Healthcare under Fire: Violations of International Laws in Gaza

By Hanin Hicazi Ridvan¹, Seyma Handan Akyon², Adem Ozkara¹

Affiliations

1. Department of Family Medicine, Ankara Bilkent City Hospital, Ankara, Turkiye
2. Department of Family Medicine, Golpazari Family Healthcare Centre, Bilecik, Turkiye

doi: 10.29271/jcpsp.2025.04.548

Sir,

In his final interview before his death on November 10, 2023, Dr. Hammam Alloh said, “And if I go, who treats my patients? We have the right to receive proper healthcare.”¹

Dr. Alloh was an eminent nephrologist who dedicated his career to serving his community despite the ongoing aggressions. Although he had many opportunities to work abroad, he returned to Gaza in 2021, focusing on critical kidney disease treatments in a region with limited healthcare resources. His words emphasise his sense of duty towards his patients and reflect the perseverance of doctors working in conflict zones. Over the past years, Gaza has faced a devastating rise in civilian and healthcare worker (HCW) casualties, yet doctors remain committed to delivering care under extreme conditions. It is astounding to see hospitals, which should be a safe place, attacked in violation of International Humanitarian Law and the Geneva Conventions.²

The Gaza Strip, with an area of 365 square kilometres, houses a population of 2.1 million, making it one of the most densely populated regions in the world. The Gaza Strip has 36 hospitals, with Al-Shifa Medical Complex being the largest healthcare facility. The hospital was attacked multiple times, raided by the Israeli Defense Forces (IDFs) and ordered evacuations. These attacks are a direct violation of international law, which has resulted in casualties among HCWs and patients.³ Since October 7, the aggressions have not stopped, affecting the infrastructure of the healthcare system in Gaza. Seventeen out of 36 hospitals are partially functional. More than 100,000 injuries were reported by the UN. The ongoing attacks are held accountable for this huge number of injuries that require medical attention in specialised healthcare facilities, which are not available in Gaza anymore. More than 44,000 fatalities have been reported; 20,535 of whom are women and children.⁴

The Hippocratic Oath prioritises patients' health and the dignity of human life. The Oath represents the building block of medical practice. Those principles guide doctors in Gaza, even under unimaginable pressure. The targeting of hospitals and HCWs constitutes a contravention of international law. During recent airstrikes, 1,151 HCWs were killed, and 264 were illegally detained. The head of the Orthopaedic Department at Al-Shifa Medical Complex was among those killed in detention due to mistreatment.⁵

Targeting healthcare institutes and the violations against healthcare professionals raise concerns about the validity of international law in ensuring the safety of medical field workers in conflict zones. It is pivotal that the international community holds the violators accountable to guarantee the protection of HCWs. Providing humanitarian aid to reconstruct the collapsed healthcare system and ensuring protection for all medical workers and health facilities, alongside remote psychological support during this unbearable stress, is crucial. Working together with international non-governmental organisations (NGOs) to provide healthcare assistance and volunteering on-site in Gaza can be a temporary solution during the ongoing attacks. Long-term efforts are essential to prevent future crises and ensure the safety of all healthcare facilities and workers.

COMPETING  INTEREST:
The authors declared no conflict of interest.

AUTHORS’  CONTRIBUTION:
HHR: Conception and design of the article. Writing the introduction and background on Dr. Hammam Alloh, his dedication, and the challenges of healthcare in Gaza. Discussion of the Hippocratic Oath and its relevance to healthcare workers in conflict zones. Drafting the overall structure and ensuring the logical flow of content.
SHA: Conducted research on healthcare statistics in Gaza, including hospital functionality, casualties, and reported violations of international law. Collected information on international humanitarian law and Geneva Convention violations. Cited relevant sources and ensured accuracy of data used in the article.
AO: Analysed the implications of attacks on healthcare facilities and violations of international law and proposed actionable recommendations.
All authors approved the final version of the manuscript to be published.

REFERENCES

1. The New Arab. Alloh Hammam: Israel kills dedicated Gaza doctor who refused to leave patients. London: The New Arab; 2023. Cited 2024 Oct 18. Available from: httpss:// www.newarab.com/features/dr-hammam-alloh-dedicated-al-shifa-doctor-killed-israel.
2. Committee of the Red Cross. Customary international humanitarian law: Rule 28. Geneva: International Committee of the Red Cross; cited 2024 Oct 18. Available from: httpss://ihl-databases.icrc.org/en/customary-ihl/v1/rule28.
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