The aftermath of a Russian attack on the Okhmatdyt Children’s Hospital in Kyiv on July 8, 2024.
Credit: Okhmatdyt Children’s Hospital
By Ed Holt
BRATISLAVA, May 19 2025 – The international community must take action to uphold international humanitarian law, say healthcare and rights advocates, as attacks on healthcare in war zones reached a record high last year.
A new report from the Safeguarding Health in Conflict Coalition (SHCC) released today (May 19) documented more than 3,600 attacks on doctors and health care workers, hospitals, and clinics in zones of armed conflict in 2024—up 15 percent from 2023 and 62 percent since 2022.
The report’s authors say attacks on healthcare in war zones are not only more numerous but are also more destructive and involve heavier weapons—there was a growing use of explosive weapons in attacks against healthcare, rising from 36 percent of incidents in 2022 to 48 percent in 2023. Perpetrator use of drones against health care facilities drove much of the increase, as their use nearly quadrupled, according to the report.
Meanwhile, more than 900 doctors were killed last year—a rise of 21 percent from 2023—and almost 500 were arrested. More than 100 were kidnapped.
However, the report suggests attacks on healthcare in war zones may be even more widespread, as the collection of data on violence is impeded by insecurity, communications blockages, and the reluctance of some entities to share data on violence.
It also says the rise in attacks has come alongside attempts by perpetrators to limit legal protections for health care and civilians in war.
It highlights how Israel has “sought to dilute legal requirements of precaution and proportionality during conflict” while “campaigns to delegitimize the International Criminal Court (ICC) are underway,” with US president Donald Trump imposing sanctions on ICC staff and their families for having charged Israelis with war crimes, Russia criminalizing cooperation with the ICC or any foreign court seeking to hold Russians to account, and other countries announcing plans to leave the ICC.
The authors say regimes around the world are increasingly flouting international human rights laws, and action must be taken to bring actors behind these attacks to justice or risk a proliferation of military targeting of healthcare.
Christina Wille, Director of Insight Insecurity, an SHCC member, told IPS that the international community has a role to play.
“International humanitarian law, which says that healthcare in conflict must be protected, is not being respected. The international community should come together to ensure that there is accountability for these attacks and the people responsible for them are brought to justice. But if nothing is done and this continues, other states may see the targeting of healthcare as a tactic that they can use in conflict without risk of censure or sanction and will go ahead with it,” Wille said.
While the report documented more countries last year reporting attacks on healthcare, the majority of recorded incidents occurred in a handful of states.
By far the largest number of attacks on health care—more than 1,300—took place in Gaza and the West Bank, but there were also hundreds of attacks in other countries that have seen brutal conflicts, including Ukraine (544), Lebanon (485), Myanmar (308), and Sudan (276), where there has been evidence of systematic targeting of local healthcare facilities and workers by attacking, or both attacking and opposing, forces.
The results of these attacks have been dire, not just in terms of the immediate casualties among healthcare workers and civilians from such strikes but also the knock-on effects on the local civilian population from the destruction of facilities, as in some cases even the most basic of medical services subsequently become unavailable.
The report points out that in Gaza, every hospital has been hit, and many multiple times, with dire impacts on their capacity to address the massive number of traumatic injuries, treatment for chronic and infectious disease, and safe childbirth.
“The health system in Gaza has collapsed. Hospitals and clinics have been completely destroyed, like the of the civilian infrastructure. Today, only 22 out of 36 hospitals are partially functioning, and that can mean only being able to treat a few patients a day. Most of the labs are not running, there is very little material available, the staff is exhausted, and some are still detained,” Simon Tyler, Executive Director of Doctors of the World, the UK chapter of the international human rights organization global Médecins du Monde network, told IPS.
A charity organization working in Gaza, Medical Aid for Palestinians (MAP), said that devastating attacks on two hospitals – the European Gaza Hospital (EGH) and Nasser Hospital in southern Gaza—in the last week had worsened the situation.
“The attacks put the EGH out of service and increased the pressure on services at Nasser, as well as destroying parts of the hospital, including the burns unit. EGH was the only hospital in Gaza providing cancer services following the destruction of the Turkish Friendship Hospital in March,” MAP communications manager Max Slaughter told IPS.
Israeli forces have often claimed that hospitals in Gaza were being used as bases for Hamas military operations.
But the UN has said Israeli forces’ attacks on healthcare in Gaza are a war crime.
Doctors in Myanmar who spoke to IPS on condition of anonymity for security reasons said the intensified use of drones by government forces fighting rebel groups in the last 18 months “posed grave threats to the provision of humanitarian aid and healthcare services.”
“Deliberate attacks on healthcare facilities, including hospitals, rural health centers, and other related infrastructure, have resulted in severe damage to health facilities, injuries, fatalities, and, in some cases, permanent disabilities among healthcare workers,” one said.
The doctors added that a combination of people being afraid to travel and frequent displacement of healthcare service sites has significantly disrupted access to essential medical care, and drone attacks targeting group activities, such as the provision of humanitarian aid, hinder effective delivery by deterring gatherings of people and creating logistical challenges.
Meanwhile, the risk posed to humanitarian workers by these attacks has reduced the presence of organizations on the ground, diminishing aid availability for affected populations.
In Ukraine, the healthcare system has faced similar widespread destruction.
Earlier this month, Ukraine’s Health Ministry said that Russian forces had damaged or destroyed more than 2,300 medical infrastructure facilities since the start of the full-scale invasion in February 2022.
In some areas near the line, healthcare systems have all but disappeared, with people having to either rely on local aid groups and NGOs for basic care and essential medicines or travel long distances in difficult conditions to facilities that are still functioning.
But it is not hospitals that have come under attack, as Russian troops regularly target ambulances—since the beginning of the full-scale invasion, 116 ambulances have been damaged, 274 destroyed, and 80 seized.
But hospitals and clinics in areas far from the fighting have not been spared. In one of the worst attacks on healthcare since the start of Russia’s full-scale invasion, the Okhmatdyt Children’s Hospital, one of the largest of its kind in Europe, was hit by a missile on July 8 last year. Two adults were killed and at least 34 people, including nine children, were injured.
Despite initial denials by the Kremlin that its forces had hit the hospital, evidence showed the building had been deliberately struck with a hypersonic missile.
Another problem faced in many conflict zones is how attacks on other infrastructure, such as energy facilities, are impacting healthcare.
Volodymyr Hryshko, Senior Legal Counsel with Ukrainian group Truth Hounds, told IPS more intense Russian targeting of energy infrastructure in 2024 had had a devastating impact on healthcare. In a survey by the group, 92 percent of doctors reported such attacks had experienced power cuts at work, and 66 percent said medical procedures had been affected. The attacks had led to deaths from oxygen deprivation as life support systems failed and staff at some hospitals were forced to work in complete blackouts.
“But the impact is not only immediate risk to patients but also long-term system degradation, staff burnout—reported by over 80 percent—and psychological trauma among both patients and healthcare providers,” he said.
However, despite the death and destruction caused by such attacks, the report shows they are increasing in number.
Wille said the reasons for this are varied and that not all strikes on medical facilities documented may be deliberate.
“Weapons may not be as accurate as believed, and heavy weapons can also have a ‘wide area’ effect—attackers may not have been aiming to hit a hospital, but the impact of the strike still damaged it,” she said.
However, she pointed out that militaries are aware they can gain an advantage in conflict by targeting healthcare systems.
“Health systems are often seen by conflict parties as a system that can help keep the enemy going—treating injuries, helping them recover, and providing a place for them to rest and recuperate.
“Attacks on health systems can also damage morale significantly because health facilities and workers supply the services the population, especially very young and old people, desperately need,” she explained.
But groups working to provide medical and humanitarian help in war zones believe the fact that the regimes behind these attacks are carrying them out with seeming impunity is fueling continued attacks on healthcare in war zones.
“The principle that civilians and aid workers should be protected is being violated time and again. In recent times, we’ve seen clinics bombed, convoys attacked, and our colleagues targeted simply for doing their job in Gaza, the West Bank, and Ukraine. We can no longer rely on or guarantee protection for our staff and services. Civilians, humanitarian workers, health workers, and infrastructure should never be targets. We firmly condemn all attacks on healthcare and call for independent investigation and accountability for the perpetrators,” said Tyler.
“The continued inaction of… some of the most powerful governments in the world in the face of the Israeli authorities’ deadly blockade is indefensible—and could be judged as complicity under international humanitarian law and human rights law. We must hold all responsible for violations accountable to ensure justice for victims, deter further violations, and prevent future escalations,” he added.
MAP’s Slaughter warned that Israel’s “… deliberate blockade of aid and continued attacks on healthcare, all with no real accountability or impunity, are setting a precedent that the international community will permit such atrocities to be committed with no recourse.”
The SHCC report calls for UN states to take action to ensure healthcare is protected in conflicts, including ending impunity by encouraging investigations, data sharing, prosecutions through the International Criminal Court and empowering monitoring bodies.
Wille admitted, though it may be difficult to get a powerful international consensus that would lead to such attacks being stopped, or at least significantly reduced.
“I have little optimism that governments can prevent such attacks in the current climate. When major powers that should uphold the rules-based international order instead question its legitimacy—and even erode the rule of law at home, as in the US—it becomes nearly impossible to build the international consensus needed to enforce those rules,” she said.
“Yet it remains essential to keep calling for these attacks to stop and for perpetrators to be held accountable because even a fractured international order can be repaired, and justice demands persistence,” she added.
IPS UN Bureau Report
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