Practice Relating to Rule 28. Medical Units
According to the Report on the Practice of Israel, Israel’s Law of War Booklet (1986) grants protection to medical facilities as long as they are clearly recognizable as such and are not used for hostile activities.
Israel’s Manual on the Laws of War (1998) states:
The wounded are regarded as persons who have stopped taking part in the fighting and they shall not be harmed. Hence, it is prohibited to interfere with the administration of medical aid. This prohibition includes the ban on striking hospitals and medical facilities, whether civilian or military, as well as wounded-collection sites, medical warehouses, ambulances and so forth … In any event, it is absolutely forbidden to attack the enemy’s medical facilities, military included, or the enemy’s wounded.
Israel’s Manual on the Rules of Warfare (2006) states: “Hospitals and medical installations, whether civilian or military, must not be used as military targets as well as the sites used for collecting casualties, medical depots, ambulances and similar facilities.”
The manual further states: “It is absolutely forbidden to attack the medical facilities of the enemy including military medical facilities.”
In the case of a large military base converted into a clearing station for the wounded, the manual states: “it must not be attacked as it is a medical facility (on the assumption that no military activities are conducted therein, being disguised as treatment for the wounded)”.
In addition, the manual states: “Protected places (hospitals, places of worship, etc.) must remain protected as long as military action is not being deployed therefrom.”
The Manual on the Rules of Warfare (2006) is a second edition of the Manual on the Laws of War (1998).
In its judgment in Physicians for Human Rights v. IDF Commander in the West Bank in 2002, Israel’s High Court of Justice stated:
[I]nternational law provides protection for medical stations and personnel against attack by combat forces. Article 19 of the Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field, of Aug. 12, 1949 [hereinafter The First Geneva Convention] forbids, under all circumstances, attack of stations and mobile medical units of the “Medical Service,” that is to say, hospitals, medical warehouses, evacuation points for the wounded and sick, and ambulances. See Y. Dinstein, The Law of War 144–45 (1983).
However, the “Medical Service” has the right to full protection only when it is exclusively engaged in the search, collection, transport and treatment of the wounded or sick. Note the provisions of Articles 24 of the First Geneva Convention as well as the provisions of article 26, which expands this protection to include the Red Cross and similar voluntary aid societies. … [emphasis in original]
Moreover, Article 21 of the First Geneva Convention provides that the protection of medical establishments shall cease if they are being “used to commit, outside their humanitarian duties, acts harmful to the enemy”, on condition that “a due warning has been given, naming, in all appropriate cases, a reasonable time limit and after such warning has remained unheeded.” …
Against this legal background, we recall our words from our decision in HCJ 2936/02:
[W]e see fit to emphasize that our combat forces are required to abide by the rules of humanitarian law regarding the care of the wounded, the ill, and bodies of the deceased. The fact that medical personnel have abused their position in hospitals and in ambulances has made it necessary for the IDF to act in order to prevent such activities but does not, in and of itself, justify sweeping breaches of humanitarian rules. Indeed, this is also the position of the State. This stance is required, not only under the rules of international law on which the petitioners have based their arguments here, but also in light of the values of the State of Israel as a Jewish and democratic state.
The IDF shall once again instruct the combat forces, down to the level of the lone soldier in the field, of this commitment by our forces based on law and morality – and, according to the State, even on utilitarian considerations – through concrete instructions which will prevent, to the extent possible, and even in severe situations, incidents which are inconsistent with the rules of humanitarian law.
The instructions which are to be given to soldiers should deal with, among other things, the reasonable and fair warnings which should be given to medical teams. These guidelines should be subject to the circumstances, and should be carried out by the IDF in a way that balances the threat of Palestinian fighters camouflaged as medical teams against the legal and moral obligation to uphold humanitarian rules regarding the treatment of the sick and wounded. Such a balance should take into consideration, among other things, the imminence and severity of any threat.
In its judgment in Physicians for Human Rights v. Prime Minister of Israel in 2009, concerning the humanitarian situation in the Gaza Strip consequent to the start of Israeli military operations (“Cast Lead”) there in December 2008, Israel’s High Court of Justice stated:
17. … Everyone agrees that the rules of customary international law – which grant protection to medical … institutions … – apply to the combat operations that are being carried out in the “Cast Lead” operation and bind the actions of the IDF [Israel Defense Forces].
18. The provisions of international humanitarian law grant protection to medical facilities … from being attacked. Thus art. 18 of the  Fourth Geneva Convention provides protection for hospitals … .
19. It is clear from these provisions that international humanitarian law attaches great importance to medical … facilities. Notwithstanding, this protection is not absolute, and it will be lost if use is made of medical facilities for non-humanitarian purposes, or if they are exploited for military purposes. … [T]he protection of medical facilities will cease if they are used “to commit, outside their humanitarian duties, acts harmful to the enemy” (art. 21 of the First Geneva Convention; art. 19 of the Fourth Geneva Convention). In this regard, the Supreme Court emphasized in Physicians for Human Rights v. IDF Commander in West Bank
, at p. 29, that the abuse that is sometimes made of medical personnel, hospitals and ambulances requires the IDF to act in order to prevent such activity, but it does not in itself permit a sweeping violation of the principles of humanitarian law, and that “this position is required not only by international law, on which the petitioners rely, but also by the values of the State of Israel as a Jewish and democratic state.”
According to the Report on the Practice of Israel, the Israel Defense Forces (IDF) do not have a policy of targeting the medical facilities of their adversaries. The report adds that the implementation of this policy is subject to such facilities being clearly recognizable and not used for hostile activities.
In 2009, in a report on Israeli operations in Gaza between 27 December 2008 and 18 January 2009 (the “Gaza Operation”, also known as “Operation Cast Lead”), Israel’s Ministry of Foreign Affairs stated: “The operational order confirmed that medical facilities … should be provided absolute protection from attack, unless they were being used by the enemy for military activities.”
The report further stated: “The IDF’s operational plans and rules of engagement order special precautions with regard to military activity in proximity to … Red Cross facilities [and] hospitals”.