Weaponizing Health in Modern Hybrid Warfare

Hybrid warfare is a complex conflict paradigm blending conventional, irregular, cyber, and political tactics to inflict harm on an opponent. 1Hybrid warfare mainly aims to undermine the enemy by exploiting vulnerabilities across multiple domains, frequently operating below the threshold of overt armed combat to perpetuate plausible deniability. 1 The conflict in Gaza exemplifies a unique form of modern hybrid warfare, characterized by the use of military operations to systematically dismantle the health care system and inflict harm. 2 Although attacks on health have been described in other conflicts, the scale and impact have been exceptionally severe in Gaza due to its unique status as an occupied territory under siege.These conditions have hindered the replenishment of medical supplies and precluded any rebuilding efforts while simultaneously restricting civilian mobility and limiting access to refuge or medical care beyond Gaza's borders. 3sraeli bombing of health care facilities has been a prominent feature of the current conflict. 2Geospatial data revealed that 83% of Gaza's hospitals had at least one M-84 bomb crater within 800 meters, while 25% were within the "lethal" 360-meter range, leading to 34 out of 36 hospitals being partially or fully damaged by May 30, 2025. 2 In addition, Israeli military sieges have been systematically implemented against hospitals in Gaza, using disproportionate force against non-military facilities, blocking medical evacuations, preventing patient movement in and out of the hospital, destroying medical equipment, and denying entry of essential resources. 3Finally, the targeting and detention of health care workers has eliminated key expertise within the system, with reports from the Office of the United Nations High Commissioner for Human Rights (OHCHR) and the World Health Organization (WHO) confirming that 1,581 health care workers have been killed and over 400 detained as of 2025. 4,5eyond the direct trauma-related morbidity and mortality of the war, which has resulted in an estimated 75,200 violent deaths, there has been a significant rise in indirect deaths (i.e., mortalities related to the indirect effects of the war). 6These indirect deaths are thought to be a result of a lack of access to proper medical care, increased infection rates, and increasing rates of malnutrition. 7,8Altogether, the systematic dismantlement of Gaza's health care system amidst conditions that have amplified health care needs has led to a drastic drop in life expectancy from 75.5 years pre-war to an estimated 40.5 years post-war, a decrease of approximately 46.3%. 9Moreover, recent estimates extrapolating from a Lancet study on excess deaths suggest that the overall death toll may be up to 186,000 deaths by June 2024, translating to 7.9% of the total population in the Gaza strip. 9rgent and decisive action is required to confront this new form of hybrid warfare that violates the principle of medical neutrality necessary for impartial and humane care during conflict. 10Thus, it is imperative that the global medical community unequivocally condemns the deliberate targeting of health care facilities, personnel, and the systematic deprivation of access to care as a war strategy. 10