There are no valid ethical arguments in support of attacks on health facilities in Gaza
Jul 5, 2024
The conflict in Gaza has generated vigorous discussion about the assumed ethical prohibition against attacks on health facilities in times of war and the circumstances in which this prohibition might be validly circumvented.
The actions of Hamas on October 7th 2023 have been widely condemned and no-one has attempted to offer an ethical justification for them (as opposed to acknowledging the possible impact of years of despair on Palestinian people). By contrast, although the Israeli response directly targeted health facilities on a large scale and has also evoked widespread revulsion there have been many attempts to justify it.
Because the role of health professionals in conflict settings is so critical it is essential for arguments claiming to justify attacks on health facilities to be fully scrutinised. In the present case, it is claimed that the Israeli actions may be justified because (1) they are in self-defence and (2) Hamas uses hospitals as military installations and patients as human shields. In addition, criticisms of Israel’s actions are rejected on the basis (3) that no reference to Israeli Defence Force actions can be made without a concurrent reference to Hamas’ attacks, and (4) that they inherently involve a pernicious claim that such actions are in some way “morally equivalent” to the those of Hamas.
The arguments about self-defence and human shields have been widely discussed, exposing a divergence between ethical and legal perspectives. Pending resolution by the International Court of Justice, the requirements of international law remain uncertain, in part because of ambiguity about the legal meaning of “proportionality”. However, the ethical viewpoint is clear.
is clear, with agreement that valid acts of self-defence are limited to those directed towards repelling violent attacks actually in progress, in which the minimum force is exercised that is needed to prevent imminent harm. Similarly, while the use of human shields is universally condemned, the killing of the shields is also considered to be wrong, except in the most extreme circumstances. These attempts to justify the Israeli actions do not therefore stand up.
The other two arguments that are invoked purportedly to refute criticisms have been less discussed, even though they are equally problematic. The insistence that Israeli actions can only be discussed if the October 7 attacks are also mentioned entails an implicit claim that there is an essential ethical link between the two, and that therefore the atrocities in Gaza are somehow justified or mitigated by the preceding attack. However, this argument is seriously flawed, because the nature of the purported link is what needs justification and it would seem that, logically, only two options are available: that the Israeli actions can be understood as punishment for the Hamas attack or else as revenge. The onus is on supporters of the IDF response to explain which of these two possibilities is the case and why it is ethically valid.
However, there is also a bigger problem here: if applied more generally, the claim that one ethically questionable act can only be considered in relation to a preceding one would generate counter-intuitive results, such as, for example, that the bombing of Hiroshima could only be mentioned if a simultaneous reference were made to the attack on Pearl Harbour. This would not only be absurd but would also fatally limit our ability to make judgments about ethically questionable acts.
The claim about moral equivalence, is similarly flawed. The repudiation of criticisms of Israeli attacks on medical facilities and civilians on the basis that they imply an ugly assertion that they are of equal moral value to the Hamas attacks misstates the ethical notion of “equivalence”. In ethical discourse, two proposed or alternative acts may be thought to be morally identical if (for whatever criteria are being applied) there is no compelling reason to prefer one to the other. This kind of assessment, however, does not apply to the retrospective characterisation of acts in order to justify one by reference to the other. In addition, to claim – implicitly or explicitly – a moral superiority of the actions of one group of people over those of another – if that is what is intended – is itself ethically unconscionable.
The Israeli attacks on health facilities in Gaza therefore remain without any cogent or coherent ethical justification. Of course, it is possible that the attempts to provide such justification are not intended as ethical arguments at all, but are in fact no more than rhetorical devices to support favoured positions. If this is the case, however, it becomes even more pressing to insist on moral clarity. This is because what is at stake is not abstract philosophical discourse but all-too-real outcomes – not just for the long-suffering people of Gaza but also for the future safety of health professionals everywhere and their ability to provide assistance and support to those in urgent and dire need.
Paul Komesaroff is Professor of Medicine at Monash University and Executive Director of the international NGO Global Reconciliation. His books include Experiments in Love and Death and Riding a Crocodile: A physician’s tale.
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