Targeting the Chain of Care: How Israel’s Healthcare Attacks Undermine Civilian Survival and Return in Southern Lebanon

Every link in this chain has come under fire, at a scale indicating a systematic campaign against the health sector. Since the start of the 2026 conflict, more than 200 Israeli strikes have killed 135 health workers and injured 406 more, damaged 17 hospitals and 175 ambulances, and shut down 44 primary healthcare centers. The impact has been most severe in southern Lebanon, and aligns with Israel’s broader campaign to make border areas uninhabitable.

Beyond disrupting emergency care, these attacks undermine the healthcare system’s ability to support everyday life. For people with chronic conditions, pregnant women, and the elderly, access to functioning healthcare services, alongside food, water, and shelter, can determine whether they remain in or return to their communities. The consequences, however, are not limited to the most vulnerable groups. When healthcare systems break down, treatable illnesses and injuries can turn into serious, sometimes fatal complications for anyone, threatening both survival and the viability of return.

A System Already Strained

When the latest escalation broke out, Lebanon’s healthcare sector was already weakened by years of economic crisis and a prior round of conflict. The 2019 financial collapse eroded the purchasing power of public health institutions as the Lebanese pound lost 98% of its value, causing shortages of medicines, equipment, and fuel. Around 40% of medical staff left the country, and those who stayed worked amid chronic underfunding that compromised care for people who need uninterrupted treatment, such as cancer and dialysis patients.

The 2023-2024 war added a further layer of damage: 241 health workers were killed and 292 wounded, and infrastructure damage was widespread; Nabatieh governorate, for instance, lost 40% of its hospital bed capacity. When hostilities resumed, hospitals were still struggling to provide routine and specialized care while carrying the operational and psychological weight of the previous conflict.

Lebanon’s healthcare system is highly fragmented, with services delivered through a patchwork of state institutions, party-affiliated organizations, and non-governmental groups. In the south, hospitals and primary healthcare centers run by the Ministry of Public Health (MoPH) operate alongside the Hezbollah-affiliated Islamic Health Association, which offers subsidized or free medical services through an extensive network of clinics. The Lebanese Red Cross and Civil Defense provide first-response and emergency services, as does the Risala Scout Association linked to the Amal Movement.

Israel has used organizational affiliation to justify its attacks, even though such ties alone do not render healthcare personnel, vehicles, or facilities lawful targets. Israeli authorities have also directly alleged that Hezbollah uses ambulances and medical facilities for military purposes. In March, Amnesty International said Israel had provided no evidence for these allegations and stressed that healthcare workers do not lose their protected status simply because they work for institutions associated with Hezbollah. Under IHL, medical facilities can only be targeted if used for acts “harmful to the enemy,” and even then, only after an evacuation warning has gone unheeded. A field investigation by The Guardian that same month, based on interviews with nine medical workers, visits to three destroyed medical centers, and inspections of two damaged ambulances, found no proof of military use at any of the sites examined, nor evidence for Israel’s broader claim that Hezbollah uses ambulances for military purposes.

Similar allegations continued as attacks on healthcare expanded. In June, after three hospitals in southern Lebanon were struck within less than a week, Israel accused Hezbollah of controlling Tebnine Governmental Hospital. The health ministry rejected the accusation as fabricated, while the hospital continued to host medical operations involving the International Committee of the Red Cross, Lebanese Red Cross, and Lebanese army.

The repeated targeting of healthcare infrastructure has created a gap between nominal capacity — what remains operational on paper — and effective capacity — whether care actually reaches people. Even if a facility is still standing, healthcare becomes functionally unavailable when responders cannot reach casualties, referral routes are severed, or the personnel and supplies needed for treatment cannot get there. This gap runs through the entire chain of care: from evacuating the injured, to referral and treatment, to ongoing care for people with chronic conditions.

Reaching and Moving the Patient

Following an Israeli strike, survival may depend on how quickly paramedics can reach the scene, evacuate the wounded, and transport them to a functioning facility. Rescue is therefore the first link in the chain of care. Under IHL, the protection of medical personnel and their right to operate do not depend on the status of the casualties they are treating. Teams may respond to civilians and wounded combatants no longer participating in fighting without losing their protected status, and attacks on them cannot be justified on the basis of who they are rescuing, especially since differentiation is not always operationally possible.

In practice, rescue operations rely on voluntary arrangements through which humanitarian organizations share information with belligerents to reduce the risk of being caught up in the fighting. These arrangements do not create the legal obligation to protect medical personnel, which exists independently under IHL. Alexy Nehme, Director of Ambulance and Emergency Medical Services at the Lebanese Red Cross, distinguishes between notification, under which teams inform UNIFIL or the relevant coordination mechanism while proceeding, and deconfliction, which requires express clearance before entering frontline areas. Even after clearance is granted, teams may be ordered to withdraw, face a warning strike, or be informed that the area has been redesignated as a red zone.

The coordination process directly affects the time it takes to reach a casualty: responders may move immediately, wait for approval, or suspend an operation until clearance is renewed. When an injury is life-threatening, even a short delay can make the difference between survival and death.

Although these coordination mechanisms are intended to protect rescue teams, they have repeatedly failed to do so. On April 12, a Red Cross volunteer was killed while stepping out of his clearly marked ambulance during a coordinated mission in Beit Yahoun, after the team had notified Israeli forces via UNIFIL and received clearance to proceed. On April 22, Lebanese journalist Amal Khalil was struck and trapped under rubble with her colleague Zeinab Faraj. The Red Cross evacuated Faraj, who survived, but came under direct fire while attempting to reach Khalil. Responders withdrew, renewed their coordination requests, and returned hours later. By the time they reached Khalil, she had died. A reconstruction by the Washington Post found that rescuers were denied access to Khalil during a crucial period when she was still alive.

These incidents show that deconfliction offers no reliable protection beyond theoretical safeguards. The clearest expression of this failure is the pattern of sequential strikes on rescue operations. On March 28, nine paramedics were killed and seven wounded across five separate attacks in a single day. On April 15 in Mayfadoun, three consecutive strikes hit successive rescue teams responding to a distress call from wounded civilians: a team from the Islamic Health Association arrived and was struck, killing two paramedics; a second team dispatched to assist was hit in a follow-up strike, injuring three; a third team from the Nabatieh Emergency Services and Risala Scout Association was then struck, killing two more and bringing the toll to four paramedics killed in a single rescue operation. The Israeli army indicated the incident was under review without acknowledging the deaths.

These repeated strikes forced rescue teams to reassess whether responding to calls was survivable, introducing a deterrent that would itself come to obstruct access to care. Israel’s use of double-tap and follow-up strikes has therefore narrowed the functional reach of the emergency response system. Coverage contracted not only through the loss of assets but also the uncertainty created by the attacks. Before dispatching a team, the Lebanese Red Cross had to weigh the casualty’s need for immediate care against the risk that responders would themselves be struck. This constraint, Nehme explained, further reduced effective capacity: the rescue decision was no longer governed by clinical urgency alone; it was filtered through the survivability of the mission and the need to preserve the workforce for subsequent emergencies.

The resulting delays varied in duration and consequence. Some missions slowed by several minutes while teams assessed immediate threats; others were suspended for 24 to 48 hours in areas subject to entry restrictions. As these restrictions narrowed the operations of other emergency providers, Nehme estimated that the Lebanese Red Cross handled around 90% of responses in some circumstances and conducted as many as 800 missions within 24 hours. Demand was consequently concentrated within the organization with the widest access to coordination channels, expanding its role from casualty evacuation to the movement of blood, staff, supplies, and repair teams.

Receiving Effective Treatment

Even when victims survive a strike and are evacuated, they must still reach a facility capable of treating them, with the staff, medicines, supplies, and equipment to provide effective care. Israeli attacks have systematically undermined that capacity by striking transport infrastructure, health facilities, and medical personnel.

In the early weeks of the war, Israeli forces struck the main bridges over the Litani River, severing the primary road connections between the south and the rest of the country. The Qasmieh coastal bridge, the last remaining crossing linking the Tyre area to Sidon, was destroyed on April 16 — an attack Human Rights Watch characterized as a potential war crime given its effect on civilian access to means of survival, including water, food, and medical care. By late May, patients south of the Litani were waiting up to 48 hours for clearance to reach a functioning healthcare facility north of the river.

The targeting of health facilities and areas around them compounded access problems. In an interview, officials from the Public Health Emergency Operations Center (PHEOC), the health ministry’s emergency coordination body, described a recurring pattern: a hospital could remain physically intact while surrounding strikes, movement restrictions, or the inability of patients and supplies to safely reach it diminished its capacity to provide care.

In other cases, the strikes hit hospitals directly. Tebnine Governmental Hospital, the only operational health facility in Bint Jbeil district, was bombed twice within three days. The attacks injured 11 staff and gutted the hospital’s emergency wing, pharmacy, oxygen supplies, and ventilators. The hospital eventually closed entirely when Israeli forces moved close to its grounds.

Jabal Amel Hospital in Tyre sustained at least five documented attacks. A strike on June 2 damaged its emergency department and intensive care unit and injured 86 people, including healthcare workers. With two of Tyre’s three hospitals damaged and the third overwhelmed, the city ceased to function as a trauma referral hub.

As facilities lost capacity or became inaccessible, PHEOC responded to coverage gaps by moving patients across hospitals and governorates, redirecting ambulances away from saturated facilities, and extending the operating hours of primary healthcare centers. These measures did not restore normal service; they redistributed scarcity, concentrating more patients in the fewer facilities that remained functional.

Along with the infrastructure damage, the healthcare workforce itself has come under attack. Israeli strikes have targeted healthcare personnel with a directness that distinguishes this escalation from incidental wartime harm, killing a total of 376 health workers in the 2024 and 2026 conflicts. On March 13, a single strike on the Burj Qalaouiyah primary healthcare center killed 12 doctors, paramedics, and nurses on duty.

The attacks exacted a less visible toll, too. Research following the 2024 hostilities found that 18.4% of healthcare workers screened were at high risk of post-traumatic stress symptoms, with significantly higher rates among nurses and those directly exposed to the war. The 2026 escalation has added a further layer of trauma, compounded by displacement. Healthcare workers have been forced to leave conflict-affected communities, creating a structural mismatch between where staff are located and where they are needed. Some facilities remained open only because workers chose to stay despite the danger.

The combined effects of attacks on supply routes, facility closures, and stockouts have constrained access to the medicines and supplies needed to treat patients, leaving a depleted workforce with fewer resources to provide care. These war-related pressures are compounded by a structural weakness: Lebanon imports around 95% of its pharmaceutical products, exposing the health system to shocks in global supply chains. The closure of the Strait of Hormuz following US-Israeli strikes on Iran in late February disrupted a key logistics corridor for roughly 80% of regional pharmaceutical imports. The delivery costs of medical supplies into Lebanon tripled as a result. By mid-April, 9% of chronic disease medicines were out of stock nationwide, while another 26% had less than three months’ supply remaining.

These accumulated pressures left the healthcare system with little capacity to absorb mass-casualty events — none more severe than on April 8, the day Lebanon would come to call “Black Wednesday.” In the space of 10 minutes, Israel launched more than 100 strikes across the country, hitting Beirut, the Bekaa Valley, Sidon, and Tyre without warning in the middle of the day. At least 357 people were killed and more than 1,200 injured, as major hospitals were inundated with casualties. Trauma kits, containing essential medicines, surgical supplies, and equipment for treating severe injuries, which normally last for three weeks were depleted in a single day, and the destruction of access routes made it harder to replenish supplies.

Continuity of Care and the Conditions for Return

Disruptions along the chain of care compound one another, producing preventable deaths from delayed or obstructed care. For those with severe injuries, delays in evacuation and treatment are directly associated with higher mortality and complication rates, particularly where clinical outcome windows are narrow. Attacks on healthcare have systematically extended that interval across the south. During Israeli bombardment, patients, including children, arrived with heavy bleeding, traumatic amputations, and complex wounds at facilities already overwhelmed by surge conditions that mass-casualty protocols alone could not address.

A second category of harm accumulates over the medium term, among patients with chronic and life-sustaining needs. For dialysis or cancer patients, treatment delays of even a few days or weeks can worsen their prognosis in ways that are difficult to reverse. Even when patients were transferred further north to resume treatment, the additional cost and distance put continuity of care out of reach for many.

Official casualty counts fail to capture deaths caused by degradation of the health system, but that does not mean indirect casualties are unmeasurable. Research published in The Lancet estimates that in recent conflicts such as the Gaza war, indirect deaths resulting from the collapse of healthcare can range from 3 to 15 times the number of direct deaths. These projections are not specific to Lebanon but reflect a historical range observed in other armed conflicts. What gives them analytical weight is that the pattern behind them is neither incidental nor unprecedented: Israeli officials openly modeled their Lebanon operations on Gaza, a targeting logic whose consequences will take years to measure.

Beyond its impact on mortality, the degradation of healthcare services affects whether civilian return to the south is viable. Return depends on the basic conditions required to sustain daily life: access to food, water, shelter, electricity, and functioning medical care when illness or injury occurs. PHEOC officials linked the destruction of health infrastructure directly to displacement, arguing that without accessible emergency and essential care, civilians face greater pressure to leave. The same reasoning applies to return: where hospitals remain open and accessible, they signal that life can be sustained and encourage people to come back. Where they are closed, damaged, or unreachable, the absence of health services can weigh on decisions about whether to return.

Primary healthcare centers are part of the wider infrastructure that supports durable return. They provide the routine consultations, medicines, and referral functions that allow communities to manage health needs close to home. Restoring them is a necessary but insufficient condition: return also depends on roads, water, electricity, housing, and the specialist services that primary care cannot substitute. The degree to which those systems have been destroyed determines the timeline and feasibility of return for those with acute health needs.

Israel has formalized this logic spatially. The so-called Yellow Line buffer zone, designated as a closed military zone in April, encompasses 55 villages south of the Litani River that have seen mass destruction of civilian infrastructure. This no-return zone is where healthcare infrastructure has been most systematically destroyed, alongside other vital resources sustaining life. Elsewhere in the south, where return was at least physically possible, the picture was hardly better. The Norwegian Refugee Council found that the April 17 ceasefire deepened displacement instead of reversing it: families who returned found their homes damaged and their villages without essential services, forcing them to leave again.

The Wider Cost

The attacks on healthcare in southern Lebanon have taken the chain of care apart, layer by layer, over successive rounds of conflict, undermining the conditions by which civilian life can be sustained. As such, Israeli actions in South Lebanon are part of a concerning wider international trend in which the protections afforded to medical care under IHL are being eroded, from Gaza and Syria to Sudan and Ukraine. If violations of this kind continue in one particular war, the legal framework meant to protect civilians in conflict is undermined everywhere.

The full scope of the destruction in Lebanon cannot be measured by casualty figures alone and may only emerge over time — in preventable deaths when people cannot get timely medical care, in the worsening health of patients with chronic illnesses, and in prolonged displacement where essential healthcare services remain inaccessible. The destruction of healthcare is therefore not a tangential consequence of the conflict: it has become an intentional theatre for prosecuting the war, one in which Israel seeks to eliminate the possibility of civilian return and survival in the areas its forces are occupying. Until the chain of care is restored as a functioning whole, the war’s effects will continue beyond the end of active hostilities, shaping not just who survives, but who gets to come home and stay.

With many thanks to Hisham Jaber, Research Manager and Health Policy Advisor, and Michael El Kassis, Senior Research Analyst, for their invaluable insights, analysis, and conducting of interviews as part of this piece.

Salma Daoudi is a Non-Resident Fellow at Badil | The Alternative Policy Institute