UN Report Confirms Israel Guilty of War Crimes and “Extermination” in Attacks on Gaza’s Hospitals

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With grimly appropriate good timing, the UN Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel issued a hugely significant report on October 10 in which it found that, as described in an accompanying press release, “Israel has perpetrated a concerted policy to destroy Gaza’s healthcare system as part of a broader assault on Gaza, committing war crimes and the crime against humanity of extermination with relentless and deliberate attacks on medical personnel and facilities.”

The timing was grimly appropriate because, although its focus on Israel’s destruction of Gaza’s hospitals only covers the period from October 7, 2023 to August 2024, a terrible, genocidal version of Groundhog Day is currently taking place yet again in the Gaza Strip, where, although its relentless slaughter has not stopped for the last year, it is currently amplifying its horrors in northern Gaza, ordering the evacuation of the last three remaining partly-functional hospitals there, as part of a new plan to ethnically cleanse the whole of the north — where an estimated 400,000 civilians remain, having refused, or been unable to comply with evacuation orders issued a year ago — with a renewed depravity plumbing previously unthinkable depths.

Because the wheels of international justice revolve so slowly, it has taken over three years for the Commission’s report to be compiled and published. It was initially commissioned by the UN Human Rights Council in May 2021, with a brief to investigate “all alleged violations of international humanitarian law and all alleged violations and abuses of international human rights law leading up to and since 13 April 2021.”

In the end, however, the Commission, understandably, chose to focus solely on events over the last year, covering not just the attacks on Gaza’s healthcare facilities, but also conditions in its gruesome prisons for Palestinians, as well as the conditions in which hostages seized on October 7 and taken to Gaza have been held. To try to ensure that these different topics — hospitals, and prisoners and hostages — get the focus they deserve, I’m writing about the hospitals in this article, and will be writing about the prisoners and hostages in a second article to follow.

The report will be presented to the UN General Assembly’s 79th session in New York on October 30, when, we can only hope, it will be greeted with the widespread, and, frankly, unprecedented revulsion that Israel’s actions deserve.

Israel’s war on Gaza’s hospitals

As the report explains, “According to the World Health Organization (WHO), between 7 October 2023 and 30 July 2024, Israel carried out 498 attacks on health-care facilities in the Gaza Strip. A total of 747 persons were killed directly in those attacks and 969 others were injured, and 110 facilities were affected.”

The attacks were described as “widespread and systematic”, moving, as I’m sure we all recall, from the north to the south of Gaza over a six-month period (some fo which I covered at the time, in my articles here and here), with the Commission also finding that “Israeli security forces attacked these facilities in a similar manner, suggesting the existence of operational plans and procedures for attacking health-care facilities.”

Throughout this sustained campaign of obliteration, “The stated justification of the Israeli security forces for the attacks was that Hamas was using hospitals for military purposes, including as command-and-control centres.” The Commission noted, however, that although “Israeli security forces asserted that over 85 per cent of major medical facilities in Gaza were used by Hamas for terror operations”, they “did not provide evidence to substantiate that claim.”

This, of course, is because there never was any evidence, just transparently false propaganda, via photos and videos, that would have been laughable if its ramifications were not so deadly. I particularly recall a completely fictional representation of a complex subterranean Hamas base beneath Shifa Hospital, akin to the fictional base invented for Osama bin Laden underneath Afghanistan’s Tora Bora mountains in November 2001, although it was, nevertheless, dutifully promoted in the western media as though it was real.

In a roll-call of atrocities, the report specifically focused on attacks on four hospitals: the two main hospitals of Shifa Hospital, in Gaza City (aka Al-Shifa Hospital), and Nasr Hospital in Khan Younis (aka Nasser Hospital), as well as Awda Hospital and the Turkish-Palestinian Friendship Hospital, noting how, in every case, although the Israelis issued evacuation orders, the Commission “found that the orders were not feasible, not issued in a coordinated fashion and could not be implemented in a safe manner”, in part because they “gave hospital administrations little time — just a few hours, in some cases — to evacuate hundreds of patients”, but also because, according to several sources, “full evacuations were not possible without endangering patients’ lives.”

As well as describing the attacks on these hospitals, the Commission noted how the hospitals also came under sniper fire, in which medical staff and patients were deliberately killed, noted the discoveries of mass graves at Shifa and Nasr Hospitals, and also noted how, at the Turkish Hospital, which was forced to close on November 1 after “damage caused by air strikes”, as well as “a lack of fuel and electricity, resulting in the death of several patients”, “about 10,000 cancer patients have been left without access to treatment”, because it was “the only dedicated oncology hospital in Gaza”, and, as a result, “patients have died owing to lack of adequate cancer treatment.”

At Shifa Hospital, meanwhile, “attacks specifically directed against the maternity ward and intensive care unit … resulted in complete or near-complete closure of these facilities” which “had serious ramifications for the rest of the already overwhelmed hospitals of Gaza, owing to the central role of those two hospitals in the overall health system.”

As the Commission further explained, “As at 15 July, of the 36 hospitals in Gaza, 20 were completely non-functional and only 16 were still partially operating, with severe overcrowding and a bed capacity of only 1,490” — for a population of over two million people.

As a result, the Commission added, “The attacks on and destruction of hospitals and the scale of traumatic injuries across the Gaza Strip have overwhelmed the remaining medical facilities, leading to a collapse of the health-care system. The siege of Gaza, which has caused, inter alia, a lack of fuel and electricity, has severely affected the functioning of medical facilities and reduced the availability of life-saving equipment, medical supplies and medications. This has resulted in deprioritizing patients with chronic illnesses, leading to avoidable complications and death. Facilities have suffered from insufficient potable water and sanitation, damaged or limited communications systems, understaffing and lack of public health services.”

As was explained in the press release, the report also specifically “found that Israeli security forces have deliberately killed, detained and tortured medical personnel and targeted medical vehicles while tightening their siege on Gaza and restricting permits to leave the territory for medical treatment”, adding, “These actions constitute the war crimes of wilful killing and mistreatment and of the destruction of protected civilian property and the crime against humanity of extermination.”

Two of those killed are discussed in the second part of the report, about Israel’s prisons for Palestinians, where “at least 53 Palestinian detainees” have died since October 7, 2023, including two doctors, Dr. Iyad Rantisi, the director of a women’s hospital in Bayt Lahya, killed in November, and Dr. Adnan al-Bursh, the head of the orthopaedic department at Shifa Hospital, who was seized in December and died at Ofer Prison in April. As noted above, I’ll be discussing the Commissions’ analysis of these monstrously lawless torture prisons in more detail in a second article follow, although it’s worth noting here that, according to the report, by mid-July 128 health workers were still detained by the Israeli authorities.

As for the targeting of medical vehicles, the Commission noted that, as of mid-July, “113 ambulances had been attacked”, with direct attacks documented on medical convoys “operated by the International Committee of the Red Cross (ICRC), the United Nations, the Palestine Red Crescent Society and non-governmental organizations.” In addition, regarding permits to leave Gaza for medical treatment, primarily in the West Bank, including East Jerusalem, less than half the permits requested — for 5,857 out of 13,872 patients — were granted between October 2023 and June 2024.

The situation has, however, deteriorated still further in the months since, after Israel seized and closed the Rafah Crossing in May, when it crossed a supposed “red line” laid down by the US government, and began attacking the city of Rafah. By August, it was reported, by the head of the Gaza media office, that the blockade had already “resulted in the deaths of over 1,000 children, patients, and injured people due to a lack of access to necessary medical care“, as well as “prevent[ing] 25,000 patients and injured people from seeking medical treatment abroad.”

Israel’s war on Gaza’s children

As was also stated in the press release, “Attacks on medical facilities in Gaza, particularly those devoted to paediatric and neonatal care, have led to incalculable suffering of child patients, including newborns. In continuing these attacks, Israel has violated children’s right to life, denied children access to basic healthcare, and deliberately inflicted conditions of life resulting in the destruction of generations of Palestinian children and, potentially, the Palestinian people as a group.”

The Commission’s focus on the effects of Israel’s war on Gaza’s hospitals on both children and women is both necessary, and also reflective of the wider “war”, in which Israel has shown, and continues to show extraordinary hostility towards both groups of people. Of the more than 42,000 people killed in Gaza over the last year, according to statistics made available on October 9 (and which are undoubtedly far short of the true death toll), nearly two-thirds — nearly 28,000 — are children (16,673) and women (11,270), confirming the extent to which Israel specifically delights in killing babies, children and women. None were “Hamas terrorists”, as Israel likes to claim everyone in Gaza is, and, moreover, most of the rest of the dead were also civilians — men who also had nothing to do with military resistance to Israel’s decades-long oppression.

Amongst the many crimes against children chronicled by the Commission were medical professionals explaining that “they have treated children with direct gunshot wounds, indicating direct targeting of children” (as widely reported in the media), and, because of the unavailability of essential medical supplies, the necessity for children to be “operated on without preoperative and post-operative care, increasing the risk of wounds becoming infected, including by insects and parasites, resulting in complications and, in some cases, death” (as was also widely reported). The Commission also noted that the collapse of the health-care system had “affected the ability to provide vaccinations”, and specifically referred to “the first case of polio in 25 years”, which “was reported by the Ministry of Health in Gaza on 16 August.” This was so alarming that the Israeli government accepted the need for polio vaccinations to take place, although distribution of the vaccine has been impeded by Israel’s evident reluctance to even pause its otherwise ceaseless killing of Palestinian civilians.

As the Commission also noted, “Attacks on the paediatric hospitals of Gaza, including Rantisi and Nasr hospitals, as well as attacks on larger hospitals, have forced children with pre-existing conditions to seek care at smaller facilities that lacking specialized paediatric staff and equipment.” A doctor in Ahli Hospital “stated that the hospital lacked the necessary medications and expertise for treating children with complex medical problems, such as severe asthma or epilepsy.”

Furthermore, despite widespread malnutrition, deliberately caused by the “complete siege” imposed by defense minister Yoav Gallant on October 9, preventing the delivery of food, water, fuel and medical supplies, few of the “stabilization centres for treating malnourished children” were functioning. In addition, hospitals “can no longer offer mental health treatment and have few specialized staff to treat children suffering psychological conditions, including those exhibiting suicidal and self-harming thoughts.” Doctors told the Commission that, “as a result of attacks on medical facilities and the limited treatment options available, infants and children in Gaza would likely suffer well into their adulthood”, and one doctor “summarized the situation by saying that the essence of childhood has been destroyed in Gaza.”

Israel’s war on pregnant women in Gaza

The Commission also confirmed the “deliberate destruction of health infrastructure providing sexual and reproductive healthcare, combined with the lack of access and availability to healthcare”, which it described as “a violation of women’s and girls’ reproductive rights and their right to life, health, human dignity and non-discrimination, as well as the crime against humanity of other inhumane acts.”

As the Commission explained, “Direct attacks on health-care facilities, including those offering sexual and reproductive health care and services, have affected about 540,000 women and girls who are of reproductive age in Gaza”, adding that “direct attacks against the main maternity wards in Shifa and Nasr hospitals rendered them inoperative”, and that other facilities “specifically designated as sexual and reproductive health-care centres were directly targeted or forced to cease operations”, including Emirati Maternity Hospital, Awdah Hospital and Sahabah Hospital, which were “the primary maternal health-care facilities in the south and north of Gaza.”

The Commission also “documented unsafe conditions for women giving birth in hospitals, including lack of specialized personnel, medication and equipment”, with medical professionals noting that “it was extremely challenging to manage patients’ pain and prevent infections, as hospitals were often lacking adequate supplies, including epidurals, anaesthesia and antibiotics.” In addition, “avoidable complications” were widespread because of “the lack of reliable lab testing or equipment”, and obstetricians “stated that women had received very little obstetric care and that a number of them were suffering from vaginal infections that, if untreated, could lead to premature births, miscarriages or infertility.” The incidence of patients “suffering from malnutrition and dehydration, as well as various infections and anaemia”, was also widespread.

Because of the destruction of hospitals, and the lack of supplies because of the “complete siege”, untold numbers of women have been “forced to give birth in unsafe conditions at home or in shelters or camps, with little or no medical support, increasing the risk of complications resulting in life-long injuries and death”, while, even for those admitted to hospitals, the massive increase in emergency admissions — mainly of the victims of Israel’s relentless bombing  — “has resulted in the deprioritization of reproductive health care at the few remaining functional medical facilities.” As the Commission noted, “Post-partum patients and their newborns were not given time for recovery after delivery. Instead, they were discharged within a few hours of delivery, mentally and physically fragile, in order to make space for new admissions”, and “about 60,000 maternity patients were not adequately monitored owing to the unavailability of prenatal and postnatal care.”

Unsurprisingly, the Commission found that Israel’s deliberate efforts to make birth as unsafe as possible “had a detrimental psychological impact on pregnant, post-partum and lactating women because of direct exposure to armed conflict and owing to displacement, famine and substandard health care”, adding, “Obstetric emergencies and premature births have reportedly surged because of stress and trauma. An increase in miscarriages of up to 300 per cent has been reported since 7 October. Experts told the Commission that the long-term psychological and physical effects of such precarious conditions for women, newborns and the family remain unknown.”

The particularly gruesome case of Hind Rajab

One specific focus of the report — described as “one of the most egregious cases” — was “the killing of five-year-old Hind Rajab, along with her extended family, and the shelling of a Palestinian Red Crescent Society ambulance and killing of two paramedics sent to rescue her”, at Tall al-Hawa on January 29. The Commission “determined on reasonable grounds that the Israeli Army’s 162nd Division operated in the area and is responsible for killing the family of seven, shelling the ambulance and killing the two paramedics inside”, which “constitutes the war crimes of wilful killing and an attack against civilian objects.”

Hind Rajab’s case has been one of the more prominent focal points illuminating Israel’s barbarity over the last year, because recordings of her desperate phone calls requesting help, as she was surrounded by the corpses of her family members, were made public and were greeted with horror around the world. Student campaigners at Columbia University in New York famously occupied and renamed Hamilton Hall ‘Hind’s Hall’ in May this year, before they were violently evicted, and the US rapper Macklemore subsequently released a single, ‘Hind’s Hall’, with an accompanying video on YouTube here, which was hugely successful in reflecting the vast outpouring of support for the Palestinians, particularly amongst young people.

The report’s conclusions

In the press release, Navi Pillay, the Chair of the Commission, summed up the report’s findings by stating, “Israel must immediately stop its unprecedented wanton destruction of healthcare facilities in Gaza. By targeting healthcare facilities, Israel is targeting the right to health itself with significant long-term detrimental effects on the civilian population. Children in particular have borne the brunt of these attacks, suffering both directly and indirectly from the collapse of the health system.”

In addition, as well as calling for specific measures to address its findings, the Commission also made reference to “the conflict’s root causes”, urging the Israeli government “to comply with the directions of the July 2024 Advisory Opinion of the International Court of Justice to end the unlawful occupation of Palestinian territory, cease new settlement plans and activities, evacuate all settlers and make reparations to victims”, a startlingly powerful opinion, which I wrote about here, but whose additional warning, to all the countries supporting Israel, that they were complicit in these crimes, largely fell on deaf ears.

In its conclusion, however, the Commission spelled out, unequivocally, that “[t]he actions of Israel violate international humanitarian law and the Palestinian people’s right to self-determination, and they are in stark contravention of the International Court of Justice advisory opinion of July 2024”, and also found Israel guilty of “collective punishment against the Palestinians in Gaza” via its “concerted policy to destroy the health-care system of Gaza.”

In relation to its attacks on Shifa, Nasr and Awdah Hospitals and the Turkish Hospital, the Commission found that, “in view of the excessive number of civilian deaths and injuries, as well as the damage caused to and the destruction of the hospitals’ facilities, Israeli security forces failed to adhere to the principles of precaution, distinction and proportionality, constituting the war crimes of wilful killing and attacks against protected objects”, and also found that that, “in the attacks on Shifa and Nasr hospitals, Israeli security forces considered the hospitals’ premises and all surrounding areas as targetable without distinction and thus violated the principle of distinction.”

In addition, the Commission also found that, after forcing the Turkish Hospital to close, when Israeli security forces seized it “for military purposes and establish[ed] a military post therein”, they were guilty of “the war crime of seizing protected property:, because their actions “were not required by the imperative of military necessity.”

Regarding Israeli claims that Gaza’s hospitals were used by Hamas as military facilities, the Commission concluded that their inability to verify these claims meant that, “at the time of Israeli security forces attacks, the hospitals and medical facilities enjoyed special protection under international humanitarian law and were immune from such attacks”, also concluding that, because Israel’s “attacks against health-care facilities directly resulted in the killing of civilians, including children and pregnant women, who were receiving treatment or seeking shelter”, and because they also “indirectly led to deaths of civilians owing to the resulting lack of medical care, supplies and equipment”, this “constitutes a violation of Palestinians’ right to life”, as well as, as noted above, “the crime against humanity of extermination.”

The Commission also called on Israel “to comply with provisional measures ordered by the International Court of Justice to prevent the commission of all acts within the scope of Article II(a)-(d) of the Genocide Convention”, which were first ordered in a startling opinion in January, in a case brought by South Africa, but which were subsequently ignored by Israel (and its allies), as were subsequent provisional measures.

The reference to genocide, however, remains particularly apposite, as all of the Commissions’ findings point to explicit efforts by Israel to undertake genocide, according to the 1948 Genocide Convention — “the intent to destroy, in whole or in part, a national, ethnical, racial or religious group”, by “killing members of the group”, by “causing serious bodily or mental harm to members of the group”, by “deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part”, and by “imposing measures intended to prevent births within the group.”

As the Human Rights Council hearing regarding the Commission’s findings approaches on October 30, it is also to be hoped that judges in the International Criminal Court are paying close attention, and will finally endorse the recommendation for arrest warrants for Benjamin Netanyahu and Yoav Gallant that the ICC’s Chief Prosecutor, Karim Khan KC, announced in May.

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Andy Worthington is a freelance investigative journalist, activist, author, photographer (of an ongoing photo-journalism project, ‘The State of London’), film-maker and singer-songwriter (the lead singer and main songwriter for the London-based band The Four Fathers, whose music is available via Bandcamp). He is the co-founder of the Close Guantánamo campaign (see the ongoing photo campaign here) and the successful We Stand With Shaker campaign of 2014-15, and the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. He is also the co-director (with Polly Nash) of the documentary film, “Outside the Law: Stories from Guantánamo” (available on DVD here, or you can watch it online here, via the production company Spectacle, for £2.50).

In 2017, Andy became very involved in housing issues. He is the narrator of the documentary film, ‘Concrete Soldiers UK’, about the destruction of council estates, and the inspiring resistance of residents, he wrote a song ‘Grenfell’, in the aftermath of the entirely preventable fire in June 2017 that killed over 70 people, and, in 2018, he was part of the occupation of the Old Tidemill Wildlife Garden in Deptford, to try to prevent its destruction — and that of 16 structurally sound council flats next door — by Lewisham Council and Peabody.

Since 2019, Andy has become increasingly involved in environmental activism, recognizing that climate change poses an unprecedented threat to life on earth, and that the window for change — requiring a severe reduction in the emission of all greenhouse gases, and the dismantling of our suicidal global capitalist system — is rapidly shrinking, as tipping points are reached that are occurring much quicker than even pessimistic climate scientists expected. You can read his articles about the climate crisis here.

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