International law aims to protect medical personnel and facilities as well as patients and the wounded in times of armed conflict. It also very strictly outlines the conditions that allow fighters to attack health infrastructures when they are suspected of being instrumentalized by certain belligerents.
During the night from Monday 16 to Tuesday 17 March 2026, a Pakistani airstrike hit a detox center in Kabul, Afghanistan. According to Afghan authorities, at least 400 people would have died, and the bombings would have left hundreds injured.
Pakistan denied deliberately targeting this medical facility. In a statement posted on the social network X, the Pakistani Ministry of Information and Broadcasting declared that these “precision airstrikes” targeted “military installations of the Afghan Taliban regime used to support terrorist activities,” including “technical support infrastructure and munitions storage warehouses.”
Worldwide, attacks on health facilities are on the rise. On March 14, 2026, an Israeli airstrike hit a care center in Lebanon, killing 12 doctors, nurses, and paramedics. This attack brings to 31 the number of health professionals killed in the country by that date.
Since the beginning of March, the World Health Organization (WHO) has recorded 27 attacks on health facilities in Lebanon alone, while Israeli strikes in the country and joint US-Israeli operations in Iran have intensified. The United Nations High Commissioner for Human Rights (OHCHR) and the WHO have condemned these aggressions, describing them as violations of international law.
What laws protect medical facilities, personnel, and patients in times of conflict? Do these protections become void if the infrastructures are used as shelters for fighters?
What does the “laws of war” say about hospital protection?
International humanitarian law corresponds to a detailed set of rules aiming to protect medical personnel, facilities, and patients as well as the wounded during armed conflicts.
This “laws of war” specifies that:
- medical personnel, which includes doctors, nurses, and paramedics, must be respected and protected in the exercise of their functions;
- there are special protections for ambulances and means of transportation exclusively dedicated to medical purposes;
- these protections extend to the wounded and the sick under their care. This includes enemy combatants requiring care and no longer participating in hostilities;
- impartial humanitarian organizations must be allowed to provide medical assistance. Consent to their action cannot be arbitrarily denied;
- medical facilities must display the distinct protective emblems of the Red Cross, Red Crescent, or Red Crystal. Medical personnel must be equipped with identification documents and armbands displaying these emblems;
- the abusive use of these symbols to cover military operations is prohibited. Such an act can amount to 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 constitute a war crime;
What is the origin of these rules?
Laws protecting medical services in times of war were developed 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 body of customary international law, form an almost universal legal framework binding all parties to the conflict, including non-state armed groups.
These rules impose on belligerents the obligation to respect and protect healthcare personnel, infrastructures, 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 worldwide. For the year 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 warfare. Recent conflicts in South Sudan, Ukraine, Gaza, Iran, and Lebanon are unfolding in densely populated urban environments. Armed groups operate within complex civilian settings, often near hospitals and clinics.
This has changed the discourse of some belligerents. What was once considered “mistakes” is now frequently justified by military imperatives. States now often claim that insurgents use hospitals or ambulances to gain a military advantage. Israeli authorities, for example, have accused Hezbollah and Hamas of using medical infrastructure for military purposes.
Can a hospital lose its protection if fighters 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 the protection enjoyed by hospitals must be very high. Thus, medical personnel are allowed to carry light weapons for self-defense. Furthermore, armed guards may be present to ensure site security. The presence of wounded combatants receiving care does not change this: 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 infrastructure as a command or liaison center;
- sheltering able-bodied combatants.
Even in such cases, if doubts persist, the hospital must be presumed protected. It is also crucial to note that verifying a diversionary use does not give a blank check to 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 period of time to be granted to end this abusive use.
If the warning remains ineffective, the attacking party must continue to comply with the fundamental principles of international humanitarian law, including:
- proportionality: the expected military advantage must be weighed against the humanitarian consequences of the attack. This includes the long-term repercussions on health services. If the foreseeable civilian damage is excessive, the attack must be cancelled;
- precaution: all possible precautions must be taken to minimize the harm caused to patients and medical personnel. This can include organizing evacuations, planning ahead for interrupted care, and assisting in restoring medical capacities after the assault.
Even when an establishment 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 deep concern: attacks on medical personnel and infrastructure – and the fact that attackers are not being held accountable – are dangerously becoming normalized.
The legal framework protecting hospitals and caregivers 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, the sick, medical personnel and their installations, 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 bring prosecutions.
How to reverse this trend?
Specialized groups in open-source investigations, such as Forensic Architecture, Bellingcat, Mnemonics, and Airwars, play an increasingly important role in preserving satellite images, geolocation data, and videos published on social networks. When independent investigative missions are carried out, their leaders can rely on these different elements to establish the occurrence of events. Such missions contribute to revealing the truth, even when states do not want or cannot play their role.
This is all the more important because if belligerents are not held accountable, places meant to save lives in times of conflict are at increasing risk of being targeted.
