[An article by Shannon Bosch – Associate Professor (Law), Edith Cowan University]
Pakistan denies intentionally targeting this medical facility. In a statement posted on the X social network, the Pakistani Ministry of Information and Broadcasting declared that these “precision aerial strikes” targeted “Afghan Taliban’s military installations used to support terrorist activities,” specifically “technical support infrastructure and ammunition storage warehouses.”
Globally, attacks on healthcare facilities are on the rise. On March 14, 2026, an Israeli airstrike hit a healthcare center in Lebanon, killing 12 doctors, nurses, and rescuers. This attack brings the total number of healthcare professionals killed in the country to 31.
Since the beginning of March, the World Health Organization (WHO) has documented 27 attacks on healthcare facilities in Lebanon alone, as Israeli strikes in the country and US-Israel joint operations in Iran have intensified. The Office of the High Commissioner for Human Rights (OHCHR) and the WHO have condemned these aggressions, calling them violations of international law.
What laws protect medical facilities, staff, and patients in times of conflict? Do these protections become obsolete if the facilities are used as shelter for combatants?
What “laws of war” say on hospital protection
The international humanitarian law consists of detailed rules aimed at protecting medical personnel, facilities, patients, and the wounded during armed conflicts.
This “laws of war” specifically state that:
medical personnel, including doctors, nurses, and rescuers, must be respected and protected in the performance of their duties;
special protections exist for ambulances and means of transportation dedicated solely 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 distinct protective emblems of the Red Cross, Red Crescent, or Red Crystal. Medical staff must be provided with identity documents and armbands displaying these emblems.
The abusive use of these symbols to cover military operations is prohibited. Such an act can be considered perfidy, a form of deliberate deception that constitutes a war crime under international law;
Deliberately attacking personnel or medical facilities displaying these emblems can also be considered a war crime;
What is the origin of these rules?
Laws protecting medical services in times of war originated 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, complemented by a body of customary international law, form a nearly universal legal framework binding on all parties to the conflict, including non-state armed groups.
These rules require belligerents to respect and protect healthcare personnel, facilities, and the wounded under 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 worldwide. In 2025 alone, there were 1,348 attacks on healthcare structures, double the number recorded in 2024.
The law itself has not changed, unlike the nature of war. Recent conflicts in South Sudan, Ukraine, Gaza, Iran, and Lebanon have taken place in densely populated urban environments. Armed groups operate in complex civilian settings, often near hospitals and clinics.
This has changed the discourse of some belligerents. What was once labeled as “errors” is now frequently justified by military necessity. States often claim that insurgents use hospitals or ambulances to gain a military advantage. Israeli authorities, for example, have accused Hezbollah and Hamas of exploiting medical facilities 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 of their humanitarian mission to commit acts intended to harm the enemy.
However, according to international law, the level of activities that could lead to the loss of protection for hospitals must be very high. In this regard, medical personnel are allowed to carry light arms for self-defense. Armed guards may be present to ensure the site’s security. Even in cases where combatants are receiving care, the protections remain valid.
These protections can only be lifted if hospitals are used for activities such as:
launching attacks;
using medical facilities as observation posts;
storing weapons;
using medical facilities as command or liaison centers;
housing combatants.
Even in such cases, if doubts persist, the hospital must be presumed protected. It is also crucial to note that verifying an abuse of function does not provide a license to attack.
Before launching an offensive against a medical facility involved in such activities, international humanitarian law requires that a warning be issued and a reasonable time be given to end the abusive use.
If the warning is ineffective, the attacking party must still adhere to the fundamental principles of international humanitarian law, including:
proportionality: the military advantage sought must be balanced against the humanitarian consequences of the attack. This includes long-term impacts on healthcare services. If the foreseeable civilian harm is excessive, the attack must be canceled;
precaution: all possible precautions must be taken to minimize the harm to patients and healthcare personnel. This may include organizing evacuations, planning for the interruption of care, and assisting in the recovery of medical capacity after the assault.
Even when a facility loses its protection, the wounded and sick must continue to be respected and protected.
Are attacks on medical facilities becoming normalized?
The UN Security Council, WHO, MSF, and OHCHR have expressed serious concern: attacks on medical personnel and facilities – as well as the fact that the attackers are not being held accountable – are dangerously becoming normalized.
The legal framework protecting hospitals and healthcare workers already exists. It is up to 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 in the midst of an ongoing conflict proves extremely challenging. In reality, states are often reluctant or unable to pursue prosecutions.
How to reverse this trend?
Specialized groups in open-source investigations, 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 leaders can rely on these various elements to establish the occurrence of facts. Such missions contribute to the pursuit of truth, even when states are unwilling or unable to fulfill their role.
This is crucial because if belligerents are not held accountable, places meant to save lives during conflict are at increasing risk of being targeted.
