Gaza hospitals protected under rules of war - why are they being targeted by Israel?

Fighting between Israel's military and Palestinian militants continues to rage outside hospitals in northern Gaza, forcing thousands to flee.

Israeli troops encircled Gaza’s Shifa hospital over the weekend and another hospital in Gaza City, Al-Quds, was forced to shut down on Sunday because it ran out of fuel.

Around 650 patients, 500 healthcare workers and an estimated 2,500 displaced people remain in the enclaves Shifa hospital compound, said Mohammed Zaqout, director of hospitals in Gaza.

This would signal a significant departure since the weekend when Gaza health officials had said about 1,500 patients, along with 1,500 medical workers and 15,000 displaced people were at Shifa.

As battles around Gaza's hospitals continue, it raises an urgent question of when do medical facilities lose special protection under international humanitarian law?

Doctors are fighting to keep 36 premature babies alive in Al-Shifa hospital after incubators were turned off when electricity supplies ran out, ITV News Correspondent Rachel Younger reports

What does Israel say?

Israel claims that Hamas locates military assets under hospitals and other sensitive sites like schools and mosques.

Over the weekend it stated that Shifa hospital is atop Hamas' command headquarters and released an illustrated map of Shifa marked with claimed locations of the underground militant installations.

But no further evidence has been supplied to back this and Hamas, and Shifa Hospital Director Mohammed Abu Selmia, deny it.

“If we see Hamas terrorists firing from hospitals, we’ll do what we need to do,” Israeli army spokesperson Lt. Col. Richard Hecht said.

Two weeks ago, Israel defended its bombing of an ambulance convoy evacuating wounded patients from Shifa, alleging that it was carrying Hamas fighters.

Daniel Hagari, the IDF spokesperson, said forces are not besieging Shifa Hospital and are allowing a safe exit point on the hospital's eastern side.

But Dr Marwan Abusada, Head of Surgery, told ITV News some of the people who tried to flee from the building over the weekend had been shot in the street, with some killed.

Israel has said it targets Hamas fighters, not civilians. However, it has used powerful explosives in strikes on densely populated areas that have killed large numbers of women and children.

What do Palestinians say?

Throughout the conflict, Palestinian families fleeing bombed-out homes have taken refuge in medical compounds, believing them to be safer than other alternatives.

Kamal Najar, a 35-year-old who sheltered at Shifa with his son and daughter this week, told AP that he believed that the hospital would be “off-limits, even for Israel."

“It was the thing we somehow told ourselves wouldn’t happen,” he said, speaking by phone from the central city of Deir al-Balah, where he arrived by foot Friday after escaping what he said were strikes on the hospital with tens of thousands of others.

The World Health Organisation said constant gunfire and bombings have "exacerbated the already critical circumstances" and the hospital is no longer functioning as it should.

Gaza's health ministry said 32 patients, including three babies, have died since the hospital's emergency generator ran out of fuel on Saturday.

Palestinian medical workers accuse Israel of mounting an all-out attack on infrastructure to punish the population and force a surrender.

“It’s to say, ‘Not only will we kill and wound you, we will ensure you have nowhere to go to be treated,’” said Dr. Ghassan Abu Sitta, a British Palestinian surgeon working for Doctors Without Borders in Gaza City.

Some 190 medical workers were among more than 11,000 Palestinians killed since the start of the conflict, according to the Hamas-run Health Ministry in Gaza. 

What does international humanitarian law say?

The claims and counterclaims over Gaza's hospitals have raised pressing questions about what is allowed under international laws governing war.

International humanitarian law lends hospitals special protections during war. But hospitals can lose their protections if combatants use them to hide fighters or store weapons, the International Committee of the Red Cross said.

Nonetheless, there must be plenty of warning before attacks to allow for the safe evacuation of patients and medical workers, ICRC legal officer Cordula Droege said.

Even if Israel succeeds in proving Shifa conceals a Hamas command center, the tenets of international law remain in place, said Jessica Wolfendale, expert in military ethics at Case Western Reserve University in Ohio.

"It doesn’t license an instant attack,” she said. “Steps need to be taken to protect the innocent as much as possible.”

If the harm to civilians is disproportionate to the military objective, the attack is illegal under international law.

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