Similar to water, electricity, and food supply chains, the healthcare system, with its staff, clinics, hospitals, ambulances, and other facilities, is an essential part of the life-sustaining infrastructures of every society. It is hard to imagine a reality where the sick and injured have nowhere to receive treatment. In times of war and armed conflict, with the presence of traumatic war injuries and the interruption of daily medical practice, the healthcare system takes on an even more crucial role in saving lives and minimizing the harm of war on civilians. Thus, it is no surprise that healthcare workers and facilities are provided special protection in international humanitarian law and the laws of war.[1]
Nevertheless, and despite our world becoming ever more monitored and surveilled, and armies having the ability to fight with increased precision, attacks on healthcare continue unabated and increase globally,[2] leaving us to wonder not only whether attacks on healthcare have been integrated into the arsenal of weapons of war,[3] but also about the usefulness of the mechanism to hold states and non-state actors accountable.
The Israeli-occupied Palestinian territories have been the site of some of the highest numbers of attacks on healthcare for the past years.[4] Since October 7, 2023, these numbers have skyrocketed. During the genocide in the Gaza Strip, the Israeli army has killed more than 595 healthcare workers, abducted and illegally detained more than 300 healthcare workers, some of whom were tortured and killed,[5] and attacked hospitals in numerous ways such as bombings in the vicinity of hospitals,[6] invasions,[7] sniper attacks, and besieging and turning hospital backyards into mass graves.[8] Much attention has been given to attacks on healthcare in the Gaza Strip.[9] This paper will focus on attacks on healthcare in the West Bank and aims to: 1) provide a brief overview of the attacks on healthcare in the West Bank since October 7, 2023; 2) compare and contrast the patterns of attacks on healthcare in the West Bank and the Gaza Strip in an attempt to portray a more thorough image of Israeli attacks on healthcare; and 3) suggest ways forward for documenting and requiring accountability for attacks on healthcare.
1. Attacks on Healthcare in the West Bank
The WHO Surveillance System for attacks on healthcare (SSA) reports that there have been 1,128 attacks on healthcare in the oPt between October 7, 2023 and October 5, 2024 (out of 1,781 attacks globally), including 779 deaths and 1,090 injuries.[10] Although the dashboard does not have separate categories for the West Bank and Gaza Strip, a recent update of attacks on healthcare in the West Bank for the period of October 7, 2023 to July 30, 2024 details 527 attacks on healthcare that killed 23 people, injured 100, and affected 365 ambulances, 54 health facilities, and 20 mobile clinics. Most of these attacks were concentrated in the northern West Bank, in Tulkarem, Nablus, and Jenin.[11] The numbers demonstrate that attacks on healthcare in the West Bank are the opposite of rare or exceptional incidents. They are regular, daily, and deadly. These attacks include the obstruction of access for ambulances, the use of force, and the detention of healthcare workers and militarized searches.
Attacks on healthcare in the West Bank are carried out in different ways. On January 30, 2024, ten to twelve Israeli soldiers dressed as civilians (one carrying a baby stroller and another pushing a person in a wheelchair) and medical staff invaded Ibn Sina Hospital in Jenin,[12] killing three men at point-blank range. Palestinian human rights groups have warned that Israel has turned hospitals into sites of extrajudicial executions. On May 21, 2024, an Israeli sniper shot and killed Dr. Osaid Jabarin, a 51-year-old surgeon, as he was walking to his workplace, the Jenin Governmental Hospital.[13] In August 2024, Israel launched operation Summer Camps and invaded and sieged several areas in the northern West Bank, including Jenin, Nablus, and Tulkarem. During the operation, the Israeli army imposed a curfew on Jenin Governmental Hospital,[14] attacked ambulances, and obstructed their work as well as the work of international NGOs such as Médecins Sans Frontières.[15] On September 12, 2024, the Israeli army raided Halhoul Governmental Hospital and kidnapped a patient. Medical and paramedical staff are regularly attacked and harassed, and ambulances are often hindered from reaching the scenes of military raids.[16]
2. A Spillover of Colonial Violence
While Palestinians in both the Gaza Strip and the West Bank live under illegal military occupation and settler colonization, the lived realities of these populations are starkly different. Analyzing attacks on healthcare as a tool of war, and the differences between these attacks in the West Bank and the Gaza Strip, can guide us in mapping Israeli attacks on Palestinian healthcare and adds another layer in our understanding of how settler colonization systematically damages health services and hinders access to healthcare. Since 2007, the Gaza Strip has been subjected to a hermetic siege that controls the movement of humans, commodities, electricity, and communication. The siege has not only de-developed the healthcare sector in Gaza by impoverishment and restrictions on the movements of patients, drugs, equipment, and staff, as well as by the lack of travel and development opportunities for healthcare workers,[17] it has been accompanied by a “biosphere of war,”[18] four wars and chronic warlike conditions. Attacks on healthcare during these wars were characterized by the bombing of clinics, hospitals, and laboratories as well as the killing of healthcare workers due to aerial bombings or sniper attacks near the Gaza border, as in the case of Razan al-Najjar during the great march of return.[19] On the other hand, while Palestinians in the West Bank enjoy a larger degree of freedom of movement, life is characterized by daily and constant encounters with soldiers and settlers because of the great number of checkpoints, settlements, and soldiers on the ground. Thus, attacks on healthcare have been characterized by attacks on ambulances and staff and raids of hospitals and clinics, as well as by impeding ambulance access to critical sites.
What we have seen during the past year has been a spillover of war tactics from one setting to the other and thus a change in the pattern of attacks on healthcare. With the ground invasion of Gaza, we started to see patterns of attacks on healthcare similar to those in the West Bank (attacks on ambulances and obstruction of access to care, siege, and raids of hospitals) but in a much more violent manner and on a larger scale. In the West Bank there have been aerial attacks and drone attacks that had previously been restricted to Gaza. In both settings, attacks have increased sharply in the past year under the guise of what Neve Gordon and Nicola Perugini call “Medical Lawfare,”[20] attacking healthcare facilities and accusing them of being operation grounds and medical shields for “terrorist groups.”
The overall pattern one can observe is that under the trope of fighting “terrorist groups” and dismantling their civilian infrastructure, attacks on healthcare in the Gaza Strip, the West Bank, and more recently Lebanon have become integrated into the norms of war. These attacks are by no means exceptional or rare as they occur daily. They are no longer surprising but have even come to be expected.
3. Looking Ahead
More than one year into the genocide in Gaza, it is becoming more evident that healthcare facilities are not offered any form of protection[21] and that violations of humanitarian laws at one site of warfare are imported quickly to all other sites. International law institutions as well as the medical community have failed to demand accountability for attacks on healthcare. Palestinian efforts at the moment can focus on several steps:
a) Accurate and public documentation: While the WHO has a standardized system for reporting attacks on healthcare, the documentation is anonymous and does not mention the name or location of the facility attacked. It thus minimizes the seriousness of the attacks and damage to hospitals as even hospitals that are surrounded by snipers can be considered “partially functional.” This policy might make sense from a global perspective with the aim of ensuring anonymity, but in the Palestinian context where most attacks are live streamed and the war unfolds in front of our eyes it is important to document these attacks in a disaggregated manner based on location (West Bank and Gaza Strip) and expose them to the media and legal institutions, while being mindful of and respectful to healthcare workers. The platform of the Institute for Palestine Studies is an important step in this direction and should be expanded and incorporated into an internationally recognized archive of attacks on healthcare in Palestine.
b) Support for quick rehabilitation of healthcare facilities: The brisk reopening of Al Shifa hospital[22] after it was sieged and burned is a heroic account of the resilience of Palestinian health workers and their ability to rebuild the decimated healthcare system and resume provision of care. All possible efforts should be made to facilitate the quick reopening of damaged healthcare facilities so that they can resume their function.
c) Training in basic life support: Access to healthcare facilities for individuals and ambulances is becoming riskier. Conducting workshops to train Palestinians in basic life support, especially in the refugee camps, can be a useful tool to teach techniques to stop wounds from bleeding and thus help save lives and limbs when medical care is hindered after military invasions.
d) Activation of the Palestinian medical community: Now more than ever, there is a need for an active Palestinian medical community that can write about, organize, and advocate for the right to health and raise awareness of the attacks on healthcare. Such activities can have wide-reaching effects if combined with the efforts of the large Palestinian medical community in the diaspora. A joint project can do a great deal to further expose the Israeli attacks on healthcare and mobilize the international medical community.
[1] Y. M. Asi, O. Tanous, B. Wispelwey, and M. AlKhaldi, “Are There ‘Two Sides' to Attacks on Healthcare? Evidence from Palestine,” European Journal of Public Health, vol. 31, no. 5 (2021), pp, 927–928.
[2] Safeguarding Health in Conflict, Insecurity Insight, Critical Condition: Violence Against Health Care in Conflict, 2024.
[3] M. Heisler, P. Kovtonyuk, and C. De Vos, “Attacks on Health Care Used as a Weapon of War in Ukraine and Globally: The Demand for Accountability,” JAMA, 329, no. 12 (2023), pp. 973.
[4] F. C. Tekin and F. Selcen Öcal, “Attacks on Health Care Worldwide: 5-year Review,” Eurasian J Emerg Med, vol. 22, no. 4 (2023), pp. 211–215.
[5] The Killing, Detention and Torture of Healthcare Workers in Gaza, Healthcare Workers Watch, 2024.
[6] D. Kunichoff, D. Mills, Y. Asi, et al., “Are Hospitals Collateral Damage? Assessing Geospatial Proximity of 2000 lb Bomb Detonations to Hospital Facilities in the Gaza Strip from October 7 to November 17, 2023,” PLOS Glob Public Health, vol. 4, no. 10, (2024), p. e0003178.
[7] Y. Asi, D. Mills, P. G. Greenough, et al., “‘Nowhere and No One Is Safe': Spatial Analysis of Damage to Critical Civilian Infrastructure in the Gaza Strip During the First Phase of the Israeli Military Campaign, 7 October to 22 November 2023,” Confl Health, vol. 18, no. 1 (2024), p. 24.
[8] M. Haddad, “Mass Graves in Gaza: Evidence of Genocidal Violence,” Policy Paper, Institute for Palestine Studies.
[9] L. Hanbali, “Documenting the Targeting and Destruction of the Health Sector in the Gaza Strip”.
[10] Surveillance System for Attacks on Health Care (SSA), WHO.
[11] “Impact of Attacks on Health Care in the West Bank,” WHO EMRO, 2024.
[12] J. Schwarz, “Here Are the Laws Plausibly Broken by Israel in Its Raid on a West Bank Hospital,” Intercept, 31/1/2024.
[13] F. Shalash, “Student, Teacher, Doctor, and a Playful Brother: The Palestinians Israel Killed in Jenin,” Middle East Eye, 22/5/2024.
[14] M. Barghouti, “Inside the Brutal Siege of Jenin,” 972 Magazine, 4/9/2024.
[15] “Access to Medical Care at Risk in West Bank as Israeli Incursions Intensify,” MSF press release, 5/9/2024.
[16] “In the West Bank, Israeli Forces Render Healthcare Inaccessible When It's Needed Most,” MSF, 13/6/2024.
[17] R. Smith, “Israel's Permanent Siege of Gaza,” MERIP Report, 290 (2019), pp. 38–42.
[18] T. Farhat, S. Ibrahim, Z. Abdul-Sater, G. Abu-Sittah, “Responding to the Humanitarian Crisis in Gaza: Damned If You Do… Damned If You Don't!,” Annals of Global Health, 89, no. 1 (2023).
[19] Y. M. Asi, O. Tanous, B. Wispelwey, and M. AlKhaldi, “Are There ‘Two Sides' to Attacks on Healthcare? Evidence from Palestine,” European Journal of Public Health, vol. 31, no. 5 (2021), pp. 927–928.
[20] N. Perugini, N. Gordon, Medical Lawfare: “The Nakba and Israel's Attacks on Palestinian Healthcare,” Journal of Palestine Studies, vol. 53, no. 1 (2024), pp. 68–91.
[21] D. Kunichoff, D. Mills, Y. Asi, et al., “Are Hospitals Collateral Damage? Assessing Geospatial Proximity of 2000 lb Bomb Detonations to Hospital Facilities in the Gaza Strip from October 7 to November 17, 2023,” PLOS Glob Public Health, vol. 4, no. 10, (2024), p. e0003178.
[22] “Health Ministry Reopens Reception and Emergency Department at Al-Shifa Medical Complex,” Middle East Monitor, 2/9/2024.
1