives and civilians or civilian objects without distinction.”[20]
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   - Finally, the principle of proportionality in attack, enshrined in
   Article 51(5)(b) of Additional Protocol I, prohibits attacks that would
   excessively affect civilian life and cause excessive damage to civilian
   objects in comparison with the concrete and direct military advantage
   anticipated.[21]
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Accordingly, attacks may only target combatants and be directed at a
specific military objective, and must be weighed against the incidental
loss of civilian life and damage to civilian objects. As such, the
indiscriminate targeting of buildings housing medical facilities cannot be
justified by military necessity, and incidental damage to health buildings,
and the functioning of health services, especially in a territory already
on the verge of collapse, should be considered unlawful under international
law. Moreover, the targeting of the Al-Rimal neighborhood, causing more
than 30 civilian casualties, including two paramedics, cannot be considered
as proportionate to the effective military objective sought by the Israeli
Occupying Forces.
The bombing and sudden closing of a number of health centers and
facilities, the disruption of essential services due to the injuries of
medical workers, and in particular, the closure of the only coronavirus
test center, have caused the discharge of patients, depriving them from
appropriate care. Bombardments have badly damaged and extensively destroyed
civilian medical properties, including equipment. Under customary
international humanitarian law, “the destruction […] of the property of an
adversary is prohibited, unless required by imperative military necessity.”
[22]
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*Violation of the Protected Status of Medical Personnel, Medical Activities
and Units *
By targeting various buildings housing health clinics, and most
particularly the Al-Rimal neighborhood and causing severe damage to
Al-Wehda main artery leading to Al-Shifaa hospital, the IOF have caused
grave delays in the delivery of medical aid, in particular the evacuation
of victims and their transfer to emergency care units, on the top of
partially crippling the functioning of the hospital itself. As a result,
the IOF have caused additional casualties and deteriorating war injuries,
in violation of multiple provisions of international humanitarian law:

   - Violation of the protected status of hospitals. Under Article 27 of
   the Hague Regulations, “in sieges and bombardments all necessary steps must
   be taken to spare, […] hospitals, and places where the sick and wounded are
   collected, provided they are not being used at the time for military
   purposes.”[23]
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It
   is supplemented by Article 18 of the Fourth Geneva Convention according to
   which civilian hospitals “may in no circumstances be the object of attack,
   but shall at all times be respected and protected […].”[24]
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The
   general rule is “to spare hospitals as far as is humanly possible.”Where
   hospitals are located in close proximity to a military objective, the
   belligerent should “take precautions to ensure that hospitals should suffer
   as little as possible from the attacks and from hostilities in general.”
   [25]
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By
   attacking main road arteries leading to Al-Shifaa hospital, the IOF have
   partially crippled the functioning of the hospital itself, which amounts to
   making the hospital the object of the attack in and of itself.

   - Infringement on medical crews’ access to health facilities. Under
   Article 15(4) of the First Additional Protocol to the Geneva Conventions,
   “civilian medical personnel shall have access to any place where their
   services are essential.” Mobility and access are essential conditions to
   the provision of health services.[26]
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By
   “where their services are essential,” it is entailed that medical health
   teams should move freely between hospitals and sites where victims are
   located, under medical justification.[27]
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On two occasions, the IOF directed an attack at an empty land in the close
vicinity of an ambulance station of the Palestinian Red Crescent, causing
severe damage to the structure. Under customary humanitarian law, directing
attacks “against medical […] objects displaying the distinctive emblems of
the Geneva Conventions in conformity with international law” is prohibited.
[28]
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The
damage caused during the first bombing should have constituted sufficient
warning for the IOF to take precautions and avoid any additional collateral
damage to the Palestinian Red Crescent in the course of the second bombing.
*Disruption of Provision of Medical Care in the Context of the Coronavirus
Pandemic*
The Israeli Occupying Forces’ attacks gravely disrupted the provision of
medical care related to the coronavirus pandemic. The only coronavirus test
center operational in the entire Gaza Strip was rendered disabled as a
consequence of the 17 May attack. As the Occupying Power of the Gaza Strip,
Israel is obligated to provide “to the fullest extent of the means
available to it […] medical supplies […],” as per Article 55 of the Fourth
Geneva Convention.[29]
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More
precisely, under Article 56 of the Fourth Geneva Convention, always “to the
fullest extent of the means available to it, the Occupying Power has the
duty of ensuring and maintaining […] the medical and hospital
establishments and services […] with particular reference to the adoption
and application of the prophylactic and preventive measures necessary to
combat the spread of contagious diseases and epidemics.”[30]
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This
notably includes “supervision of public health, education of the general
public, the distribution of medicines, the organization of medical
examinations and disinfection, the establishment of stocks of medical
supplies, the dispatch of medical teams to areas where epidemics are
raging, the isolation and accommodation in hospital of people suffering
from communicable diseases, and the opening of new hospitals and medical
centers.”[31]
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It
is complemented by Article 14(1) of the First Additional Protocol I that
prescribes that the Occupying Power has a “duty to ensure that the medical
needs of the civilian population […] continue to be satisfied.”[32]
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By
targeting the only laboratory devoted to coronavirus testing, in addition
to injuring dozens of medical agents notably providing coronavirus-related
medical consultations, Israel is not only infringing on its duty to support
the containment of the epidemics in the Gaza Strip, but directly
contributes to the deterioration of epidemic situation and to the spread of
the disease. Due to the destruction of main coronavirus clinics as well as
the main laboratory of Al-Rimal, coronavirus detection has dropped from
4,000 tests a day to some 1,500, rendering the virus quasi-untraceable.[33]
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*Conclusion *
In the course of Israel’s offensive on Gaza from 10 to 21 May 2021, the
occupying forces have carried out indiscriminate, systematic and
disproportionate attacks against civilians and civilian proprieties, a
great number of them including health centers, the main laboratory – only
coronavirus testing center, and two Palestinian Red Crescent ambulance
stations. Such attacks have had a heavy cost on the capacity of health
personnel to pursue essential and critical health services, in particular
in the context of the coronavirus pandemic, and will have an enduring
impact until reconstruction is achieved.
The Israeli Occupying Forces’ attack against the health sector in Gaza
displays a pattern of multiple violations amounting to war crimes under the
Rome Statute of the International Criminal Court, including:

   - Article 8(2)(a)(iv) prohibiting the “extensive destruction and
   appropriation of property, not justified by military necessity and carried
   out unlawfully and wantonly,”
   - Article 8(2)(b)(i) prohibiting the act of “intentionally directing
   attacks against the civilian population as such or against individual
   civilians not taking direct part in hostilities,”
   - Article 8(2)(b)(ii) prohibiting the act of “intentionally directing
   attacks against civilian objects, that is, objects which are not military
   objectives,”
   - Article 8(2)(b)(iii) prohibiting the act of “intentionally directing
   attacks against personnel, installations, material, units or vehicles
   involved in a humanitarian assistance […],”
   - Article 8(2)(b)(iv) prohibiting the act of “intentionally launching an
   attack in the knowledge that such attack will cause incidental loss of life
   or injury to civilians or damage to civilian objects,”
   - Article 8(2)(xiii) prohibiting the act of “destroying or seizing the
   enemy’s property unless such destruction or seizure be imperatively
   demanded by the necessities of war,”
   - Article 8(2)(e) prohibiting the act of “intentionally directing
   attacks against buildings, material, medical units and transport, and
   personnel using the distinctive emblems of the Geneva Conventions in
   conformity with international law.”

Accordingly, Al-Haq urges the Prosecutor of the International Criminal
Court (ICC) to investigate Israel’s military attacks on critical civilian
infrastructure in the Gaza Strip, in particular the targeting of health
facilities and health personnel, from 10 to 21 May 2021.

------------------------------
[1] For additional information, see Health Cluster Occupied Palestinian
Territory, “Health Facilities in the Gaza Strip,” August 2018,
http://healthclusteropt.org/admin/file_manager/uploads/files/1/5be175905d6d0.pdf
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[2] For additional information on the impact of the COVID-19 pandemic on
Gaza, see Research for Health in Humanitarian Crisis, “COVID-19 in Gaza:
Community Perspectives on the Pandemic,”
https://www.elrha.org/researchdatabase/covid-19-in-gaza-community-perspectives-on-the-pandemic/
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[3] Al-Haq, “Divide and Conquer: A Legal Analysis of Israel’s 2014 Military
Offensive Against the Gaza Strip,” 2015, 57,
https://www.alhaq.org/cached_uploads/download/alhaq_files/publications/DIVIDE.AND.CONQUER.pdf
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=4ae8d16f9b&e=08c14cf485>
[4] Al-Haq, “Divide and Conquer: A Legal Analysis of Israel’s 2014 Military
Offensive Against the Gaza Strip,” 2015, 58-60,
https://www.alhaq.org/cached_uploads/download/alhaq_files/publications/DIVIDE.AND.CONQUER.pdf
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=ed29787333&e=08c14cf485>
[5] Associated Press, “Beset by Virus, Gaza’s Hospitals Now Struggle with
Wounded” (Voice of America) (14 May 2021)
[6] Al-Haq Field Documentation, 11 May 2021; Devina Halim, “Indonesian
Hospital in Gaza Suffers Damage by Israeli Attack,” *AA*, 12 May 2021
[7] Al-Haq Field Documentation, 11 May 2021.
[8] Al-Haq Field Documentation, 11 May 2021.
[9] Al-Haq Field Documentation, 16 May 2021.
[10] Al-Haq Field Documentation, 16 May 2021.
[11] Al-Haq Field Documentation, 16 May 2021.
[12] Al-Haq Field Documentation, 16 May 2021.
[13] Al-Haq Field Documentation, 16 May 2021.
[14] Al-Haq Field Documentation, 17 May 2021.
[15] Al-Haq Field Documentation, 17 May 2021.
[16] Al-Haq Field Documentation, 17 May 2021.
[17] Al-Haq Field Documentation, 17 May 2021.
[18] Reported by Al-Haq Field Researchers, Al-Haq Field Documentation, 17
May 2021.
[19] Protocol Additional to the Geneva Conventions of 12 August 1949, and
relating to the Protection of Victims of International Armed Conflicts
(Protocol I), 8 June 1977, Article 48,
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=8A9E7E14C63C7F30C12563CD0051DC5C
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=ae4aa28341&e=08c14cf485>
;
ICRC, Customary International Humanitarian Law Database, Rule 1 “The
Principle of Distinction between Civilians and Combatants,”
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=8A9E7E14C63C7F30C12563CD0051DC5C
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=4dd0596eed&e=08c14cf485>
[20] Protocol Additional to the Geneva Conventions of 12 August 1949, and
relating to the Protection of Victims of International Armed Conflicts
(Protocol I), 8 June 1977, Article 51(4),
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=4BEBD9920AE0AEAEC12563CD0051DC9E
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=82e183f9de&e=08c14cf485>
;
ICRC, Customary International Humanitarian Law Database, Rule 11,
“Indiscriminate Attacks,”
https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule11
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=86561ed05f&e=08c14cf485>
;
ICRC, Customary International Humanitarian Law Database, Rule 12,
“Definition of Indiscriminate Attacks,”
https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule12
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[21]  Protocol Additional to the Geneva Conventions of 12 August 1949, and
relating to the Protection of Victims of International Armed Conflicts
(Protocol I), 8 June 1977, Article 51(5)(b),
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=4BEBD9920AE0AEAEC12563CD0051DC9E
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=0800e41e9c&e=08c14cf485>
;
ICRC, Customary International Humanitarian Law Database, Rule 14,
“Proportionality in Attack,”
https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule14
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=7607377fab&e=08c14cf485>
[22] ICRC, Customary International Humanitarian Law, Rule 50, “Destruction
and Seizure of Property of an Adversary,”
https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule50
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[23] Convention (IV) respecting the Laws and Customs of War on Land and its
Annex: Regulations concerning the Laws and Customs of War on Land, 18
October 1907, Article 27,
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=3C43C56CFC87D4E3C12563CD005167AA
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[24] Convention (IV) relative to the Protection of Civilian Persons in Time
of War, 12 August 1949, Article 18,
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=59AB4DAFFBF70295C12563CD0051BB01
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=8309decb34&e=08c14cf485>
[25] Convention (IV) relative to the Protection of Civilian Persons in Time
of War, 12 August 1949, Commentary of 1958, Article 18,
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=59AB4DAFFBF70295C12563CD0051BB01
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=64e9e4deca&e=08c14cf485>
[26] Protocol Additional to the Geneva Conventions of 12 August 1949, and
relating to the Protection of Victims of International Armed Conflicts
(Protocol I), 8 June 1977, Commentary of 1987, Article 15, para.630,
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Comment.xsp?action=openDocument&documentId=5600580CF7F9EB06C12563CD00430B8D
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=a60621bce1&e=08c14cf485>
[27] Protocol Additional to the Geneva Conventions of 12 August 1949, and
relating to the Protection of Victims of International Armed Conflicts
(Protocol I), 8 June 1977, Commentary of 1987, Article 15, para. 632,
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Comment.xsp?action=openDocument&documentId=5600580CF7F9EB06C12563CD00430B8D
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=1eee9b511b&e=08c14cf485>
[28] ICRC, Customary International Humanitarian Law, Rule 30, “Persons and
Objects Displaying the Distinctive Emblem,”
https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule30
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[29] Convention (IV) relative to the Protection of Civilian Persons in Time
of War, 12 August 1949, Article 55,
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=8803ECCAB8E2414BC12563CD0051BE3B
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=30edec6731&e=08c14cf485>
[30] Convention (IV) relative to the Protection of Civilian Persons in Time
of War, 12 August 1949, Article 56,
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/ART/380-600063?OpenDocument
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=98cb9c8e05&e=08c14cf485>
[31] Protocol Additional to the Geneva Conventions of 12 August 1949, and
relating to the Protection of Victims of International Armed Conflicts
(Protocol I), 8 June 1977, Commentary of 1987, Article 56, 313,
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Comment.xsp?action=openDocument&documentId=5600580CF7F9EB06C12563CD00430B8D
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=3798cfd5f1&e=08c14cf485>
[32] Protocol Additional to the Geneva Conventions of 12 August 1949, and
relating to the Protection of Victims of International Armed Conflicts
(Protocol I), 8 June 1977, Article 14(1),
https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=224F14A85C295774C12563CD0051D805
<https://alhaq.us2.list-manage.com/track/click?u=10071401ba4201bc1a4992f68&id=dcabd78def&e=08c14cf485>
[33] “Coronavirus Spread ‘Untraceabe’ in Gaza, after Israeli Bombardment
Destroys Covid-19 Clinics,’ *New Arab*, 25 May 2021,
https://english.alaraby.co.uk/news/israeli-assault-gaza-destroyed-coronavirus-facilities-medic
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