There is ‘mounting evidence that the Israeli army has targeted health facilities or professionals’

Philip Luther

An immediate investigation is needed into mounting evidence that the Israel Defense Forces launched apparently deliberate attacks against hospitals and health professionals in Gaza, said Amnesty International, as it released disturbing testimonies from doctors, nurses and ambulance personnel working in the area.

The attacks have left at least six medics dead - see briefing below for full details

Hospitals, doctors and ambulance staff - including those trying to evacuate people injured in Israeli attacks - have come under increased fire since 17 July. Some medical teams have even been prevented from reaching critical areas altogether, leaving hundreds of injured civilians without access to life-saving help and entire families without assistance in removing the bodies of their loved ones.

Dr Bashar Murad, director of Palestinian Red Crescent Society’s (PRCS) emergency and ambulance unit, said that since the conflict started at least two PRCS ambulance workers had been killed, at least 35 had been injured and 17 health vehicles had been left out of service after attacks by the Israeli army. He said:

“Our ambulances are often targeted although they are clearly marked and display all signs that they are ambulances. The army should be able to distinguish from the air that what they targeting are ambulances.”

Ambulance worker Mohammad Al-Abadlah was killed on 25 July. He was in Qarara helping an injured person when he was shot in the hip and chest with gunfire and bled to death. Mohammad was travelling in a visibly marked ambulance and wearing his medical uniform Colleagues who approached him to help him were also shot at but were not injured. A’ed Mustafa Bur’i, another ambulance worker, burned to death on 25 July in Beit Hanoon after a shell hit the clearly marked vehicle he was travelling in.

Amnesty International Middle East and North Africa Director Philip Luther said:

“The harrowing descriptions by ambulance drivers and other medics of the utterly impossible situation in which they have to work, with bombs and bullets killing or injuring their colleagues as they try to save lives, paint a grim reality of life in Gaza. “Even more alarming is the mounting evidence that the Israeli army has targeted health facilities or professionals. Such attacks are absolutely prohibited by international law and would amount to war crimes. They only add to the already compelling argument that the situation should be referred to the International Criminal Court.”

Al-Aqsa Martyrs hospital, 21 July

Jaber Khalil Abu Rumileh, who supervises ambulance services in the Al-Aqsa Martyrs hospital, told Amnesty about a shelling attack on the hospital on 21 July that lasted for half an hour:

“It was 3pm and I was working in the emergency unit. I heard bombing that shook the hospital. It was a shelling that had hit the fourth floor, the pregnancy and caesarean unit. Then there were a few more hits. People were terrified, patients ran out, doctors could not enter to help the injured and remove the dead. Then the third floor was hit and four people were killed. I saw one women come running with the child she just gave birth to. Some women gave birth during the shelling.”

Nasser hospital, 24 July

Mohammad Abu Jumiza is partially deaf after suffering head injuries during an attack that took place while he was transferring injured people in his ambulance in Khan Younis on 24 July:

“We were on our way back to Nasser hospital, driving with the lights and sirens on as always. The ambulance was clearly marked as such. The doctor, nurse and I were all wearing medical uniforms. When we reached the Islamic University I heard an explosion right next to us and the front and back windows of the car fell out. As I was turning another missile hit next to us, and then a third one. When the fourth missile hit, I lost control and we crashed, so we ran out of the car and found shelter in a building. Then there were two more missiles fired and some people were injured.”

Blockade shortages

Hospitals across Gaza are also suffering from fuel and power shortages, inadequate water supply, and shortages of essential drugs and medical equipment. Such shortages, already prevalent due to Israel’s seven-year blockade, have been made much worse during recent hostilities.

UK arms to Israel

Amid mounting political pressure on the UK government to announce a suspension of export licences for arms to Israel, over 40,000 people have supported an Amnesty call on the Foreign Secretary Philip Hammond to suspend licences.

Amnesty is calling for an immediate suspension of all UK arms transfers to Israel - as well as for pressure to be exerted on those supplying Palestinian groups in Gaza with munitions. Last year the UK sold £6.3m of arms to Israel - in the past, UK-supplied equipment has been used by the Israeli military to commit human rights violations in Gaza.

Briefing: Evidence of medical workers and facilities being atrgeted by Israeli forces in Gaza

7 August 2014

Since Israel launched Operation “Protective Edge” on 8 July, Gaza has been under intensive bombardment from the air, land and sea, severely affecting the civilian population there. As of 5 August, according to the UN Office for the Coordination of Humanitarian Affairs, 1,814 Palestinians had been killed, 86% of them civilians. More than 9,400 people have been injured, many of them seriously. An estimated 485,000 people in Gaza have been displaced, and many of them are taking refuge in hospitals and schools.

Amnesty has received reports that the Israeli army has repeatedly fired at clearly marked ambulances with flashing emergency lights and paramedics wearing recognisable fluorescent vests while carrying out their duties. According to the Palestinian Ministry of Health, at least six ambulance workers, and at least 13 other aid workers, have been killed as they attempted to rescue the wounded and collect the dead. At least 49 doctors, nurses and paramedics have been injured by such attacks; at least 33 other aid workers were also injured. At least five hospitals and 34 clinics have been forced to shut down due to damage from Israeli fire or continuing hostilities in the immediate area.

Hospitals across Gaza suffer from fuel and power shortages (worsened by the Israeli attack on Gaza’s only power plant on 29 July), inadequate water supply, and shortages of essential drugs and medical equipment. The situation was acute before the current hostilities due to Israel’s seven-year blockade of Gaza, but has been seriously exacerbated since. Amnesty has repeatedly called on Israel to immediately end the blockade on Gaza, which is collectively punishing its entire population in breach of Israel’s obligations under international humanitarian and human rights law.

Amnesty is aware of reports that Palestinian armed groups have fired indiscriminate rockets from near hospitals or health facilities, or otherwise used these facilities or areas for military purposes, though Amnesty has not been able to confirm these reports. While the use of medical facilities for military purposes is a severe violation of international humanitarian law, hospitals, ambulances and medical facilities are protected and their civilian status must be presumed. Israeli attacks near such facilities - like all other attacks during the hostilities - must comply with all relevant rules of international humanitarian law, including the obligation to distinguish between civilians and civilian objects and military targets, the obligation that attacks must be proportional and the obligation to give effective warning. Hospitals and medical facilities must never be forced to evacuate patients under fire.

Mohammad Al-Abadlah, 32, a paramedic who worked for the Palestinian Red Crescent Society (PRCS), was killed on 25 July in Qarara by Israeli army gunfire when he was attempting to rescue an injured man stranded in an area controlled by the Israeli military.

Hassan Al-Attal, 40, a colleague of Al-Abadlah’s who was with him at the time and witnessed the shooting, told Amnesty:

“On 25 July, my colleague Mohammad Al-Abadlah and I were tasked with reaching an injured man in Qarara. We went in the afternoon but were unable to cross the area because there were piles of sand blocking the roads next to which Israeli tanks were stationed. We were not able to reach our destination, so we cancelled the mission and we went back.

“At 10pm on the same day, we were tasked again with the same mission. We arrived at the intersection between Salah Al-Din and Al-Umda Streets and then headed north to try to access from a way other the one we had tried earlier. We were communicating with the Red Cross the whole time, relying on them every step of the way; we were communicating to them everything in details as we always do when we enter areas under Israeli military control. “At one point while driving in the ambulance we were blocked by live electric wires on the road. We informed the Red Cross that the road was blocked and we could not cross. They asked us to try to cross somehow, but we told them we couldn’t. They then called the Israelis and told them about the wires blocking the road and how we were unable to cross. They got back to us saying the army says to get out of the car and cross on foot with our flashlights. So, Mohammad said to me ‘Let’s go, they agreed that we can go walking and collect the case from them directly’. “We got out, we crossed about 10-12 metres and suddenly we were being fired at directly. My colleague screamed and said ‘I’ve been shot’. The shooting continued everywhere, so I could not pull him away or else I too would have got shot and fallen beside him - so I ran and sat in the ambulance. I called the station and told them we had been fired at and Mohammad was injured. The head of the centre came with two ambulances to try and save our colleague. When the colleagues got out to try and take Mohammad, they too were fired at. The head of the centre asked the Red Cross to ask for shooting to stop while we evacuated Mohammad. We brought him but sadly he died. “When he was shot and I had gone back to the ambulance, we continued - he and I - to shout at each other. I could hear him. He was saying ‘come to me’ and I asked him to try and crawl closer to me, so that if he came closer I could pull him away - just so that he would move away from the shooting. He kept saying that he could not crawl to us and we couldn’t get to him. After that we coordinated with the Red Cross and the rest of our colleagues came and we were able bring him back, but he died.”

Amnesty spoke independently to Mohammad Ghazi Al-Hessy, head of the PRCS’s centre in Khan Younis, who received the call to rescue Mohammad and attended to it with his other colleagues. He told Amnesty:

“When we received this call from the Red Cross, they said it was Israel that had requested the evacuation of the injured person. A team including Mohammad Al-Abadlah as the ambulance driver, medic Hassan Al-Attal, and volunteer Ghaleb Abu-Khater were sent off to get the case. Fifteen minutes later, I heard Hassan Al-Attal on the radio shouting ‘There is shooting at us - we are being shot at by the Israelis and Mohammad Al-Abadlah has fallen and is not responding to me’. “I immediately took two ambulances and went to the area while all the time communicating with the Red Cross. I tried calling Mohammad Al-Abadlah’s two mobiles but neither mobile responded. We first drove to a safe area nearby about 100 metres from where they were. I understood that Mohammad, Hassan and Ghaleb were out of the car because they could not reach the injured man with the ambulance; the Israelis had asked them to get out of the car, so the driver and the medic got out with a stretcher and a flashlight. The minute they entered the dirt road leading to the injured person, they were shot at directly and specifically at Mohammad Al-Abadlah. “I asked the Red Cross to coordinate our entry to collect Mohammad. My colleagues and I got out. There were six or seven of us. We put the stretcher next to him and suddenly we were surrounded by very heavy gunfire from the soldiers in the area. “They were direct shots aimed over our heads, under our feet, so we had to evacuate the area. During that time, Mohammad was bleeding very heavily, he was still alive at that point - his white uniform was completely red. Because of the gunfire we were unable to put him on the stretcher. “So we ran and called the Red Cross and told them we were being shot at and it would not do. We remained there for ten minutes then the Red Cross called back and told us to let two of us go in and grab him. Two of the colleagues did indeed go back in, put Mohammad on the stretcher and we drove him to Nasser Hospital. He was still alive and breathing. We worked on him at Nasser Hospital, but he died in the intensive care unit.”

Speaking to Amnesty about the killing of Mohammad Al-Abadlah, Dr Bashar Murad, head of PRCS’s emergency and ambulance unit, said:

“We had received permission to enter the area. The army had called the Red Cross asking for an ambulance. The call was about an injured person and when our ambulance worker Mohammad arrived he was killed, although he was travelling in an ambulance clearly visible as such. He was in medical uniform, which distinguishes him, and he was carrying a stretcher when he was shot by a sniper. He received bullets in the hip and chest, and even when his colleagues tried to rescue him they were also shot at. We had called the Red Cross and informed them and asked them to interfere and allow us to rescue the medic, but we were prevented from getting to him for half an hour. Mohammad bled to death. “He was killed despite assurances we received from the Red Cross that the area was safe for us to work in. Our entrance to the area was checked twice with the army through the Red Cross. His colleagues would also have been killed if they had not found shelter in a house nearby. There was shooting at them. The Red Cross needs to call for accountability in this case”.

A’ed Al-Bor’i, 28, a volunteer medic with the PRCS ambulance service, was killed at around 4.30pm on 25 July in Beit Hanoun when a shell fired by the Israeli army hit the ambulance he was in on the way to treat an injured person. Jawad Budier, 50, a paramedic who was with A’ed Al-Bor’i and was injured in the attack, told Amnesty:

“I received a call from the ‘dispatcher’ in Jabaliya ambulance centre while I was working in the Beit Hanoun area as there were injuries on Masriyeen Road. They were difficult conditions. Masriyeen Road was about 100 metres away from where I was in the Beit Hanoun hospital, which was our centre, so my team and I moved from there into Masriyeen Road. We went no more than 100 metres - to where the injured were. There was a side road around six metres wide which we tried to dive into, but suddenly there was an explosion directly on the ambulance - we were shocked. “Suddenly there was fire on top of my head and my face was burnt - my hair was on fire along with my hand. I tried to put the fire out, but when I tried to open the door next to me to get out it would not open. So I thought I could get out through the door on the right – past the medic Hattem Shahine, who had been sitting next to me. Behind me was the late A’ed Al-Bor’i. To my surprise I could not find Hattem Shahine or the seat next to me. There was no one next to me. “I managed to get out… and was shocked to find A’ed thrown on the ground dead and his upper torso ripped apart (I could see his insides) - I am not sure how. “I looked at the back of the car, and I could not see a back to the car, the back half of the car was all gone, totally separated from the front of the car, nothing was attached, no doors, nothing. I got out from the back and ran till I got to Beit Hanoun hospital, no more than 200 metres away. When I got to the hospital door I fainted from the shock and horror of the situation; I had also been fasting. The medical team took care of me and I was miraculously saved. I believe I was directly targeted. The Occupation [Israeli military] does not discriminate between rocks or trees or human beings.”

Dr Bashar Murad told Amnesty that an ambulance which was sent to retrieve A’ed Al-Bor’i’s body was also shot at, which resulted in the injury of another medic. The PRCS were not able to retrieve the body until the next day.

Mohammad Abu Jumiza, 47, a Ministry of Health paramedic ambulance worker, was injured on 24 July when two ambulances were hit by Israeli military aerial attacks in Khan Younis. He told Amnesty:

“On 24 July at night, I received a call to transfer a case from Nasser Hospital, where I am based, to the European Hospital. That was around 11-11.30pm. The case needed a nurse and a doctor; Dr Majdi Al-Amoor and colleague Shadi Abu Mustafa came with me. We picked up the injured person and took him along with two of this relatives to the European Hospital and dropped them off. On our way back to Nasser Hospital, it was only the three of us in the ambulance, it was clearly marked as such. All three of us were in medical uniform, and we were driving with the lights and sirens on as always. “When we reached the Islamic University I heard an explosion right next to us. The front and back windscreens of the car fell out. My colleague asked me to speed up, so I did, and as I was going around a bend another missile hit next to us and then after that a third one hit next to us. Each of the hits moved the car. When the fourth missile hit, I lost control and we crashed. I was driving at 70-80km per hour at the time. When we crashed we ran out of the car and found shelter in a building. There were two more missiles fired; there were people there and some got injured. All the missiles that hit when I was driving hit very close to us. “The people came out of their houses because of the bombing. Everyone was terrified, and some were injured by shrapnel. We found shelter and we called an ambulance. We called the PRCS and told them that medics were injured, so ambulances arrived after ten minutes. I got in the car with my colleague; my head was injured and my face was bleeding. I got a ride with my colleague from PRCS Salem Abu Al-Kheir, along with three other people who were injured from the shrapnel. As we were driving we were hit by a missile, and then after another 30 metres another missile hit. There was a huge explosion; the sound was loud and the ambulance window fell out. I was sitting behind the driver. We stopped the car, got out and ran. We found a house and took shelter. My colleague was bleeding, as was I. My colleague called the PRCS and informed them about what had happened, but we told them not to send another car - because it would be hit - without first coordinating with the Red Cross. After 20-25 minutes, a PRCS ambulance came and took us to Nasser Hospital. My colleague from the PRCS was injured in his arm. Now I cannot hear, as well receiving injuries to the face (ear and lips) and to the head.”

Hani Ja’farawi, head of the Palestinian Ministry of Health’s ambulance unit, spoke to Amnesty about some of the dangers he faced while joining ambulance missions in northern Gaza:

“During my rides I saw massive destruction. I would be driving with the heavy sound of bombing the whole time. We were not directly targeted but there was the danger of fire around us. They fired right next to us when they wanted to tell us not to advance any more, and so we stop. They gave warning by firing at us. “On Thursday, 24 July, I accompanied an ambulance going to transfer injured people to Jerusalem through Erez. We worked to transfer at least six injured people per day. We would always go in a bunch of ambulances. We took off from the European Hospital and after we handed over the injured people we would come back on Salah Al-Din Street. We had lights and sirens on and, as we were driving in the empty streets - no one there, not a soul - we found two men injured and lying on the side of the road. When we stopped, the Israelis fired shells right next to us. There was some damage to the outside of the ambulances and one medic received an injury from the shrapnel. There was no one around us. The shelling targeted us although it did not hit the ambulance directly. How would you explain it otherwise? It was only us and injured men.”

On 21 July parts of the Al-Aqsa hospital in Deir al-Balah were struck by Israeli shelling, killing four people and wounding dozens, including medical workers, patients and people fleeing the violence and looking for refuge in the hospital. Jaber Khalil Abu Rumileh, supervisor of emergency and ambulance services at the hospital who was there at the time, told Amnesty:

“On 21 July, at 3pm, after midday prayer, I was at my workstation in the hospital. While I was working in the emergency unit, I heard a sound of bombing. It shook the hospital - a shelling. It hit the fourth floor, pregnancy and caesarean unit, then there were a few more hits. People were terrified, patients ran out, doctors could not enter and take out injured and killed people. And then as we were trying to calm people and attend to injuries and others, more shelling hit the building. The third floor was hit. It includes other surgery units, the childcare unit and the heart unit. Four people were killed from these hits. One shell went through the eastern wall on this third floor, through the wall in the middle and hit Nurse Eman Abu Jayyab. Her right arm was broken. “It was chaos. All patients, visitors, people taking shelter at the hospital, nurses, doctors, workers - there were around 30-40 child patients - everyone was panicking. Everyone came down to the ground floor, everyone was scared, and when everyone was downstairs, another shell hit, and the glass down there fell out. The shelling kept on for 30 minutes from beginning to end. Ambulances and ambulance workers were hit when rubble fell down on them outside. “It was a tragedy for all the pregnant women or those who gave birth. I saw one women come running with the child she had just given birth to. Some women gave birth during the shelling, the doctors did it on the ground floor, and three women were transferred to other hospitals. “We were scared ourselves, I was worried about myself, but I have a duty to preform so I had not to worry about myself and attend to patients and my injured colleagues. We called the Red Cross and journalists. When the Red Cross came, we told them what happened. When they went up to see what happened, the hospital was hit again. They stopped their visit and left. Everyone was asking them for protection. We said that the hospital anywhere in any circumstances should be a safe place.”

Past attacks

Amnesty has previously documented and reported on attacks by the Israeli army on health workers during military operations in Gaza in 2008/9 and 2012. Endangering the lives of aid and medical workers and obstructing their work is a violation of international law.

The Fourth Geneva Convention relative to the Protection of Civilian Persons in Time of War of 12 August 1949 (Fourth Geneva Convention) obliges states to respect and protect the wounded, to allow the removal from besieged areas of the wounded or sick, and the passage of medical personnel to such areas. The deliberate obstruction of medical personnel to prevent the wounded receiving medical attention may constitute “wilfully causing great suffering or serious injury to body or health”, a grave breach of the Fourth Geneva Convention, and a war crime.