A claim that a hospital has been used by fighters does not, by itself, make the hospital a lawful military target. International humanitarian law gives medical facilities special protection because they care for wounded and sick people, including wounded combatants. There are narrow circumstances in which that protection can be lost, but the rules require evidence, warning and continued safeguards for patients and staff.
The issue is not hypothetical in Iran’s 2026 conflict. In its March 11 account of the regional health emergency, the World Health Organization (WHO) said it had verified 18 attacks on health care in Iran since February 28, resulting in eight deaths among health workers. These are figures reported as of March 11, not a count for October 2026. Nor does the phrase “attacks on health care” mean every recorded incident was a direct strike on a hospital.
Why hospitals receive special protection
The rule has deep roots in the laws of war. Early Geneva Convention protections for military medical services were expanded and developed in the 1949 Geneva Conventions and later humanitarian law. The underlying idea is simple: treatment must remain possible even when opposing forces are fighting. Hospitals, medical workers, ambulances and people who are wounded or sick are protected because of the medical function they perform or need.
The International Committee of the Red Cross explanation of hospital protection makes an important distinction. Treating wounded fighters does not turn a hospital into a military base. Nor does the presence of guards, or of medical staff carrying light weapons strictly for defense, automatically end a facility’s special protection. In cases of doubt about harmful military use, the presumption favors continuing that protection.
This principle matters to civilian patients as well as soldiers. A person with a heart condition, a newborn needing intensive care and a wounded combatant may be in different wards of the same building. Medical care does not cease to be humanitarian because the patients come from different sides of a conflict.
What could cause a hospital to lose that protection?
The exception concerns a facility being used, outside its humanitarian duties, to commit acts harmful to the opposing party. Examples may include using a hospital as a firing position, weapons store, military observation post or shelter for fighters who are not being treated. Those are uses of the facility for military operations, not ordinary medical work.
Even then, it is not enough for an armed force to announce that a hospital has been misused. In their analysis of the special protection of hospitals, ICRC legal advisers explain that the relevant conditions are cumulative: harmful use outside medical duties must be established; a warning must be issued, with a reasonable time limit whenever appropriate; and that warning must go unheeded. A hospital’s alleged misuse also does not automatically make it a military objective.
The distinction between allegation and established fact is crucial in wartime reporting. A statement by a military spokesperson may be evidence of that party’s position. It is not independent proof that weapons were present, that hostile operations were being conducted, or that the relevant legal threshold was met.
A warning is not a blanket permission to attack
Under the special rules for medical facilities, a warning is meant to give those responsible a chance to stop harmful activity and, where necessary, permit arrangements for patient safety. If the harmful activity ends, the basis for a military response against the hospital falls away.
Where the warning goes unheeded and the facility qualifies as a military objective, the attack still has to comply with other rules. The attacking party must take feasible precautions to reduce harm and assess whether expected incidental civilian damage would be excessive compared with the concrete and direct military advantage anticipated. Planning must account for patients who cannot be moved easily, medical staff, and the impact of losing an essential service. A warning alone does not satisfy these separate duties.
That last point extends beyond a hospital’s walls. Destroying its only operating theatre, interrupting oxygen supplies or cutting the power needed for dialysis can harm patients who are nowhere near the initial blast. These foreseeable consequences belong in a serious assessment of the operation, not merely in a reconstruction budget afterward.
Why WHO attack reports are not war-crime verdicts
WHO counts a wider range of interference than bombings. Its methodology for documenting attacks on health care includes physical violence, threats and obstruction that disrupt the availability, access or delivery of health services. WHO also explains that its surveillance system does not collect or verify the identity of perpetrators. An incident can be verified as an attack on health care without the organization deciding who caused it or whether it constituted a war crime.
That is why three questions should stay separate: Did an incident affecting health care occur? Who was responsible, and what was known at the time? Did the conduct breach a particular legal obligation? The first may be established through health-system monitoring; the latter two can require operational records, witness accounts, reliable imagery and a legal assessment.
Peiknet’s earlier report on the civilian crisis and damaged services in Iran describes how health care also depends on power, transport and basic supplies. A facility need not be completely destroyed to stop functioning, and the disruption can persist well after a particular incident.
What credible investigation should establish
If a party claims that a hospital was a legitimate target, meaningful scrutiny should establish what the facility was being used for, when the alleged harmful activity occurred, whether a warning was communicated, what response followed and what precautions were planned for patients and staff. Investigators also need to distinguish verified damage from attribution and legal responsibility.
This is where Peiknet’s guide to verifying images of airstrikes is relevant. A photograph may help establish location, timing and physical damage, but it rarely reveals the intelligence available to commanders or whether a warning was given. Imagery can contribute evidence; it cannot substitute for all the missing records.
For Iran, the immediate public-interest question is therefore more precise than whether every reported hospital incident can be labeled a war crime. It is whether the facts needed to test the special protections are being preserved and independently examined, and whether affected communities can still obtain essential care. The law’s exceptional provisions cannot become a shortcut around its central purpose: keeping medical treatment possible during war.
