Photo Source: © Mohammed Abed/AFP via Getty Images
Photo Source: © Mohammed Abed/AFP via Getty Images

Atrocity Alert No. 347: Sudan, Israel and the Occupied Palestinian Territory and Health Care in Armed Conflict

17 May 2023

Atrocity Alert is a weekly publication by the Global Centre for the Responsibility to Protect highlighting situations where populations are at risk of, or are enduring, mass atrocity crimes.


Heavy fighting in Sudan between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) has entered its second month, with devastating consequences for civilians and civilian infrastructure. Khartoum remains the epicenter of the fighting, as the SAF continues to launch airstrikes in densely populated areas. Shelling and explosions have destroyed large parts of the city. The RSF have reportedly evicted residents in Khartoum and taken over numerous buildings to expand their operational and strategic positions. There have also been reports of increased sexual and gender-based violence, including rape, by armed forces.

Tens of thousands of people remain trapped indoors and have run out of essential supplies. Neither the SAF nor the RSF are facilitating safe passage for civilians to flee or for humanitarian workers to provide aid and critical supply lines remain cut off. According to the World Health Organization, 70 percent of health centers in conflict-affected areas are out of service. Despite the risks, local resistance committees, doctors and volunteers continue to attempt to provide assistance.

On 11 May, upon request by more than 50 states and a call by civil society organizations, the UN Human Rights Council (HRC) convened a special session on the human rights impact of the conflict in Sudan. The UN High Commissioner for Human Rights, Volker Türk, strongly condemned the “wanton violence, in which both sides have trampled international humanitarian law, notably the principles of distinction, proportionality and precaution.” The HRC adopted a resolution that enhances the monitoring and reporting mandates of the UN High Commissioner and his designated Expert on human rights in Sudan.

Diplomatic efforts by the UN, regional and sub-regional organizations, and Saudi Arabia and the United States have not resulted in a permanent end to hostilities. While the parties signed a “Declaration of Commitment” in Jeddah on 11 May, in which they committed to protect civilians and uphold International Humanitarian Law (IHL) by allowing for the safe delivery of humanitarian assistance, fighting continues unabated. At least 676 people have been killed and 5,576 injured since the fighting began on 15 April.

Meanwhile, in the Darfur, Blue Nile and Kordofan regions, violence between the SAF and RSF has triggered inter-communal clashes, particularly in West Darfur. A new wave of attacks has occurred in El-Geneina since 12 May, with local sources reporting that armed groups and RSF fighters have attacked, looted and burned down entire neighborhoods, reportedly killing at least 280 people.

All parties to the conflict in Sudan must urgently agree to an immediate and sustained ceasefire, as well as respect their obligations under IHL and International Human Rights Law to ensure the protection of civilians and civilian infrastructure. The international community must scale up its humanitarian response and ensure all parties return to a credible political transition that respects people’s desire for democratic reform.


From 9-13 May Israel and Palestinian armed groups in Gaza engaged in intense hostilities after the Israeli military launched a military operation, codenamed “Shield and Arrow,” and carried out airstrikes and shelling across the blockaded and besieged Gaza Strip. Palestinian armed groups in Gaza fired numerous rockets from multiple locations toward Israel, the majority of which were intercepted by Israeli air defenses. The Office of the UN High Commissioner for Human Rights verified 32 Palestinian deaths, including at least 13 civilians, while the Ministry of Health in Gaza confirmed at least 106 Palestinians injured, including 36 children and 21 women. In Israel, two people were killed and 35 injured.

Israeli airstrikes and shelling reportedly hit residential areas and caused extensive damage to schools and civilian infrastructure, including roads, the electricity network, water installations and agricultural land. The Ministry of Public Works and Housing in Gaza reported that over 560 housing units were damaged. The UN Office for the Coordination of Humanitarian Affairs reported that the nature of the airstrikes raised concerns about “whether sufficient precautions were taken to avoid, or to minimize, incidental loss of civilian life, injury to civilians and damage to civilian objects, and whether Israeli forces demonstrated respect for the prohibition of indiscriminate attacks and the principle of proportionality.”

Following a ceasefire reached on 13 May between Israel and Palestinian Islamic Jihad, UN Secretary-General António Guterres said in a statement, “The hostilities have led to needless human suffering.” Likewise, the UN Relief and Works Agency for Palestine Refugees stated that “the current escalation in hostilities exacerbates an already severe humanitarian situation for Palestine refugees in the Gaza Strip, among them many women and children.” Both Israeli-controlled crossings from blockaded Gaza into Israel were closed during the hostilities, preventing the movement of medical patients, aid workers, food, medical supplies and fuel. These closures undermined the provision of vital services, including health and water, sanitation and hygiene.

On 15 May the 75th anniversary of Nakba Day was marked, commemorating over 700,000 Palestinians who fled or were expelled from their homes in the events surrounding the establishment of Israel in 1948. The legacy of the Nakba events continues to this day. Israel must cease its collective punishment of the Palestinian people and lift its blockade of the Gaza Strip. All violations and abuses of International Humanitarian Law should be urgently investigated, and perpetrators held accountable.


This May marks the seventh anniversary of the adoption of UN Security Council Resolution 2286, the first-ever resolution addressing the protection of health care in conflict. The resolution condemned attacks and threats against medical personnel and facilities and demanded accountability for those responsible for these crimes under international law. Yet attacks on health care – including hospitals, medical facilities and health workers – continue to be widespread in armed conflicts around the world and perpetrated with impunity.

In 2022 the World Health Organization verified over 1,300 attacks on health care in emergency-affected countries and fragile settings. More than a third of these attacks were perpetrated in Ukraine alone, as Russia has destroyed Ukrainian health care infrastructure at an unprecedented scale with targeted and indiscriminate aerial assaults. Between 24 February 2022 and 7 April 2023 at least 889 attacks on health care were documented. Many health workers have also been threatened, imprisoned, taken hostage or forced to work under Russian occupation.

Years of airstrikes and other unlawful attacks targeting hospitals and clinics have crippled Syria’s health service infrastructure. The earthquake in northwest Syria during February compounded precarious access to health care in a region already desolated by more than 12 years of conflict and atrocities. Since the 1 February 2021 coup in Myanmar (Burma), the military has targeted health care, occupied dozens of hospitals across the country and arrested scores of health workers accused of supporting the civil disobedience movement. At least 100 attacks on health care were recorded between January and April this year alone, according to Insecurity Insight.

Medical workers and civilians are also finding themselves caught up in indiscriminate violence by perpetrated armed groups. In the eastern provinces of the Democratic Republic of the Congo, a resurgence of armed group activity in the past year has strained health care services already weakened by decades of conflict, as health workers are kidnapped, and facilities deliberately and routinely looted and attacked.

Christine Caldera, Research and Advocacy Officer at the Global Centre for the Responsibility to Protect, said, “War-related destruction of health facilities and targeted attacks on medical workers results in tremendous human suffering and potential mass atrocity crimes. Such attacks have long-lasting effects for civilians, restricting access to care and spreading fear of seeking treatment.” Deliberate attacks on medical facilities and workers, the obstruction of medical aid and indiscriminate attacks that affect civilian infrastructure – including hospitals and health clinics – are war crimes. When such attacks are committed as part of a state policy on a widespread or systematic basis, they can amount to crimes against humanity.

Health care infrastructure and services must be protected from attacks and obstruction. To combat impunity, all attacks on health care facilities and health workers should be impartially investigated and the perpetrators held accountable. The UN Secretary-General should also publicly list those states, and non-state armed groups, that deliberately target health care during armed conflict.

Global Centre for the Responsibility to Protect


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