As a basic principle of the international law of armed conflict—as well as basic humanity—attacks against civilian sites are prohibited, unless, for example, those civilian sites are used for military purposes. On top of the standard protection of civilian objects, hospitals have a special level of protection under international law, given that they are places of sanctuary. Those in need of medical attention should be able to receive it without fear or danger.

That is also why international law specifically requires that hospitals not be used to shield military objectives from attack, for example, if a hospital is used for "interference, direct or indirect, in military operations, such as the use of a hospital as a shelter for able-bodied combatants or fugitives, as an arms or ammunition store, as a military observation post, or as a center for liaison with combat forces," per the U.S. Department of Defense law of war manual. Such uses can lead to a hospital losing its protected status.

If a hospital is being used for military purposes it does not mean the patients and staff inside the hospital automatically lose their civilian status. The medical staff, transportation, and wounded inside them remain protected. Even if a hospital is being used for acts harmful to the enemy, the response must follow all the laws of armed conflict—including proportionality and taking feasible precautions to mitigate civilian harm.

The law also requires that the attacking force give advance warning and time for the party to stop using the hospital. But if a force is coming under fire from a hospital, the defending force may respond without having to provide advance warning.

Because of all the special protections surrounding hospitals, they have alarmingly and increasingly been used for military purposes by combatants such as Al-Qaeda in Iraq (AQI), Islamic State of Iraq and Syria (ISIS), and especially Hamas, who historically do not follow the laws of war and intentionally shield themselves behind protected objects and groups.

As a result, the United States and many other countries have recently had to conduct operations against enemy forces in hospitals.

In April 2003, an American soldier, Private First Class........

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