In the weeks of the United States and Israel’s war with Iran, Defense Secretary Pete Hegseth has made clear his disregard for international law and rules of engagement. He has referred to these standards as “stupid” and has vowed “no quarter, no mercy for our enemies.” And unsurprisingly, his rhetoric has been the backdrop to potential war crimes, including attacks on healthcare workers and facilities.
These attacks are part of a much larger war strategy that has recently taken hold in the world’s major conflict zones.
The bombing campaigns that started in Iran and spread into Lebanon have taken an appreciable toll on local healthcare systems. Per the World Health Organization, there have been 18 verified attacks on health care facilities in Iran that have resulted in the deaths of eight medics. Further, more than 100 Israeli strikes have resulted in the deaths of 40 medical workers in Lebanon, according to the country’s Health Ministry. And not far from the Middle East battlefield, Pakistani airstrikes in Afghanistan killed over 400 in a Kabul rehabilitation center, according to that country’s government, and 64 people died in a hospital attack in Sudan’s Darfur region, according to WHO.
These attacks are part of a much larger war strategy that has recently taken hold in the world’s major conflict zones. In Russia’s attack on Ukraine and Israel’s attack on Gaza, a dangerous precedent was established as health care facilities and staff were targeted with impunity. And if these unlawful assaults are once again permitted to continue unchecked in Iran and Lebanon, then we risk losing not only the healers of these besieged countries, but also our common humanity.
The advent of warplanes has allowed for civilian hospitals to be targeted more frequently and ferociously. Notably, international protections would become necessary after Allied forces indiscriminately bombed German hospitals during World War II, and the U.S. utilized both napalm-filled and nuclear bombs and caused widespread civilian damage in its bombardment of Japan.
In 1949, the Fourth Geneva Convention enshrined into international law that civilian hospitals “may in no circumstances be the object of attack, but shall at all times be respected and protected.” A 1977 amendment further bolstered protections for civilians and those requiring medical care.
“In the case of hospitals, we have a very clear prohibition against the targeting of hospitals. Hospitals are absolutely protected unless they’ve been used to commit acts that are harmful to the enemy,” said Jessica Peake, director of the International and Comparative Law Program at UCLA. Yet, even if hospitals are used for military purposes, the law says, civilian medical staff and patients retain their legal protection.
We have a very clear prohibition against the targeting of hospitals. Hospitals are absolutely protected unless they’ve been used to commit acts that are harmful to the enemy.
JESSICA PEAKE, DIRECTOR OF THE INTERNATIONAL AND COMPARATIVE LAW PROGRAM AT UCLA
Despite this prohibition, attacks have continued. In 2015, America’s airstrikes against a Médecins Sans Frontières trauma hospital in Kunduz, Afghanistan, killed 42 people. The United Nations duly responded with Security Council resolution 2286 to strongly condemn the assault and to curb future wartime incidents involving medical infrastructure.
But most grisly has been the recent trend in warfare, which has left civilians cut off from access to health care. A 2025 study in the British Medical Journal found that from 2020 to 2024, the number of attacks on healthcare in many of the world’s major conflict zones — Sudan, Gaza, Lebanon, Myanmar and Ukraine — has almost tripled. Many of these attacks and the resulting injuries and deaths have occurred in Ukraine and Gaza, perpetrated by Russia and Israel, respectively.
As Len Rubenstein, professor at Johns Hopkins Bloomberg School of Public Health, told the British Medical Journal, “This is a very disturbing trend … where highly explosive weapons are being used throughout the areas of conflict and beyond — missiles, rockets, air power, bombs — in which combatants do not distinguish between military or civilian targets, or they deliberately target hospitals and other civilian infrastructure.”
The decimation of Gaza’s health care system is particularly chilling because of its apocalyptic magnitude. According to a WHO report from Jan. 31, 2026, all 36 hospitals have been damaged at various times while only 18 of 36 hospitals remain partially functional. Further, it says 96 of 197 primary health care facilities are operational and that 937 attacks on health care infrastructure have been reported. This has all left 993 health care workers dead and 216 ambulances damaged or destroyed. It has been Israel’s standard response to call every hospital it has struck a “command and control center” for Hamas. But after Israel struck Gaza’s al-Shifa Hospital in 2023, The Washington Post reported that “the evidence presented by the Israeli government falls short of showing that Hamas had been using the hospital as a command and control center, according to a Washington Post analysis of open-source visuals, satellite imagery and all of the publicly released IDF materials.”
“What we have seen in the Gaza Strip is a systematic annihilation of the healthcare system. Not just in terms of bombing hospitals but evacuating them, invading them, destroying medical equipment, arbitrary abductions and arrests of healthcare providers who have nothing to do with military activity and direct killing of healthcare providers. All of this is happening on a scale that we have not seen in any previous conflict,” said Tanya Haj-Hassan, a pediatric intensive care doctor who has worked in Gaza numerous times.
The targeting of hospitals during wartime can have a generational impact. Not only does their loss leave a gaping hole in local health care, but it also makes civilians scared to pursue any kind of medical care due to the risk of attack and possible death. It also dissuades people from wanting to become medical workers, which further deepens the societal blow.
Humanitarian protections of hospitals and medics have been gutted in our world of modern, lethal weaponry and where international law is selectively applied. As these global attacks continue to occur regularly with impunity, we find ourselves on a slippery slope where any further assault on health care in places such as Iran or Lebanon risks our collective descent into a black hole of lawless inhumanity.
While the perpetrators of these war crimes need to face criminal prosecution, that is a labyrinthine process which will provide no immediate succor in war zones. More urgently, the supply of weapons to aggressors targeting health care infrastructure should be ceased. Further, states will have to muster the courage and political will to vociferously decry these medical attacks, resolve not to fund them and prioritize the issue in all conflict zones. And finally, there is an ethical obligation for leading medical bodies and physician leaders to add their voices to the global outcry.
As civilians in war zones increasingly lose access to lifesaving care because of these proliferating attacks on medical facilities, the world must not become inured. This is a strategy that threatens a society in the most fundamental way: by crushing the very health care that promises to preserve life amidst the rain of bullets and bombs.
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