Introduction
With the commencement of the military attacks by the United States of America and Israel against Iran on 28 February 2026, which continued until 8 April 2026 and resulted in the establishment of a temporary two-week ceasefire between the parties (as of the time of drafting this report), numerous reports have indicated widespread disruptions to the country’s healthcare infrastructure.
These disruptions encompass a spectrum ranging from minor to severe damage to medical facilities, reduced efficiency of emergency services, and a noticeable decline in the healthcare system’s capacity to respond to a sudden surge in medical demand. The effects of this situation have extended beyond direct conflict zones and have tangibly impacted the broader domain of public health.
In this context, international law—and more specifically, international humanitarian law—accords a fundamental status to the protection of medical facilities, healthcare services, and medical personnel. Under this framework, medical units, relief equipment, and healthcare staff must, at all times, be respected and protected and must remain immune from any form of attack.
The importance of such protection lies not only in the humanitarian function of these institutions in saving lives and alleviating human suffering, but also in ensuring the continuity of essential services during armed conflicts. Indeed, even indirect damage—such as blast waves, destruction of critical infrastructure, disruption of energy supply, and the forced evacuation or closure of medical centers—can rapidly undermine the operational capacity of healthcare systems at the most critical moments.
Incidents
Overall, a significant number of Iran’s health, medical, and relief centers sustained severe damage, partial damage, or complete destruction during the attacks carried out by the United States of America and Israel on Iranian territory.
According to available data, as of 15 March 2026, a total of 153 healthcare facilities—including 56 comprehensive health service centers, 25 health bases, 18 county health centers, 18 rural health houses, and 36 other medical facilities—had been damaged or destroyed[1].
Furthermore, based on updated statistics released on 21 March 2026, this figure increased significantly within approximately one week. According to the Iranian Ministry of Health, as of that date, 48 emergency bases, 38 treatment centers, and 182 healthcare facilities had been damaged or destroyed[2], and approximately 30 ambulances had been rendered out of service[3].
In addition to the damage inflicted on healthcare, medical, and relief facilities, personnel working within these centers also suffered casualties. According to reports, by 25 March 2026, a total of 23 individuals had been killed and 112 injured[4].
In this regard, the following are among the most prominent affected facilities:
- Hor Welfare Center, Tehran
This center was considered one of the most significant institutions providing daily services and social support to beneficiaries and persons with disabilities in eastern Tehran.
The center managed over 40,000 rehabilitation case files and 2,000 employment-related cases, all of which were completely destroyed[5]. As a result, the facility has been entirely removed from the service cycle.
According to Alireza Mohammadi, Deputy for Social Health and Head of the Crisis Committee of the Tehran Welfare Organization, what remained of the center is no longer usable, and all case files, equipment, and support facilities were completely obliterated[6].
Reports indicate that both staff and clients had evacuated the premises prior to the attack.
- Pasteur Institute of Iran
Since the beginning of the war initiated by the United States and Israel against Iran, the institute has been affected by attacks three times, with the most recent incident occurring on 2 April 2026.
During these attacks, several key departments—including the cell bank, malaria research division, clinical research units, and biotechnology sections—sustained significant damage, and parts of the buildings were destroyed[7].
According to the head of the institute, the affected complex spans approximately 23,000 square meters and includes:
- 13 national reference laboratories
- 3 collaborating reference laboratories
- 8 public health laboratories
- 23 research departments
- 2 World Health Organization collaborating centers
- 3 biobanks
- 3 research network secretariats
- 3 research centers
- 1 vaccination unit
- 1 laboratory approved by the Iranian Food and Drug Administration[8]
- Gandhi Hospital, Tehran
Following an attack in the early days of the war, Gandhi Hospital suffered extensive damage, with financial losses estimated at approximately 1,400 billion Iranian tomans.
During the incident, one hospital security officer sustained severe injuries resulting in paralysis, and 15 hospital staff members were wounded.
The hospital, including critical departments such as the intensive care unit (ICU) and pediatric ward, was completely evacuated by medical personnel[9].
This attack occurred on 2 March 2026, just two days after the outbreak of the war. Immediately after the incident, and according to Dr. Hossein Kermanshahpour, Head of the Public Relations and Information Center of the Ministry of Health, the hospital was fully evacuated[10].
Following the declaration of an emergency situation, patients and newborns were transferred by hospital staff to safe locations and other medical facilities.
- Central Building of the Iranian Red Crescent Society and Nearby Medical Facilities
On 1 March 2026, multiple projectiles struck within a radius of 50 to 100 meters of the central building of the Iranian Red Crescent Society, causing severe damage.
Due to the fact that the targeted area was predominantly a medical and hospital zone, several nearby healthcare facilities were also affected. These include:
- Vali-e-Asr Hospital
- Red Crescent Rehabilitation Center
- Khatam Al-Anbiya Hospital
- Shahid Motahari Trauma and Burn Hospital
- Shahid Rajaei Heart Hospital
- Ameneh Infant Care Center
According to the head of the Iranian Red Crescent Society, the blast wave was extremely powerful, causing all windows in the rehabilitation center to shatter and false ceilings to collapse. Patients present at the time experienced severe panic, and the continuation of services became practically impossible.
Similar conditions were reported in nearby hospitals, where patients, medical staff, and healthcare workers were significantly affected[11].
- Imam Ali Hospital, Andimeshk
This hospital has been damaged twice since the beginning of the war.
The first incident occurred on 6 March 2026, and following a second attack at noon on 21 March 2026, the situation deteriorated significantly. Consequently, the Khuzestan Provincial Government ordered the immediate evacuation of the hospital and the initiation of clearance and reconstruction operations.
According to the head of Jundishapur University of Medical Sciences, ceilings in inpatient wards, operating rooms, and other units collapsed, and due to severe structural damage and the risk of further collapse, the hospital had to be evacuated[12].
It is important to note that this hospital is the only and most critical medical center in the city of Andimeshk[13]. Following the bombardment, officials advised residents to seek medical services in other cities, including Ahvaz and Dezful.
After the attacks, the Andimeshk Health Network announced that due to damage caused by blast waves, several units of the hospital remained unusable, and patient admission was no longer possible until repairs were completed[14].
- Other Healthcare, Medical, and Relief Centers
Other major facilities across Iran that have been directly or indirectly affected include:
- Besat Hospital, Tehran
- West Tehran Emergency Base
- Red Crescent Building, Mahabad
- Emergency base in Hamadan
- Sarab Emergency Base
- Chabahar Emergency Base
- Razi Hospital, Ahvaz
- State Welfare Organization of Iran
- Baghaei Hospital, Ahvaz
- Khorshid Hospital, Isfahan
- Hazrat Abolfazl Hospital, Minab
- Tehran Emergency Medical Center
- Taleghani Hospital, Urmia
- Shohada Hospital, Sarpol-e Zahab
- Red Crescent Branch, Khomein
- Red Crescent Branch, Zalian (Lorestan)
- Field Hospital, Salas-e Babajani
- Shohada-ye Khalij-e Fars Hospital, Bushehr
- Abuzar Hospital, Ahvaz
- and numerous others
These facilities represent a broader pattern of damage affecting healthcare infrastructure across multiple regions of Iran.
Challenges and Responses
- The Obligation to Protect Medical Units
Under customary international humanitarian law, “medical units must be respected and protected at all times and must not be the object of attack[15].”
At the treaty level, this obligation is explicitly reaffirmed in Additional Protocol I to the Geneva Conventions (Article 12), which provides that medical units shall be respected and protected at all times and shall not be targeted[16].
With regard to civilian hospitals, Fourth Geneva Convention (Article 19) stipulates that civilian hospitals enjoy special protection and must not be attacked. This protection is lost only if such hospitals are used, outside their humanitarian function, to commit acts harmful to the enemy. Even in such cases, protection may cease only after due warning has been given and a reasonable time limit has expired—conditions that do not appear to have been met in any of the cases examined in this report[17].
Medical services encompass medical personnel, medical units, and medical transport, all of which benefit from a special protective status during armed conflict[18]. Accordingly, ambulances and other medical transport vehicles must, in principle, be immune from attack. Any restriction or attack against them requires strict legal justification, including proof that they have ceased to function in a medical capacity[19].
- Principles of Distinction, Proportionality, and Precaution
These three principles constitute the cornerstone of international humanitarian law.
- The principle of distinction requires parties to a conflict to distinguish at all times between military objectives and civilian persons or objects. Attacks must be directed exclusively against military targets and must not target civilians or healthcare facilities[20][21].
- The principle of proportionality prohibits attacks in which the expected incidental harm to civilians or civilian objects would be excessive in relation to the anticipated concrete and direct military advantage[22][23].
- The principle of precaution obliges the attacking party to take all feasible precautions to minimize harm to civilians and medical facilities. This includes the choice of means and methods of warfare, timing of attacks, verification of targets, and heightened caution when medical facilities are located near potential military objectives[24][25].
- Proximity of Alleged Military Targets and the Challenge of Distinction
In a prominent example—namely, Gandhi Hospital[26]—available evidence suggests that a substantial portion of the damage resulted from strikes or explosions in the vicinity, rather than direct targeting.
However, even assuming the presence of a military objective nearby, such proximity does not absolve the attacking party of responsibility. Under international humanitarian law, the attacking party is obligated to be aware—or should reasonably have been aware—of the presence of medical facilities in the area and to take all necessary precautions to prevent or at least minimize incidental harm.
Accordingly, an attack that foreseeably causes damage to a hospital, in the absence of a rigorous assessment and effective precautionary measures, is not only unjustifiable but also indicative of a violation of the fundamental principles of distinction and precaution, and may give rise to international legal responsibility.
- The Possibility of a Recurrent Systematic Pattern
Verified data from the World Health Organization indicating the registration of at least 13, and subsequently 18, attacks against healthcare infrastructure[27], alongside repeated reports from Iranian authorities regarding forced hospital evacuations, damage to emergency facilities, and the gradual withdrawal of medical units from service, suggest more than a mere accumulation of isolated incidents.
Rather, these data point toward a recurring pattern, in which similar consequences are reproduced across different locations and timeframes, exceeding the threshold of sporadic or incidental events.
While establishing a “systematic” pattern in the strict criminal law sense—i.e., demonstrating the existence of a deliberate policy or plan targeting healthcare infrastructure—requires additional evidence concerning targeting processes, decision-making structures, and operational repetition under comparable conditions, the available evidence nonetheless indicates a degree of operational consistency.
In other words, although gaps remain in conclusively proving systematic intent, the current body of evidence moves beyond randomness and suggests the existence of at least a recurrent operational pattern affecting healthcare infrastructure.
In this regard, precedents from Gaza further reinforce this concern. Reports have documented direct attacks on medical facilities, including:
- Sheikh Hamad bin Khalifa Al Thani Hospital
- Yafa Hospital
- Gaza European Hospital
- Pediatric hospitals such as Al-Rantisi and Al-Nasr
Additionally, independent medical reports have indicated direct strikes on facilities such as Al-Quds Hospital and other healthcare units.
The recurrence of similar patterns across different time periods and geographical contexts strengthens the argument that damage to healthcare facilities may not merely result from incidental or accidental events, but rather reflects a reproducible operational pattern[28].
- Domestic Reactions
The Think Global Health, affiliated with the Council on Foreign Relations, addressed the impact of the war on Iran’s healthcare system in an analytical note.
The report examines the humanitarian—particularly health-related—consequences of the 28 February 2026 war, emphasizing that armed conflicts tend to undermine healthcare systems first and foremost. Vaccination programs are disrupted, maternal and child healthcare services are weakened, and patients with chronic conditions are left without treatment.
According to the data presented, at least 18 attacks on healthcare facilities had been recorded by 11 March 2026, and critical infrastructure such as water and oil facilities had also been damaged, posing broader risks to public health.
The crisis has further disrupted regional and transnational supply chains for pharmaceuticals and humanitarian aid, demonstrating that the collapse of public health systems transcends national borders.
The report highlights the concept of “health diplomacy”, suggesting that medical and scientific cooperation between Iran and Gulf Cooperation Council countries could help mitigate crises and build trust. It concludes by emphasizing the need to halt attacks on healthcare facilities, rebuild health infrastructure, and utilize regional and international cooperation mechanisms to prevent further escalation[29].
The non-governmental organization Physicians for Human Rights (PHR), based in New York, also issued a statement addressing the situation.
In response to the escalation of conflict involving Iran, the United States, and Israel, the organization stressed the obligation of all parties to comply with international humanitarian law and human rights law and called for the immediate protection of healthcare workers and medical facilities.
The statement referenced damage to hospitals such as Gandhi Hospital and Red Crescent-affiliated facilities in Tehran, as well as casualties among relief workers in Lebanon. It warned of an increasing trend of attacks on healthcare infrastructure.
The organization emphasized that under the Geneva Conventions, the protection of hospitals and medical personnel is an absolute obligation, leaving no room for ambiguity. It also cited WHO confirmations of multiple attacks and highlighted their consequences, including disruption of treatment, preventable deaths, and the collapse of healthcare systems.
The statement further addressed disruptions in the supply of medicines and medical equipment and the regional impact of the crisis, including interruptions to WHO logistical operations. It concluded by calling for an immediate cessation of attacks, guaranteed access to healthcare services, and accountability for violations[30].
The National Nurses United also issued a statement in response to the military actions of the Trump administration.
The union described the attack on Iran as illegal, unauthorized by Congress, and imperialistic, strongly condemning it. It argued that the burden of war ultimately falls on the American working class, which is already facing rising costs of healthcare, housing, and food.
The statement characterized the war as a continuation of historical U.S. interventions in Iran and criticized domestic policies that reduce access to healthcare, particularly for low-income populations.
Nurses warned that civilians and vulnerable populations are the primary victims of war, citing examples such as the destruction of civilian infrastructure—including attacks on schools and damage to hospitals—which constitute violations of international humanitarian law.
They also referred to casualties among U.S. soldiers and escalating violence, calling for global solidarity and an immediate end to the war, and urged the U.S. government to prioritize domestic welfare and healthcare reform over military engagement[31].
- International Reactions
The International Committee of the Red Cross has consistently emphasized the necessity of compliance with the rules of armed conflict and the protection of hospitals, medical personnel, and humanitarian workers.
In this regard, Mirjana Spoljaric Egger, President of the ICRC, stated at the outset of the war that the rules of war are binding obligations, not optional considerations. She stressed that civilian infrastructure—including hospitals, homes, and schools—must not be targeted and that medical personnel must be able to carry out their duties safely and without interference[32].
The World Health Organization, in addition to providing verified data on casualties and damage, warned that continued attacks on healthcare facilities effectively deprive communities of access to life-saving care at the most critical moments, potentially leading to the collapse of healthcare systems and the intensification of humanitarian crises[33].
Tedros Adhanom Ghebreyesus, Director-General of the WHO, reacted to attacks on civilian infrastructure—including hospitals and schools—by stating on social media that such acts are not “miscalculations” or “collateral damage,” but constitute war crimes. He emphasized:
“Bombing a hospital or a school is not a mistake… Killing an emergency worker is not collateral damage.”
He concluded by asserting that such actions are war crimes—plain and simple[34].
The United Nations Human Rights Council, in its Geneva sessions, expressed concern over rising civilian casualties and the risk of escalation, emphasizing the necessity of compliance with international law and warning of potential war crimes.
Simultaneously, the Office of the High Commissioner for Human Rights and independent UN experts described certain attacks as serious violations of international law. These experts condemned U.S. and Israeli attacks on Iran in June 2025 and again in March 2026, citing damage to hospitals, residential areas, and humanitarian institutions—including Red Crescent and healthcare facilities—as violations of the principles of distinction, proportionality, and precaution, and therefore as serious breaches of both international humanitarian law and human rights law[35].
The UNICEF warned on 20 June 2025 about the impact of attacks on children in Iran and called on all parties to uphold their obligations to protect humanitarian personnel and critical civilian infrastructure such as hospitals.
On 5 March 2026, UNICEF reported that at least 10 hospitals in Iran had been damaged, disrupting children’s access to essential healthcare services[36].
The International Federation of Red Cross and Red Crescent Societies reported on 27 June 2025 that four Iranian Red Crescent relief workers had been killed during the attacks, including two who were killed in Tehran on 16 June 2025 while traveling by ambulance to provide assistance.
The federation also reported damage to ambulances, helicopters, and Red Crescent buildings. On 4 July 2025, it expressed deep sorrow over the deaths of five members and volunteers of the Iranian Red Crescent during humanitarian missions, emphasizing that humanitarian workers and the Red Cross/Red Crescent emblems must be respected and protected at all times[37].
Conclusion
During the period from 28 February 2026 to 8 April 2026, a series of attacks and related incidents significantly affected healthcare infrastructure and the capacity to deliver medical services in Iran, in some cases resulting in casualties among healthcare personnel.
Available data indicate that these impacts were not confined to one or a few isolated incidents, but rather manifested in the form of recurring patterns, including destruction, disruption of hospital operations, forced evacuation of medical centers, and their temporary removal from the service cycle.
A portion of the reported damage resulted from blast effects in nearby areas, pressure waves, and other indirect consequences of attacks, while in certain cases, allegations have been made regarding direct strikes on ambulances or service facilities. Taken together, these developments present a concerning picture of sustained pressure on the healthcare system and a reduction in its resilience under conditions of armed conflict.
From the perspective of international law, the immunity of medical units, relief vehicles, and healthcare personnel constitutes a well-established and fundamental principle. Any attack against such protected entities is conceivable only under strictly limited circumstances and rigorous legal conditions.
At the same time, establishing international—particularly criminal—responsibility requires precise proof of both the material and mental elements of violations, including intent and the civilian character of the targeted objects, based on reliable and verifiable evidence. Given the heterogeneity and dispersion of the currently available data, such determination cannot be made without a specialized and comprehensive investigation.
Nevertheless, the volume and nature of existing reports clearly underscore the necessity of conducting an impartial, prompt, and technically rigorous inquiry—one capable of clarifying the factual circumstances through field evidence, operational data, and relevant documentation, and of laying the groundwork for determining potential responsibility in accordance with international legal standards.
References
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