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Hospitals in Gaza are near collapse despite protections under international law


Protecting the wounded and sick in times of war is a fundamental responsibility covered by the Geneva Conventions. Yet in Gaza, the health care system is on the verge of collapse because of attacks on health care facilities and lack of aid. Israel claims Hamas is using hospitals as cover for their military operations. Medical workers, like doctors Nahreen Ahmed and Ismail Mehr in Gaza, put a fine point on the suffering.

NAHREEN AHMED: The wounds that we see are anywhere from, you know, injuries from being stuck under rubble, from shrapnel, quadcopter bullets that are tearing through people's bodies.

ISMAIL MEHR: Literally, there's patients dying on the floors and dying due to the lack of supplies, such as a grandmother with a urinary tract infection.

SUMMERS: Leonard Rubenstein is a professor at Johns Hopkins University, where he focuses on health and human rights in armed conflict. He joins me now. Thank you for being here.

LEONARD RUBENSTEIN: Thanks for having me.

SUMMERS: You've spent time in medical facilities and war zones all over the world. So I want to just start by asking you, hearing the comments from the medical professionals that we just played, what comes to mind for you?

LEONARD RUBENSTEIN: Unfortunately, it sounds all too familiar. The bombing and shelling of hospitals and killing and arrests of medical personnel has been a feature of war for well over a century. But still, there are two features of the war in Gaza that are quite unique. One is the enormous scale of damage and destruction as the entire health infrastructure has been largely destroyed. Ninety percent of the hospitals have been subject to air strikes or shelling, some of them multiple times.

The second feature is the large number of violent ground assaults by Israel on hospitals in Gaza, which is a response to what you mentioned - the Israeli claims that Hamas is embedding in those structures. But they have catastrophic consequences, both for the patients and the hospitals. Al-Shifa Hospital, which is the largest in Gaza, was destroyed in March.


LEONARD RUBENSTEIN: Patients have died in these assaults.

SUMMERS: I'm hoping you can just walk us through how health care facilities, hospitals are supposed to be treated during times of war.

LEONARD RUBENSTEIN: There are a few basic rules. One is that patients must be provided with the care they need and, second, that health facilities and personnel who care for them must be protected from attack. Safe passage of medical convoys and ambulances must be assured as well. There's one exception, and that is that if a health facility is used for military purposes, it loses protection. But even there, precautions have to be taken.

SUMMERS: If I can, I just want to press on that because as we mentioned earlier, Israeli spokespeople have claimed that Hamas is using various hospitals for their military operations and that that is why they have directly attacked so many medical facilities. According to international law, would that justify Israel's attacks?

LEONARD RUBENSTEIN: If there is evidence that they are being misused, the hospital becomes a legitimate target. But - here's a major but - there has to be protection of the patients inside. And so there's specific requirements. One is you have to give warning so there can be either provisions made for continuing care or evacuation of the patients. And even in the assault, you have to make sure, under the rules of the Geneva Conventions, to take all feasible precautions to avoid or at least minimize harm to civilians. But the evidence is that Israel hasn't done that. And as a result, people have died because electricity was out for lack of equipment. Babies died in incubators. People in the intensive care unit couldn't get oxygen because those precautions weren't taken.

SUMMERS: So much of the conversation that we're having is really about accountability. In international law, what mechanisms exist to hold countries accountable in situations like the one that we're discussing there?

LEONARD RUBENSTEIN: In the first place, an attack on a health facility, on patients, on staff could be a war crime. So those can be prosecuted in international or domestic tribunals. Unfortunately, it's been a characteristic that, despite the rather ancient protection of health care in war, there's been complete impunity. There's never been a prosecution specifically directed on attacks on health care. And that means that perpetrators know that there will be no consequences for engaging in these acts.

SUMMERS: Leonard Rubenstein is a professor at the Johns Hopkins School of Public Health. He's also written the book "Perilous Medicine: The Struggle To Protect Healthcare From The Violence Of War." Thank you for being with us.

LEONARD RUBENSTEIN: Thank you very much. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Juana Summers is a political correspondent for NPR covering race, justice and politics. She has covered politics since 2010 for publications including Politico, CNN and The Associated Press. She got her start in public radio at KBIA in Columbia, Mo., and also previously covered Congress for NPR.
Sarah Handel
[Copyright 2024 NPR]
Jonaki Mehta is a producer for All Things Considered. Before ATC, she worked at Neon Hum Media where she produced a documentary series and talk show. Prior to that, Mehta was a producer at Member station KPCC and director/associate producer at Marketplace Morning Report, where she helped shape the morning's business news.