On Friday, March 13, nearly two weeks into the Lebanese front of “Operation Roaring Lion,” Israeli forces bombed Burj Qalaouiyah, a village in the country’s south. The strike destroyed a health care center, killing twelve doctors, paramedics, nurses, and patients; The New York Timesreported that “only one severely injured worker survived.” Among the victims, according to the journalist Lylla Younes’s reporting for Drop Site, was a paramedic who had spoken last fall at a memorial service for several colleagues killed by an Israeli airstrike during the previous war in Lebanon. “Even if we are killed one by one,” he reportedly said then, “we will not abandon our duty.”

The US and Israel’s illegal war on Iran, launched in the late stages of negotiations to renew a nuclear deal, spread quickly to Lebanon. Hezbollah joined the fray on the second day, after a US–Israeli strike killed Ali Khamenei in Tehran. Israel has conducted near-daily airstrikes in Lebanon in the fifteen months since the two countries signed a truce, killing more than three hundred people, but since March 2 its fighter jets have been relentlessly bombing south Lebanon, Beirut, and other cities; it recently launched a ground incursion in the south. Where in Iran the US and Israel are operating side by side, in Lebanon Israel has taken the lead, with the US providing arms and other support.

A grave toll has been exacted from both fronts. Within less than two weeks more than four million civilians have been displaced in the two countries, up to 3.2 million in Iran and more than a million in Lebanon, where Israel has by now issued evacuation orders that cover 14 percent of the country’s territory. The total death toll is already in the thousands, with over twenty thousand more injured. As of Thursday, according to a UN statement drawing on statistics from the Iranian Red Crescent, more than 65,000 civilian sites have sustained damage in Iran alone.

Among them are a disturbingly high number of medical centers. The Red Crescent reports that US–Israeli strikes have so far damaged 236 health facilities. By March 11 the World Health Organization (WHO) had verified eighteen of these attacks, reporting that they alone caused the deaths of eight health care workers. On the war’s second day airstrikes did significant damage to the Gandhi Hospital in Tehran, where footage and photographs showed the building’s blown-out, debris-strewn façade and broken equipment and shattered glass inside the wards. The head of Iran’s medical council, Mohammad Raeiszadeh, disclosed on state media that the strike disabled the hospital’s in vitro fertilization department; witnesses told the state-run television network Al-Alam that newborn infants and other patients had to be evacuated.

In Lebanon, health infrastructure appears to be under still more direct attack. The country’s health ministry has documented at least 128 Israeli strikes on medical facilities and ambulances in the south, mostly affiliated with the region’s Islamic Health Association (IHA), which have killed forty health care workers and wounded over a hundred more. By March 11, before the strike on the medical center in Burj Qalaouiyah, the WHO had already confirmed twenty-five of these attacks; a further forty-nine primary health care centers and five hospitals had needed to close, it noted, “following evacuation orders issued by Israel’s military.” The result is that services have shrunk even as the need for medical care intensifies. The attacks on health care seem designed to encourage the mass displacement: in an interview with the Guardian, an IHA emergency worker called them part of a campaign “to prevent life in our region and push people to flee.”

Since the start of Operations Roaring Lion and Epic Fury, critics have charged that Israel is expanding its Gaza doctrine—a combination of mass displacement, mass killing, and mass destruction of civilian infrastructure—to other parts of the Middle East. (In some sense this is a return of “the Dahiyeh doctrine,” named after the neighborhood in Beirut’s southern suburbs that the Israeli military ruthlessly pummelled during the 2006 Lebanon War—only in Gaza the destruction was not confined to a specific area and the people living within it but became the military’s modus operandi throughout the territory.) Israel, surprisingly or not, has embraced the accusation, dropping leaflets on Beirut reminding the city’s residents of the Israeli military’s “great success in Gaza.” One of the more pronounced features of the Gaza doctrine—and of contemporary warfare more generally—is turning life-saving medical sites like hospitals, health clinics, and ambulances into targets: it was the “deliberate and systematic dismantling of Gaza’s health and life-sustaining systems” that Physicians for Human Rights Israel (PHRI) cited to argue that the Israeli military’s conduct in the Strip met the legal definition of genocide. The reports emerging out of Iran and Lebanon raise the deeply troubling prospect that Israel hopes to replicate that “success” abroad.

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The 1949 Geneva Conventions and 1977 Additional Protocols give medical units “specific protection” in addition to the “general protections” afforded to civilian structures during war. Under these constraints, belligerents cannot attack medical units unless they “commit, outside their humanitarian function, acts harmful to the enemy.” But even when medical units commit such acts, the specific protections oblige warring parties to weigh the advantage they expect to derive from an attack against the harm it is likely to generate, issue a warning, and allow enough time for evacuation.

By any measure, Israel’s assault on Gaza’s health system violated these principles countless times. None of the Strip’s thirty-six hospitals were spared. Many were subjected to prolonged siege, often while sheltering large crowds of displaced people, before being raided and dismantled. In March 2024, as PHRI has documented, thousands of patients, staff, and displaced people at al-Shifa—the largest hospital in Gaza—suffered two weeks under attack “without food, water, electricity, or medical care.” By the time Israeli forces pulled back, “the hospital was in complete ruin” and at least eighty bodies—and possibly hundreds—lay buried around it in mass graves. Between October and December 2024, as Israel’s army carried out the “general’s plan” in North Gaza, Kamal Adwan Hospital weathered “more than eighty days of siege, bombardment, and systematic obstruction of humanitarian access,” in PHRI’s words, before a raid left it “completely inoperative.”

In a pattern that Israel now seems to be repeating in Lebanon, these attacks served as engines of mass displacement. In a recent lecture at Queen Mary University of London, Guy Shalev, the director of PHRI, stressed that Israel’s assault on Kamal Adwan was directly tied to the military’s efforts to drive the Palestinian population to the south. When the last lifeline is destroyed and “people have no medical center that can treat their family members,” he explained, “they leave.”

The harm generated by these strikes reverberates broadly. Ever since March 2025, when Israel demolished the Turkish–Palestinian Friendship Hospital, the only cancer hospital in Gaza, the 10,000 patients the facility treated each year simply have had nowhere to go. “To have cancer in Gaza means death, and before death, it means a lot of suffering and pain,” the Palestinian oncologist Sobhi Skaik told The Lancet Oncology. Since an additional 2,000 to 2,500 people in Gaza are diagnosed with cancer annually, the hospital’s destruction will undoubtedly cause thousands of excess deaths in the years to come.

This kind of analysis can be extended to the harm caused by Israel’s destruction of five of the seven dialysis units in Gaza, including the only kidney center in northern Gaza. In a letter to the British Medical Journal in March 2025, the Gazan physician Abdullah Wajih Kishawi reported that 44 percent of the dialysis patients in the Strip—or close to five hundred people—had died in the previous year and a half, either through direct injury or because they were unable to access dialysis; since Israel’s blockade stopped the flow of immunosuppressive medication, he speculated, many of Gaza’s 450 kidney transplant patients had likely died as well. The enclave’s surviving dialysis recipients, as the Gaza-based medical intern Amro Hamada wrote in these pages last year, were stuck in “a constant balancing act between hope and exhaustion.”

In some instances, when critics accused Israel of illegally attacking health care facilities and other protected sites in Gaza during the first two years of the assault on the Strip, they were met with simple denials. Pressed by the BBC about Israel’s then-ongoing attack on al-Shifa, the Israeli president Isaac Herzog dismissed the reports as “spin by Hamas,” even as all evidence suggested otherwise. In other cases, drawing on a playbook they had used extensively since the 2008–2009 war on Gaza, Israeli political and military spokespeople accused Hamas of misusing the medical facilities by shielding combatants or weapons within them. Doing so, after all, invokes the one legal exception that may nullify both general and specific protections for these facilities.

The case of al-Shifa is instructive. Weeks before Israel first sent troops into the hospital in November 2023, its spokespeople began building a legal case to support an attack. “The claims were remarkably specific,” a Washington Postinvestigation noted. Israel alleged, in the paper’s account, “that five hospital buildings were directly involved in Hamas activities; that the buildings sat atop underground tunnels that were used by militants to direct rocket attacks and command fighters; and that the tunnels could be accessed from inside hospital wards.” The military’s spokesperson, Daniel Hagari, insisted they had “concrete evidence.” At that press briefing he presented a 3-D animated clip depicting the hospital as a shield for Hamas’s headquarters, showing a series of underground tunnels beneath the facility that were allegedly being used “in order to do command and control for terror activities.”

The Post noted that the Israeli military “released multiple sets of photos and videos showing alleged evidence of Hamas military activity inside and underneath the hospital” over the course of its prolonged occupation of al-Shifa, including footage of Hagari exploring a tunnel shaft in the complex. The paper’s investigation concluded, however, both that “the rooms connected to the tunnel network…showed no immediate evidence of military use by Hamas” and that none of the footage showed “that the tunnels could be accessed from inside the hospital wards.” Even if the proof the Israeli military claimed to provide had turned out to be authentic, it would have fallen well short of proving that Hamas had been misusing the hospital to hide its “command and control center”—and, regardless, the attack on the hospital would have hardly met the proportionality threshold, given the services al-Shifa provided to the population. It was perhaps the highest-profile example of an oft-repeated pattern. Between October 2023 and January 2026 Israel attacked health care facilities 937 times in Gaza alone, time and again failing to offer any concrete evidence that they were being misused for “acts harmful to the enemy.”

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The statistics about the current attacks on Iran and Lebanon’s medical systems—as reported by the respective countries’ health ministries—index a range of violations. Already on March 6 the head spokesperson for Iran’s health ministry reported that the US–Israeli strikes had put nine hospitals out of service, destroyed more than a dozen “pre-hospital emergency bases,” and damaged multiple local-level and rural health facilities. Among the Tehran medical centers that sustained damage in the war’s first days, Al Jazeera reported, were the Motahari Hospital, which specializes in burn victims, and “the main building of the province’s medical emergency services” in the city’s downtown. In Ahvaz strikes reportedly damaged a children’s hospital; in Sarab and Hamedan, as the director of the WHO noted, local sources related that they damaged emergency rooms.

By Monday the death toll of health care workers in Lebanon had risen to at least thirty-eight. That same day alone, Younes reported, six paramedics were killed in separate strikes on three different ambulances, one of which was responding to a call after yet another strike hit a house in the southern village of Kfar Sir. “Some of our personnel have been killed at our medical centers, others while they were out in the field, trying to pull people out from under the rubble,” a spokesperson for the Islamic Health Association told Younes.

He added that “the exact place they went to do their rescue work was targeted again once they arrived.” The Guardian reports that since March 2 Israel has carried out at least five “double-tap” strikes of this kind, whereby an initial strike is followed by a pause during which first responders often arrive, before the area is bombed again. A number of legal scholars maintain that this tactic likely violates Common Article 3 of the Geneva Conventions of 1949, which prohibits targeting civilians, the wounded, or those placed hors de combat.

When pressed about these attacks on medical facilities and other civilian infrastructure, Israel and the US have repeatedly reached for responses out of the Gaza playbook. After a strike killed 175 people, most of them young children, at a girls’ school in southern Iran on the first day of the war, President Trump denied responsibility, suggesting to reporters as late as March 7 that an Iranian missile had misfired. On March 11 The New York Timesreported that an ongoing military investigation had made a preliminary finding that the school was hit by a US Tomahawk missile. The previous day, in a press briefing, US defense secretary Pete Hegseth had accused Iran of “moving rocket launchers into civilian neighborhoods near schools, near hospitals to try to prevent our ability to strike. That’s how they operate…. They target civilians. We do not.”  

After Israel’s attack on the health care facility in Burj Qalaouiyah, meanwhile, an Israeli military spokesperson alleged on X that Hezbollah fighters were using ambulances and the medical facility for military purposes. To disguise a military vehicle as an ambulance would amount to medical perfidy, a war crime under international law. Hezbollah (not unlike Hamas) does provide various kinds of social welfare and health services to the local population, and the Islamic Health Association is indeed part of that social-welfare network. But under international law these are civilian sites, and the spokesperson offered no evidence that ambulances or medical infrastructure were being misused. Nor have Israeli strikes been limited to IHA facilities: the Guardian relates that they have also hit “the state civil defense service, the Amal movement’s Islamic Scouts Association health service, a local healthcare charity, and the Lebanese Red Cross.”

Indeed, as Drop Site has noted, for the time being the party implicated in medical perfidy during the current war is in fact Israel. A week earlier, Israeli paratroopers had entered the cemetery of Nabi Chit, a town in Lebanon’s northeastern Bekaa Valley, in an effort to retrieve remains that may have belonged to an Israeli navigator shot down and captured by the militant group Amal forty years ago. After the Israeli forces killed a Hezbollah fighter, a firefight broke out between the Israeli troops, Hezbollah fighters, and local residents. By the time the Israelis withdrew, at least forty-one people had been killed, according to Lebanon’s health ministry. Interviewed by reporters from the BBC, the Sydney Morning Herald, and the London-based Arabic paper Asharq Al-Awsat, residents recounted that some of the Israeli forces had arrived in a Lebanese ambulance wearing uniforms associated with the IHA. This would not be the first time in recent memory that Israeli forces had engaged in medical perfidy: in December 2024 five Israeli soldiers used an ambulance to enter the Balata refugee camp, in the West Bank, in a raid that killed two civilians, including an eighty-year-old woman; less than a year earlier, Israeli assassins disguised as Muslim women and doctors had raided a hospital in Jenin and executed three Palestinians hors de combat.

Denying well-substantiated allegations of crimes and accusing enemies of such crimes with no serious evidence: these are preludes to the still more radical step of rejecting international law altogether. Perhaps the most shocking development in the current war is that Israel and the US have not even bothered to justify bombing civilian infrastructure. “No quarter, no mercy,” Hegseth said in a press conference on March 13, echoing President Trump’s infamous assertion, following the illegal abduction of Venezuelan President Nicolás Maduro, that “I don’t need international law.” Referring to Israel’s attacks on Iran and Lebanon, Benjamin Netanyahu said on March 12 that the “dramatic shift in our power relative to the power of our enemies is the key to ensuring our existence. Threats come and go—but when we become a regional power, and in certain fields a global power, we have the strength to push dangers away from us and secure our future.” The terms “law” and “legal order” were not mentioned once.

These are the words of men drunk on their own power. The Gaza doctrine is a direct reflection of this intoxication, and the wholesale destruction of health facilities is just one of its manifestations, which can now be seen the world over. The Safeguarding Health in Conflict Coalition, a group of more than thirty organizations working to protect health workers, services, and infrastructure, documented an average of ten attacks on medical units per day during 2024—a ninefold increase since 2016, the year the United Nations Security Council adopted a resolution “strongly condemning attacks against medical facilities [and] personnel in conflict situations.” Driving this increase were not just Israel’s wars in the occupied Palestinian territories and Lebanon but also the wars in Sudan, Ukraine, and Myanmar. As the current US–Israeli war erodes the post-World War II international order still further, we ought to ask what new tools we can develop to protect the world from men for whom only might makes right.