When Hospitals Become Battlefields, What Is International Law Actually Worth?

Nicole Chunye, Political Columnist

War is violent by nature, but even war has rules. Civilians are entitled to protection, and hospitals are supposed to remain safe places where the wounded and sick can receive treatment. Yet in many of today's conflicts, being inside a hospital no longer guarantees safety.

The World Health Organisation has recorded more than 900 attacks on healthcare in conflict zones so far in 2026, with hundreds of people killed and many more injured. From Ukraine to Sudan and Gaza, hospitals, ambulances, healthcare workers and patients have repeatedly found themselves caught in the violence.

International humanitarian law clearly protects medical facilities and those who work within them. If these protections already exist, why do attacks on healthcare continue to happen?

The Geneva Conventions require warring parties to respect medical facilities and allow them to continue treating the sick and wounded, regardless of which side they belong to.

However, these protections are not absolute. A hospital can lose its protected status if it is used for acts that harm the opposing side outside of its medical purpose. Even then, strict conditions apply before an attack can legally take place. This becomes particularly complicated when armed forces claim that hospitals are being used for military purposes. It raises an important question: who determines whether these claims are legitimate, and what happens when they are not?

Attacks on healthcare are not limited to one conflict. Since Russia invaded Ukraine in 2022, the World Health Organisation has verified more than 3,100 attacks on healthcare in the country. The impact goes beyond those killed or injured in an attack. Damaged hospitals can leave entire communities without emergency care, maternity services or treatment for long-term illnesses, while healthcare workers are forced to operate under increasingly dangerous conditions.

Gaza's healthcare system has also suffered widespread destruction. According to the WHO, every hospital in Gaza has been damaged and only around half remain partially functional. Israel has repeatedly accused Hamas of using hospitals and other medical facilities for military purposes, claims that have been disputed in some cases. Regardless of these disputes, the destruction and disruption of medical facilities have severely reduced civilians' access to healthcare.

Sudan shows a similar pattern. In April 2026, the WHO reported that 37 per cent of the country's health facilities were no longer functioning. That same month, an attack on Al Jabalayn Teaching Hospital killed ten healthcare workers and injured 22 people. The emergency room and operating theatre were destroyed while, according to the WHO, a Caesarean section was taking place. Incidents like this show that the consequences of attacks on healthcare are not confined to the battlefield. They directly affect civilians at some of their most vulnerable moments.

So why do hospitals continue to be attacked despite their protected status? There is no single explanation. In urban warfare, hospitals can be caught in widespread bombardment as fighting takes place in densely populated areas. In other cases, armed forces accuse their opponents of using medical facilities for military purposes, which can lead to disputes over whether a hospital still qualifies for protection under international law.

Attacks on healthcare can also place enormous pressure on civilian populations. When hospitals are damaged or destroyed, access to treatment becomes more difficult, and living conditions deteriorate further. But another factor may simply be the lack of deterrence. If attacks on healthcare repeatedly take place without meaningful consequences, there is little to discourage similar violations in the future.

The problem may not be a lack of rules, but a lack of accountability. International law already protects healthcare during conflict, but enforcing those protections remains difficult.

Since 2018, the WHO has verified more than 10,400 attacks on healthcare, yet its database has recorded no accountability proceedings for them. While institutions such as the International Criminal Court and the UN can investigate violations, the process is often slow and complicated by political alliances, disputes over responsibility and governments rejecting accusations.

This raises a difficult question: can international law deter attacks if those responsible believe they are unlikely to face consequences?

The impact of an attack on a hospital does not end when the fighting stops. When a medical facility is destroyed, entire communities can lose access to essential care. Women may be unable to give birth safely, cancer patients can lose treatment, children may miss vaccinations and injuries that would normally be treatable can become fatal.

The effects can spread even further as doctors flee, medicines become harder to access, and nearby hospitals struggle with more patients. The WHO has also warned that attacks on healthcare can disrupt disease monitoring and treatment, increasing the risk of outbreaks. One attack can therefore continue costing lives long after the initial destruction.

International humanitarian law cannot make war humane, but it is supposed to place limits on what can happen during conflict. The protection of hospitals, patients and healthcare workers is one of the clearest examples of those limits.

The question is no longer whether hospitals are protected under international law. They clearly are. The real question is whether the international community is willing and able to make those protections mean something.

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