The bombing of the Al-Ahli Arab Baptist Hospital, located in the Zeitoun neighborhood in Gaza City, was the culmination of the Israeli occupation's crimes in its current war against the besieged enclave. Palestinian doctor Ghassan Abu Sitta, who was in the hospital at the time of the bombing, said doctors heard loud explosions and then part of the operating room roof fell while doctors operated on one of the injured.
With the appearance of the heinousness of the crime, the Israeli occupation tried to wash its hands of it with the help of the United States, by claiming - without evidence - that the hospital was hit by a rocket fired by mistake from the Gaza Strip. However, this does not explain the continuous series of Israeli attacks on Gaza's health facilities, as shortly after the "Baptist massacre", the occupation bombed the vicinity of the European Hospital in Khan Younis, south of Gaza. Richard Peppercorn, WHO Representative in the West Bank and Gaza Strip, explains that 51 attacks on health facilities in the Gaza Strip have taken place in the past days (as of 18 October), killing 15 health workers and injuring 27 others (2).
Dangerous medicine in the shadows of war
Health care services are targeted during wars with the aim of destroying morale and terrorizing the population. (Photo: Anatolia)
For example, in May 2021, Israeli warplanes bombed the vicinity of the Indonesian Hospital and Hala Shawa Health Center in the northern Gaza Strip, destroying the roads leading to them and leaving them out of service, as well as damaging the headquarters of the Ministry of Health, Beit Hanoun Hospital, and Al-Daraj Health Center, which the Palestinian Ministry of Health spokesperson described at the time as saying: "The occupation deliberately kills the health system" (3).
This targeting, which is repeated repeatedly beyond any doubt deliberate, is explained in the views of the Prussian general and war historian Carl von Clausewitz, considered the most prominent war theorist of the early nineteenth century. Clausewitz believed that the moral end of the war was a quick victory, albeit through "brutality," leaving no room for restraint or compassion.
In his famous book On War, Clausewitz elaborates on the importance of health care services during wars, advising targeting them to prevent soldiers from receiving treatment that may return them to fighting, and points out that the elimination of health resources destabilizes internal stability, leads to a loss of trust in the state, constitutes a higher degree of repression, and there is a psychological aspect of destroying morale and spreading terror in the population. Hostile forces sometimes position themselves and place their weapons inside hospitals after seizing them, which reduces the ability of the resistance to respond, fearing for the lives of the people receiving treatment.
On War by the Prussian war historian Carl von Clausewitz. (Photo: Social Media)
Marion Duprai, a scientific collaborator on the Right to Truth program, agrees with Clausewitz on the effects of targeting health systems, adding that threatening health facilities discourages those affected from using them even in critical situations (4). According to the World Health Organization, it also has consequences for the mental health of health workers and affects their willingness to go to work (5).
Despite reports of increasing targeting of healthcare systems in recent years, studies on this have not expanded as much, and there are only a few authoritative recent books discussing the issue, such as "War or Health" by Finnish physician and activist Ilka Taipal and Victor Seidel's 2007 book War and Public Health. But the most comprehensive book in discussing this issue is Dangerous Medicine: The Struggle to Protect Health Care from the Violence of War, published in 2021 by Columbia University Press, by Leonard Rubinstein.
Rubinstein is a professor and director of the Human Rights and Health in Conflict Program at the Johns Hopkins School of Public Health and was previously president of Physicians for Human Rights. Although the book is a global study, the Arab region occupies a prominent space in its chapters, reflecting the strategic and systematic targeting of health care in that region.
"Dangerous Medicine" consists of 8 chapters, through which Rubinstein tries to answer a set of questions related to the targeting of health systems during conflict: What is the motive behind these attacks? Has the nature of contemporary warfare increased it? Are human values eroding? What can be done to protect health care from violence? What are the contraindications to the implementation of the required steps? The book also monitors some incidents of targeting during the last quarter of the century.
The book "Dangerous Medicine: The Struggle to Protect Health Care from the Violence of War" by Leonard Rubinstein. (Photo: Social Media)
In the book's introduction, Rubinstein mentions the troubling fact that the targets of health care systems were brought to justice only once, after the attack on the Vukovar hospital in Croatia in 1991, due to the veto power of the permanent members of the Security Council, through which they provide protection to the perpetrators.
Another Prussian theorist, Francis Lieber, is cited by another Prussian theorist as one of those who entrenched the idea of harming civilians in order to end the war quickly, and Lieber's theories are based on the idea that "it is ethical to use brutal means to end a just war," and that hospitals should be protected only to the extent permitted by combat emergencies. Rubinstein asserts that this logic is still present today in the thinking of some military commanders, and that Libre's approach of subjecting humanity to necessity has had serious consequences for health care, especially with the availability of modern warfare technologies such as air power.
Interestingly, the U.S. Department of War (annexed to the Department of Defense at the end of the forties) appointed Lieber in 1863 as a member of the War Management Board, and although he was the only civilian among the members, he drafted most of the Code of Conduct for Union Soldiers in the Civil War, and since then it has been known as the Lieber Act, and its influence continues today. Suffice it to mention that the US military revised the Lieber Act before World War I, and adopted it as a reference in the rules of land warfare, and the current version of the Department of Defense Law of War Manual still praises the Lieber Act, describing it as "the basic law of war document of the United States," although it admits that "parts of it no longer reflect the current law."
Palestine.. Daily suffering
When entire communities are seen as enemies, for example through intolerance and ideological differences, civilians and the health-care system are targeted in cold blood. (Photo: French)
"Dangerous Medicine" highlights the suffering of the health system in the occupied Palestinian territories through an entire chapter, starting with the harmful impact of the intransigence of military checkpoints during the movement of health workers, and the deliberate delay by the occupation army of ambulances carrying patients, which leads to an increase in deaths or often exacerbates injury.
Rubinstein documents the killing of 6 Palestinian emergency paramedics by Israeli soldiers during the height of the second intifada in the occupied territories in March 2002, when paramedics were evacuating those injured in the fighting in the West Bank. Rubinstein, meanwhile, was leading a group of medical investigators from Physicians for Human Rights in Gaza and the West Bank. Among the victims are Dr. Khalil Suleiman, director of the Palestine Red Crescent Society, part of the International Red Cross and Red Crescent Movement, in the West Bank city of Jenin, and Dr. Ahmed Othman, director of a hospital near Bethlehem.
One of the clever observations of "dangerous medicine" that works for Palestine is when entire communities are seen as enemies, for example through fanaticism and ideological differences, which leads to cold-blooded targeting of civilians and the health care system. Rubinstein recalls that between 2000 and 2002, Israeli soldiers injured 134 Palestinian Red Crescent Society emergency paramedics and damaged 174 ambulances.
Rubinstein explains that the effects of these attacks go beyond areas of engagement, fueling feelings of immorality, loss of trust in the surroundings, entrenching anger, and threatening moral values such as the neutrality of health care providers, which preserve an individual's right to treatment regardless of affiliation or race. Rubinstein asks: How can a doctor be neutral when blowing up his workplace and putting his life at risk? The negatives also extend to more serious matters, and the book gives a clear example by pointing to attacks on workers in Pakistan's vaccination campaign, which could push the entire planet back years and undermine the decades-long effort to eradicate a disease like polio.
War crimes?!
International humanitarian law specifically protects hospitals, and the Geneva Conventions and their Additional Protocols provide for the protection of the sick, wounded, and medical staff. (Photo: Reuters)
With regard to international laws, Alex Whiting, former Prosecutor of the International Criminal Court and professor of international law at Harvard University (6), explains that international law is somewhat evasive about targeting health facilities during wars, and in order to put this in the context of war crimes, it must be proven that the attack was carried out deliberately, but if there are military targets close to the health facility, proving the war crime is difficult, which provides a loophole for the occupying entity and justifies it to escape its crimes. He always claims that his raids on Gaza primarily target tunnels and headquarters run by the Islamist group Hamas. At the same time, several tweets on the X platform (formerly Twitter) accused the BBC of involvement in inciting the occupation to bomb health care facilities in Gaza, following allegations by Lise Doucet, the chief international correspondent in the south of the occupation state, that there are tunnels of resistance under hospitals, schools and mosques in Gaza (7).
Marion Duprray disagrees with Whiting (8), noting that international humanitarian law specifically protects hospitals, and the Geneva Conventions and their Additional Protocols provide for the protection of the sick, wounded and medical staff, and may not be targeted under any circumstances, but also applies to wounded military personnel treated in hospital, and to armed medical personnel, if they are armed to defend their lives and the lives of the wounded.
The First and Fourth Geneva Conventions provide that the only exception is when hospitals and medical units are used outside their humanitarian duty to commit military acts, such as an attack from the hospital itself. However, even so, the attack must be preceded by a warning, and the attacker must take all measures that would protect the lives of civilians and patients inside the facility.[9] Additional Protocol I even included attacks on military medical units as war crimes.
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