International humanitarian law is clear that “even if health care facilities are being used for military purposes, there are stringent conditions which apply to taking action against them, including a duty to warn and to wait after warning”, said Steven Solomon, the World Health Organization’s (WHO) principal legal officer.

“Disproportionate attacks are strictly prohibited. All combatants should understand that health facilities and health workers are off limits. Targeting them, or militarising them, are both prohibited,” added Solomon in response to a question about Hamas using Gaza hospitals as military bases.

Earlier, WHO Director-General Dr Tedros Adhanom Ghebreyesus reiterated his call for a ceasefire in Gaza, describing the situation as “inhumane”.

Paralysed patients moved

Over the past few days, the WHO has assisted to move 32 patients from the Nasser Medical Complex in southern Gaza, following “a week-long siege” and “a military raid”, according to a  WHO statement.

“Patients transferred included three suffering from paralysis – two of them with tracheostomy – and several others with external fixators for severe orthopaedic injuries. Two of the paralyzed patients required continuous manual ventilation throughout the journey, due to the lack of portable ventilators,” the WHO reported.

“As of 19 February, only 12 out of 36 hospitals with inpatient capacity are still functioning, and only partially. There have been more than 370 attacks on health care in Gaza since 7 October,” according to a statement issued on Wednesday by the Principals of the Inter-Agency Standing Committee that includes the WHO, UNICEF, UN Women and a range of humanitarian agencies.

“Diseases are rampant. Famine is looming. Water is at a trickle. Basic infrastructure has been decimated. Food production has come to a halt. Hospitals have turned into battlefields. One million children face daily traumas,” they added, calling for an immediate ceasefire, the release of all hostages and the safe passage of aid into Gaza.

“Rafah, the latest destination for well over one million displaced, hungry and traumatized people crammed into a small sliver of land, has become another battleground in this brutal conflict. Further escalation of violence in this densely populated area would cause mass casualties. It could also deal a death blow to a humanitarian response that is already on its knees,” adds the committee.

Tedros described Gaza as “a dead zone”: “Much of the territory has been destroyed. More than 29,000 people are dead. Many more are missing, presumed dead and many, many more are injured.” 

Severe malnutrition has increased from under 1% before the war to “more than 15% in some areas” – one in six children under two years of age – and “we note with apprehension that the World Food Programme cannot get into northern Gaza with supplies”, he added. 

“What type of world do we live in when people cannot get food and water? Or when people who cannot even walk are not able to receive care? What type of world do we live in when health workers are at risk of being bombed as they carry out their life saving work? 

“What type of world do we live in when hospitals must close because there is no more power or medicines to help save patients and they’re being targeted by a military force?” he asked.

“We need a ceasefire now. We need hostages to be released. We need the bombs to stop dropping and we need unfettered humanitarian access. Humanity must prevail.”

Tereza Zakaria, WHO health emergency intervention technical officer, added that the WHO was unable to provide proper assistance to people in Gaza because of operational challenges.

“​​The biggest challenge at the moment is in what happens after supplies get inside Gaza. And this is where things things get extremely challenging because of road damage or lack of security,” said Zakaria.

“Many of the missions that we are jointly planning with other humanitarian partners are being denied or not facilitated. So that’s a major challenge. And that’s just one amongst many other operational challenges that renders our current humanitarian response not sufficient; really just a tiny drop in the ocean.”

‘Even wars have rules’

Earlier in the week, seven United Nations experts issued a statement calling for an  independent investigation of “credible allegations” of extrajudicial killing, sexual assault and other forms of violence against Palestinian girls and women by Israeli forces.

“We are particularly distressed by reports that Palestinian women and girls in detention have also been subjected to multiple forms of sexual assault, such as being stripped naked and searched by male Israeli army officers. At least two female Palestinian detainees were reportedly raped while others were reportedly threatened with rape and sexual violence,” said the experts, who include Reem Alsalem, Special Rapporteur on violence against women and girls, and Francesca Albanese, Special Rapporteur on the situation of human rights in the Palestinian territories occupied since 1967.

However, Israel’s UN Mission in Geneva described the rapporteurs’ claims “despicable and unfounded” and condemned their silence regarding “the horrific sexual violence and gender-based violence perpetrated by Hamas on and since October 7”. On Wednesday, Israel’s Association of Rape Crisis Centers also delivered a detailed report to UN Women compiling dozens of eye-witness accounts of rapes, gang rapes and instances of sexual mutilation allegedly committed by Hamas on 7 October, when Hamas-led forces invaded some two dozen Israeli communities near the Gaza border, killing more than 1200 people, mostly civilians.

Dr Mike Ryan, WHO’s executive director of health emergencies, said that the WHO did not have any knowledge of the specific incidents referred to by the UN rapporteurs,  but “the use of sexualised violence and conflict is well recognised and increasingly used”.

“We’ve certainly had the reports of sexual violence against female Israeli hostages in Gaza. We now have allegations of sexual violence and and extrajudicial killings on the other side. I think all of these require investigation by the appropriate authorities. Because even war has rules.”

Treating NCDs in emergencies

Next week, the WHO has convened a meeting in Copenhagen to “discuss how to include and integrate non-communicable diseases (NCDs) into the preparation and responses to emergencies”, Tedros told the briefing.

People living with NCDs such as diabetes, heart and lung disease and cancer are facing a “precarious situation” in conflicts, “especially those who depend upon lifesaving commodities like insulin, dialysis, cancer medicines”, he added.

“We’ve seen a huge caseload in places like Gaza for untreated cancer patients, people who’ve lost access to their hypertension and diabetes medications, people who don’t have access to dialysis any more,” added Ryan. 

“We saw exactly the same pattern in Yemen. We saw exactly the same pattern in Syria. We’re seeing exactly the same pattern in Sudan. 

“When you displace six million people in an already fragile situation and you move two million them across the border and you scatter four million of them across the country in the middle of an open war, and you attack healthcare facilities and you occupy those facilities that are used for the purposes of military purposes, then people will continue to get sick. They will stay sick, and they will ultimately die from diseases that they don’t need to die from.”

Ryan added that the global increase in NCDs brought “a new complexity” to emergency care, particularly in cases where the diagnostic process is complex and needs, for example, CT scanners and laboratory tests? 

“We have to find ways to adapt our care to adapt our diagnostic and care process so that it does the best it can in those situations.”

-Elaine Ruth Fletcher contributed to the editing and reporting on this article.

Image Credits: WHO EMRO.