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Civilian mortality and damage to medical facilities in Gaza

  1. Bram Wispelwey
  2. David Mills
  3. Yara M Asi
  4. Weeam Hammoudeh
  5. Dennis Kunichoff
  6. A Kayum Ahmed

A fundamental principle of health ethics is the preservation of human life, though disagreements may arise on how this is best achieved in times of war. With ongoing events in Israel and Gaza, concerns have been raised about the betrayal of this core ethic. Because of the possibility of war crimes and the scale of Palestinian morbidity and mortality, the rate and sum of which are unprecedented in the 21st century and still growing, it is crucial to find a way to adjudicate two opposing claims. Is the Israeli military (a) taking appropriate precaution to avoid harming civilians, or (b) making no or insufficient attempt to avoid killing civilians?

A new study by Poole and colleagues adds some evidence to address this by examining the pattern of damage to medical buildings compared to non-medical buildings in Gaza. The authors conducted a geospatial analysis of infrastructure damage between 7 October and 7 November 2023 and found no convincing evidence that medical complexes were spared bombing damage relative to non-medical buildings . Of 167 292 buildings assessed for damage, including 106 medical complexes, 9% of both medical and non-medical buildings were damaged during the first month of bombardment. Given the protected status of healthcare entities under international humanitarian law (IHL), and their crucial role in serving civilians in war time, Poole et al raise the larger question of whether IHL’s three principles of engagement—distinction, proportionality and precaution—are being honoured by Israeli forces with respect to civilian objects in Gaza. Scrutinising Palestinian mortality data, we offer additional insights.

Read the full report on BMJ