In the current circumstances in Gaza, lack of access to medical care has critical consequences. Doctors report severely-injured people they could not save, and others left permanently disabled for lack of proper treatment, which could have spared them a life of suffering and pain. Epidemics easily preventable with proper care are rapidly spreading, endangering tens of thousands of lives.

According to the World Health Organization, of the 36 hospitals operating in the Gaza Strip before the war, only 14 are now functioning – seven in the north and seven in the south. Yet even they are only partly operational: only some departments are working, with medical teams stretched far beyond capacity and contending with severe shortages of staff, equipment, medication, fuel for running the facilities, and food and water for patients and teams. With the hospitals working at more than double their capacity, patients are treated on the floor. Another two hospitals, in Khan Yunis, are providing basic services alone, and only to people sheltering there. Since the war began, more than 90 healthcare facilities and 80 ambulances have been damaged.

Aid organizations report that Israel is placing insurmountable obstacles on transferring medical supplies to hospitals, primarily in northern Gaza, and that they are hard pressed to evacuate wounded people due, among other things, to relentless bombings, destruction of roads, fuel shortages and difficulties coordinating the transfer of supplies or injured persons.

The lack of basic medical services is especially worrying given the steady spread of infectious diseases, due to harsh conditions in the overcrowded IDP camps: more than 1 million people huddled together without clean water, enough food or conditions for maintaining basic hygienic. Tens of thousands of cases have already been reported of respiratory infections, diarrhea (especially in children under 5) and Hepatitis-A – all going untreated. This situation also naturally exacerbates chronic conditions such as diabetes, heart conditions, high blood pressure, cancer and mental disorders.

Israel argues that the responsibility for this dire reality lies solely with Hamas, for using hospitals to establish command centers, dig tunnels underneath, hide weapons, and stage attacks, among other things. However, these claims do not override the special protection granted by international humanitarian law to hospitals, medical teams, patients and displaced persons. They certainly do not absolve Israel of its obligations, as the principle of reciprocity does not apply in this body of law: one party violating the rules does not permit the other party to follow suit. The actions of Hamas in no way relieve Israel of its responsibility for the harm caused to civilians.

Nonetheless, Israel has repeatedly breached these rules since the war began. Despite knowing full well that hospitals are sheltering hundreds of patients and tens of thousands of displaced persons, it treats them as legitimate military targets. It demands their immediate evacuation, although the population inside has nowhere safe to go. It is also blocking the entry of sufficient humanitarian aid, including medical supplies, to meet the growing needs.

As Israel now claims it has achieved effective control over at least part of the Gaza Strip, this would render it the occupying power there, in the absence of another entity controlling the territory. This would confer on Israel positive duties towards the population, including to provide the necessary medical care itself. Military control does not stand alone, and with such control comes responsibility for civilians living in the occupied territory.

International humanitarian law provides special protection for the most vulnerable populations that cannot protect themselves, to ensure that every person who needs medical care receives it. Denying it sentences thousands of people in Gaza to death, pain and indescribable suffering. This approach is both immoral and illegal, and empties a key moral principle of international humanitarian law of meaning.

B’tselem