Human Rights Watch / October 30, 2024
Israel’s allies should suspend arms sales.
Beirut – The Israeli military has repeatedly attacked medical workers and healthcare facilities in Lebanon, Human Rights Watch said today. Human Rights Watch documented three attacks, involving apparent war crimes, in which Israeli forces unlawfully struck medical personnel, transports, and facilities, including paramedics at a civil defense center in central Beirut on October 3, 2024, and an ambulance and a hospital in southern Lebanon on October 4, killing 14 paramedics.
As of October 25, Israeli attacks have killed at least 163 health and rescue workers across Lebanon over the past year and damaged 158 ambulances and 55 hospitals, according to Lebanon’s Ministry of Public Health. The Israeli military should immediately halt unlawful attacks on medical workers and healthcare facilities, and Israel’s allies should suspend the transfer of arms to Israel given the real risk that they will be used to commit grave abuses.
“The Israeli military’s unlawful attacks on medical workers and hospitals are devastating Lebanon’s already frail health care system and putting medical workers at grave risk,” said Ramzi Kaiss, Lebanon researcher at Human Rights Watch. “Strikes on medical workers and healthcare facilities also compound risks to injured civilians, severely hindering their ability to receive urgently needed medical attention.”
The United Nations should urgently establish, and UN member countries should support, an international investigation into the recent hostilities in Lebanon and northern Israel, and ensure that it is dispatched immediately to gather information and make findings as to violations of international law and recommendations for accountability.
Human Rights Watch interviewed eight people, including paramedics, civil defense, and hospital officials, and visited the site of the attack on the Islamic Health Committee’s civil defense center, where it additionally interviewed three residents and witnesses to the attack. Human Rights Watch also analysed photographs, videos, and satellite imagery of the attacks. Human Rights Watch sent a letter outlining its findings and posing questions to the Israeli military on October 7 but has not received a response. On October 21, Human Rights Watch sent a letter outlining its research findings and posing questions to the Islamic Health Committee, which responded on October 23.
An overnight Israeli strike on October 3 struck a civil defense center in the Bashoura neighbourhood of central Beirut, killing seven paramedics. The center belonged to the Islamic Health Committee, a civil defense and ambulance organization affiliated with Hezbollah. In Lebanon, the civil defense is a civilian force whose duties include providing emergency medical and rescue services and assisting with the evacuation of the civilian population. On October 4, the Israeli military struck an Islamic Health Committee ambulance near the entrance of Marjayoun Hospital in southern Lebanon, killing seven other paramedics and forcing the hospital to evacuate its staff and shut down. That same day, the Israeli military struck Salah Ghandour Hospital in the southern Lebanese town of Bint Jbeil, around two and a half hours after issuing an evacuation warning by phone to local officials.
The Israeli government has accused Hezbollah of using ambulances to transport fighters and hospitals to hide weapons and equipment. Human Rights Watch did not find any evidence indicating use of these three facilities for military purposes at the time of the attacks that would justify depriving them of their protected status under international humanitarian law.
In the absence of military justification for the attacks on the facilities, the attacks are unlawful. Such attacks directed against medical facilities, if carried out with criminal intent—that is, intentionally or recklessly—would be war crimes.
Membership or affiliation with Hezbollah, or other political movements with armed wings, is not a sufficient basis for determining an individual to be a lawful military target. Guidance by the International Committee of the Red Cross (ICRC) sets out that people who have exclusively non-combat functions in armed groups, including political or administrative roles, or are merely members of or affiliated with political entities that have an armed component, such as Hezbollah, may not be targeted at any time unless and only for such time as they, like any other civilian, directly participate in the hostilities. Medical personnel affiliated with Hezbollah, including those assigned to civil defense organizations, are protected under the laws of war.
On October 21, a strike near Rafik Hariri University Hospital reportedly killed 18 people, including 4 children, and damaged the hospital.
Under the laws of war, doctors, nurses, paramedics, and other health and medical personnel must be permitted to do their work and be protected in all circumstances. They lose their protection only if they commit, outside their humanitarian function, “acts harmful to the enemy.”
Likewise, ambulances and other medical transportation must be allowed to function and be protected in all circumstances. They could lose their protection only if they are being used to commit “acts harmful to the enemy,” such as transporting ammunition or healthy fighters in service. The attacking force must issue a warning to cease this misuse and can only attack after such a warning goes unheeded.
Under international humanitarian law, all parties to the conflict are under a duty, at all times, to distinguish between combatants and civilians and to target only combatants. Individuals who commit serious violations of the laws of war with criminal intent—that is, intentionally or recklessly—may be prosecuted for war crimes. Individuals may also be held criminally liable for assisting in, facilitating, aiding, or abetting a war crime. All governments that are parties to an armed conflict are obligated to investigate alleged war crimes by members of their armed forces.
In November 2023, Human Rights Watch called for investigations into the Israeli military’s repeated, apparently indiscriminate attacks on medical facilities in Gaza. Human Rights Watch has called on Israel’s key allies to suspend military assistance and arms sales to Israel, given the real risk that they will be used to commit grave abuses.
“With more than a hundred health workers killed, Israeli strikes in Lebanon are putting civilians, including medical workers, at grave risk of harm,” Kaiss said. “Medical workers should be protected, and countries should take action to prevent further atrocities, including by suspending arms sales and military assistance to Israel.”
As of October 28, 2024, Israeli attacks in Lebanon have killed at least 2,710 people and injured more than 12,592 people since October 2023, according to Lebanon’s Ministry of Public Health.
As of October 25, the Ministry of Public Health said Israeli strikes in Lebanon had damaged 51 emergency medical centers and facilities tied to various governmental and nongovernmental health organizations, including the Lebanese Red Cross, the General Directorate of the Lebanese Civil Defense, the Amel Association International, the Islamic Risala Scout Association, the Islamic Health Committee, and the Lebanese Succour Association. The ministry stated that the attacks had damaged a total of 158 ambulances belonging to these groups and that 55 hospitals were damaged in strikes that killed 12 people and injured 60, as of October 25. On October 25, the UN Special Coordinator for Lebanon said that, since October 2023, “27 attacks targeted ambulances used by first responders.”
On October 3, the World Health Organization’s (WHO) director general said that 28 on-duty medics were killed in Lebanon in the span of 24 hours. The WHO warned on October 8 about disease outbreaks in Lebanon following the partial or full closure of at least nine hospitals in addition to crowded conditions in shelters for displaced persons. On October 8, an official with the Islamic Health Committee told Human Rights Watch that Israeli strikes had killed 60 of the committee’s paramedics since the escalation of hostilities in mid-September.
Human Rights Watch did not independently verify the circumstances of each of these cases.
Since October 2023, Hezbollah has launched thousands of rockets and missiles into towns in northern Israel, killing at least 16 civilians. In July, 12 children were killed in an attack on the town of Majdal Shams, in the occupied Golan Heights. Israeli and United States officials said that Hezbollah was responsible for the attack, which the group denies.
The Israeli military has repeatedly claimed that Hezbollah is using civilian infrastructure for military purposes. In a speech before the UN General Assembly on September 27, Israel’s Prime Minister Benjamin Netanyahu accused Hezbollah of hiding rockets and missiles in hospitals. In March, Israel’s Arabic-language military spokesperson, Avichay Adraee, accused Hezbollah and the Lebanese Amal Movement of using ambulances “for terrorist purposes,” including to transport personnel and combat equipment. In October, the spokesperson reiterated these claims in a post to his X account, warned medical crews to stay away from Hezbollah members, and called on them not to cooperate with the group. He did not distinguish between Hezbollah combatants and other civilian members of the group’s institutions or political office. He said that “any vehicle proven to have an armed saboteur using it for terrorist purposes, regardless of its type, will have appropriate measures taken against it to prevent its military use.”
The claims made by the Israeli military spokesperson are contested. Human Rights Watch has not been able to corroborate them.
Methodology
Human Rights Watch spoke to members of the Islamic Health Committee; the Islamic Risala Scout Association, a civil defense and ambulance organization affiliated with the Amal Movement, a Lebanese political party and Hezbollah ally; and officials at Mays al-Jabal Hospital, Marjayoun Hospital, and Salah Ghandour Hospital in southern Lebanon.
Human Rights Watch also spoke with three officials from the General Directorate of the Lebanese Civil Defense and reviewed statements provided by the Islamic Health Committee and the Islamic Risala Scout Association pertaining to attacks on their centers and crews.
On October 3, Human Rights Watch visited the site of the attack on the Islamic Health Committee’s civil defense center and interviewed residents and witnesses to the attack. On October 7, Human Rights Watch interviewed an individual who operated an art studio in the same building as the civil defense center in Beirut.
One paramedic with the Lebanese Civil Defense, whom Human Rights Watch interviewed, was subsequently killed in an Israeli strike on a civil defense center in the southern Lebanese town of Dardghaya on October 9.
Human Rights Watch analysed 57 photographs and videos posted on social media platforms or shared directly with researchers. The images were taken in Beirut, southern Lebanon, and the Bekaa governorate. Human Rights Watch analysed satellite imagery from Salah Ghandour Hospital and Marjayoun Hospital recorded before and after the attacks. Human Rights Watch visited the site of the strike on the civil defense center in Beirut but did not visit the sites of the strikes at the hospitals in southern Lebanon.
Strike on the Islamic Health Committee Civil Defense Center
Shortly after midnight, on October 3, an Israeli strike hit the Islamic Health Committee’s civil defense center in central Beirut, on the second floor of a residential building. A statement published that day by the committee said that the strike killed seven paramedics. Those victims, according to the committee, included two volunteer paramedics, the head of the committee’s civil defense in Beirut, the head of operations in Beirut, the head of equipment in the Beirut area, the head of machinery and maintenance, and the head of rescue work.
The Ministry of Public Health said that the attack killed nine people and that DNA tests on recovered body parts are ongoing to verify the identity of the remaining unidentified victims. Two witnesses said that among the victims were bystanders who were near the building at the time of the strike.
On the October 3 visit to the site, Human Rights Watch observed damage indicating that at least two munitions detonated in rooms containing the Islamic Health Committee’s offices and blast damage on the floors above and below. Researchers also observed primary and secondary fragmentation damage on adjoining and adjacent apartment buildings, businesses, and Al-Bashoura Islamic Cemetery, across the street.
The Islamic Health Committee’s civil defense director general said in a statement provided to Human Rights Watch that the center has 13 employees and 45 volunteers, who provided rescue and first aid services to residents and displaced people from the south and the southern suburbs of Beirut.
One neighbourhood resident, who was at his shop at the time of the attack, said he immediately rushed to the building after the strike to help those injured. He said he saw three lifeless bodies, including one that was severely mutilated. “Everybody knows it’s a medical center,” he said. “They help everyone here.”
Mahmoud Karaki, an Islamic Health Committee spokesperson, said that the paramedics at the center at the time of the strike had gone there to rest after a day of rescue work in Beirut’s southern suburbs, after a series of Israeli strikes overnight.
“All of the people who were in the office were paramedics,” Karaki said. “Some were managers, but all are paramedics.” He said the center was established in the Bashoura neighbourhood since 2009.
Human Rights Watch reviewed two images circulating on social media that showed one paramedic killed in the strike, Wissam Mahmoud Salhab, in military clothes on martyr posters that are highly similar to those issued by Hezbollah’s military wing, in addition to a video of Salhab firing an assault rifle. Another photo reviewed by Human Rights Watch showed another paramedic killed in the strike, Sajid Shirri, in military clothes donning a Hezbollah patch.
Human Rights Watch noticed discrepancies in the martyr posters, including the use of two separate photos, ranks and pseudonyms for the same person. The same camouflage and scarf used in Sahlab’s posters were found on other apparent martyrs’ posters circulating online. In its response to a letter from Human Rights Watch, the Islamic Health Committee denied that the martyr posters for Salhab were issued by Hezbollah’s military wing, and said instead that “such posters, often are designed by family members and friends of those killed who consider photos in military clothes post-martyrdom to be a source of pride.”
Human Rights Watch could not verify the source of the martyr posters. The statement said that Hezbollah’s military wing did not issue those posters on its Telegram channel, which Human Rights Watch confirmed, and said that Salhab had worked for more than 10 years as the head of emergency operations and logistics at the civil defense center in Beirut. The Islamic Health Committee also said that Shirri was “never a member of Hezbollah’s military wing and has never held a role in that regard … and his work was limited to health, rescue and emergency services.” It said that the military clothes worn by Shirri in the circulated photos could have belonged to his relatives or have been bought from a store, and that such military clothes do not necessarily belong to Hezbollah. Human Rights Watch could not verify this claim.
The Islamic Health Committee further said that none of the paramedics killed in the Bashoura strike and the strike on a group of paramedics near Marjayoun Hospital had held a combat function or mission in the military wing of Hezbollah since joining the committee. It denied that the committee has any ties to military operations and stated that there is a “complete separation between the military wing [of Hezbollah] and the social services wing.”
Maria Hibri, an artist who owns a workshop on the ground floor of the same building said that the building was made up of three blocks, with 27 families living in each block, and that the targeted floor was solely occupied by the civil defense center. “There was no evacuation warning given to anyone in the building,” she said. “Why? They would have left. Nobody wanted to die.”
Strikes on ambulance near Marjayoun Hospital
In an October 4 statement, the Islamic Health Committee said that seven of the group’s paramedics had been killed “in a direct attack on the ambulance crew at Marjayoun Hospital.”
Shoshan Hassan Mazraani, the emergency room head nurse at the hospital, said she witnessed the strike while she was drinking coffee outside the entrance of the hospital’s emergency room. She said that the strike was “directly on the ambulances,” three of which were on the road leading to the hospital’s entrance at the time of the attack.
“I ran to the ambulances and told people that they hit the paramedics,” she said. “Once I got to the road I couldn’t continue. Staff at the hospital were saying don’t go near the ambulances, they might strike again. And the injured paramedics were calling out for me to help them.”
Mazraani, who is usually responsible for providing death tolls from the hospital to the Ministry of Public Health, said that seven paramedics were killed and five were injured.
“These guys, we knew them,” she said. “For a year they were bringing injured people to the hospital. We became familiar with them. They are paramedics, just like any other ambulance crew.”
In statements to the media on October 4, the Marjayoun Hospital director, Dr. Moanes Kalakish, said that the hospital’s main entrance “was targeted as paramedics were approaching” and that the hospital was not warned before the attack. Mazraani also said that neither she nor other hospital staff received evacuation warnings.
The hospital was evacuated and shut down after the strike that day, news reports and Mazraani said. One photograph taken on October 4 and geolocated by Human Rights Watch to approximately 150 meters from the hospital shows a burned ambulance and a truck on fire under a burned palm tree. Human Rights Watch analysed satellite imagery from October 11 of the area around Marjayoun Hospital showing the burned vehicles.
Satellite imagery from October 11, 2024, shows two burned vehicles under a burned palm tree, about 150 meters from Marjayoun Hospital, Lebanon. Human Rights Watch geolocated at the same place a photograph from October 4 showing a truck on fire and a burned ambulance. Image © 2024 Planet Labs PBC. Graphic © Human Rights Watch
Human Rights Watch also analyzed one video and two photographs uploaded to X on October 11, showing a large crater blocking one of the main roads into Marjayoun Hospital.
Israeli strikes on roads leading to the hospital hindered hospital staff from returning to their homes, Mazraani said. For 12 days before the hospital shut down, hospital workers had been sleeping there, according to Mazraani.
“There was a lot of danger, and we knew that if we left, we won’t be able to go back to the hospital,” she said.
The Israeli military did not publicly provide any evidence that Marjayoun Hospital or the ambulances targeted near the entrance were being used to carry out hostile acts.
Strike on Salah Ghandour Hospital
The head of Salah Ghandour Hospital in Bint Jbeil, Dr. Mohammed Suleiman, said that the hospital was struck on October 4, two-and-a-half hours after they received an evacuation warning. Suleiman said that a local official in Bint Jbeil received a call, reportedly from an Israeli military official, at around 6 p.m. on October 4 informing him that the paramedics around the hospital should be evacuated within four hours as the hospital could be struck.
“We deemed that this warning did not concern the medical staff of the hospital, so we evacuated the paramedics and the area around the hospitals, but the staff stayed,” Suleiman said. “But we were surprised that 2.5 hours later … a strike took place at 8:30 pm before the end of the [four hour] warning period. The hospital was struck three times. One shell struck the on-call room and two shells struck the paramedics’ waiting room, [both] inside the hospital.”
Nine hospital workers were injured, including doctors and medical workers, three of whom are in critical condition, Suleiman said.
Lebanese media reported that after the attack, the Israeli military did not respond to requests from UNIFIL, the UN peacekeeping force in Lebanon, to allow a Lebanese Red Cross and Lebanese Army convoy to approach the hospital and help evacuate people. Suleiman said that the hospital staff were forced to evacuate injured people in their own cars.
On October 5, the Israeli military said that an Israeli Air Force aircraft attacked “Hezbollah terrorists who were operating within a command center that was located inside a mosque adjacent to the Salah Ghandour Hospital.” The military said that Hezbollah used the command center “to plan and execute terrorist attacks against IDF troops and the State of Israel,” referring to the Israeli military; and that “notices were sent to residents and conversations were held with significant parties” in villages with hospitals being used “in defiance of the laws of armed conflict.” The military said that it demanded that “any military activity carried out from the hospitals should stop immediately,” but did not give further details of what ‘terrorist activity’ took place from the Salah Ghandour Hospital.
Suleiman said that the military first struck the hospital from the side that is furthest away from the mosque, before striking the mosque afterwards. In the warning to the village, Suleiman said, no mention was made of the mosque or of its use by Hezbollah.
The Israeli military did not provide public evidence that either the hospital or the mosque were being used to commit hostile acts.
Human Rights Watch geolocated a photograph and a video posted to social media the day after the attack and received from a contact, showing the destroyed mosque adjacent to the hospital.
Low-resolution satellite imagery recorded on the morning of October 4 shows no signs of damage in Salah Ghandour Hospital, but an image collected 24 hours later, in the morning of October 5, confirms the site was struck.
A very high-resolution satellite image from October 11, analysed by Human Rights Watch, shows the mosque completely destroyed, and heavy damage to the hospital’s northwestern side, facing the mosque, and smaller damage to the hospital rooftop on the opposite northeastern side.
Satellite imagery from October 11, 2024, shows the mosque adjacent to Salah Ghandour hospital in Bint Jbeil, Lebanon, destroyed, heavy damage to the hospital’s north-western side, in addition to smaller damage to the hospital rooftop on the north-eastern, side. Image © 2024 Planet Labs PBC. Graphic © Human Rights Watch
Healthcare facilities are civilian objects that have special protections under the laws of war against attacks and other acts of violence, including bombing, shelling, looting, forced entry, shooting into, encircling, or other forceful interference such as intentionally depriving facilities of electricity and water. Healthcare facilities only lose their protection from attack if they are being used to commit “acts harmful to the enemy,” and after a required warning.
According to the ICRC, “prior to an attack against a medical unit which is being used to commit acts harmful to the enemy, a warning has to be issued setting, whenever appropriate, a reasonable time limit and that an attack can only take place after such warning has remained unheeded.”
Other Strikes on Health Centers, Medical Workers
Human Rights Watch identified at least two other attacks, in the southern Lebanese towns of Sohmor and Kafra, that significantly damaged healthcare centers and vehicles and killed medical personnel.
On September 29, six members of the Islamic Health Committee were killed in Sohmor, in the Bekaa governorate, the Ministry of Public Health said. Videos taken from the site of the strike, posted on social media on September 30 and analysed by Human Rights Watch, show a damaged civil defense car and two damaged ambulances with the logos of the committee, as well as a burning vehicle. Human Rights Watch geolocated the site of the strike to a building in the northeastern part of Sohmor but could not determine whether there were military targets present at the site.
The civil defense commissioner for the Islamic Risala Scout Association, Rabih Issa, said that a separate strike on September 30 hit a group of paramedics when they were changing shifts at one of the group’s assembly points in Kafra, in the Nabatieh governorate, damaging three ambulances belonging to the association and injuring several paramedics. Human Rights Watch analysed two videos received from a contact and posted on social media on September 30 and geolocated them to the main road in Kafra. The videos show one destroyed ambulance in addition to two burned vehicles on a damaged road.
Evacuation Warnings to Medical and Civil Defense Centers
On September 30, Issa told Human Rights Watch that two other civil defense centers belonging to the Islamic Risala Scout Association in southern Lebanon received a phone call from the Israeli military the previous week ordering them to evacuate the centers within two hours. It is unclear whether the two centers were subsequently hit.
The head of the Lebanese Civil Defense Force in Tyre, Abdullah Moussawi, also told Human Rights Watch on September 30 that two civil defense centers in southern Lebanon received a phone call from the Israeli military ordering staff to evacuate their centers. He said that the centers were not attacked despite the evacuation warnings.
Moussawi and four other paramedics were killed in a strike “that targeted the civil defense center” in Dardghaya, near the southern Lebanese city of Tyre, on October 9, according to the General Directorate of the Lebanese Civil Defense.
The director of medical supplies at the Mays al-Jabal Hospital, Dr. Halim Saad, said that the hospital also received an evacuation warning on October 4 from the Israeli military, instructing the staff to leave immediately. Saad said that the attacks in the surrounding area since October 2023 had damaged the hospital. The hospital shut its doors on October 4 and evacuated its staff after the Israeli military reportedly ordered its evacuation.
It remained unclear whether Mays al-Jabal Hospital was directly attacked after the Israeli military’s evacuation warning.
Human Rights Watch analysed and geolocated seven photographs and one video provided by Saad that showed damage consistent with kinetic damage to the hospital’s facade, entrance doors, and windows facing south, as well as a remnant of an artillery-fired smoke projectile in the hospital’s yard. Saad said that the hospital depended on UNIFIL to deliver needed supplies, such as water, fuel, and medical supplies, but had been unable to receive supplies in the week before it closed.
“The strikes that have happened on and near the hospital since last year, in addition to the evacuation warnings we received and the inability to get medical supplies, water, and fuel to the hospital forced us to close our doors,” Saad said.
Customary international law prohibits “acts or threats of violence the primary purpose of which is to spread terror among the civilian population.” Statements that call for evacuating areas that are primarily intended to cause panic among residents would fall under this prohibition. Civilians, including medical workers, who do not evacuate following warnings are still fully protected by international humanitarian law.
