Supporting military necessity: Why hospitals can become legitimate targets when used for combat purposes

Under international humanitarian law, hospitals are not automatically immune from attack. They lose their protected status when they are used to commit acts harmful to the enemy—such as storing ammunition, sheltering combatants, or serving as observation posts. In such cases, striking the facility can be a lawful act of war, provided the attack is proportionate and precautions are taken to minimise civilian harm. In Gaza, Israeli officials argue that Hamas has embedded command centres beneath hospitals, using the medical staff and patients as human shields. In Ukraine, Russian forces claim that Ukrainian troops fired from hospital grounds. If these claims are true, the attacking force has a legal right to target the military element, even at the risk of collateral damage. The principle of military necessity recognises that a state must be able to defend itself effectively. Allowing one side to abuse hospital immunity while the other refrains creates an unfair advantage and prolongs conflicts. Critics of this view often overlook that the real violation is committed by the party misusing the hospital, not by the side that responds. As long as the attacking force follows the rules of distinction and proportionality, such strikes remain within the bounds of lawful warfare. The problem, then, is not the targeting of hospitals per se, but the exploitation of protected status by combatants. Strengthening enforcement against misuse, rather than banning all strikes, is a more practical approach.