Introduction Medical facilities are civilian objects specially protected during armed conflict by international humanitarian law (IHL). These protections are customarily applied regardless of the conflict, parties or contexts involved. Attacks on medical care have characterised the bombardment campaign of the Gaza Strip beginning 7 October 2023. This study presents evidence regarding patterns of damage to medical complexes relative to all other buildings in the first month of this conflict. Methods This is an observational pre/post-study of damage to buildings during the first month of the Israel Defence Force bombardment of Gaza from 7 October to 7 November 2023. Open-source polygons for the Gaza Strip were spatially joined with building damage assessments from satellite imagery analysis. Medical facilities were included in the analysis if they were cross-referenced by a minimum of two datasets. Logistic regression was used to test for statistically significant differences in the proportions of damaged medical complexes and other buildings. Results A total of 167 292 unique buildings were identified, including 106 cross-referenced medical complexes. Approximately 9% of non-medical buildings and medical complexes alike sustained damage during the first month of the bombardment. No difference in the odds of damage was detected between medical complexes and all other buildings (OR: 0.89; 95% CI: 0.45-1.76; p>0.74). Conclusion There is a lack of evidence of differential damage to medical and non-medical complexes during the first month of the bombing campaign. This finding raises concerns about combatants’ application of the principles of distinction, proportionality and precaution, suggesting the importance of further investigation. Data are available upon reasonable request. The data produced by this study are available from the corresponding author upon reasonable request.

中文翻译：

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以色列-哈马斯战争期间加沙地带医疗设施受损：地理空间分析

简介 医疗设施是武装冲突期间受国际人道法 (IHL) 特别保护的民用物体。无论涉及何种冲突、各方或背景，通常都会应用这些保护措施。自 2023 年 10 月 7 日开始，加沙地带的轰炸活动以医疗设施袭击为特征。这项研究提供了有关这场冲突第一个月内医疗综合体相对于所有其他建筑的受损模式的证据。方法 这是对 2023 年 10 月 7 日至 11 月 7 日以色列国防军轰炸加沙第一个月期间建筑物受损情况进行的观测前/事后研究。加沙地带的开源多边形在空间上与建筑物受损评估相结合卫星图像分析。如果医疗设施被至少两个数据集交叉引用，则它们将被纳入分析。使用逻辑回归来测试受损医疗综合体和其他建筑物比例的统计显着性差异。结果 共识别出 167 292 座独特建筑，其中包括 106 座交叉引用的医疗综合体。在轰炸的第一个月内，大约 9% 的非医疗建筑和医疗综合体遭受损坏。医疗综合体和所有其他建筑之间的损坏几率没有差异（OR：0.89；95% CI：0.45-1.76；p>0.74）。结论 缺乏证据表明轰炸行动的第一个月对医疗和非医疗综合体造成了不同程度的损害。这一发现引起了人们对战斗人员应用区分、相称和预防原则的担忧，表明进一步调查的重要性。数据可根据合理要求提供。本研究产生的数据可根据合理要求从通讯作者处获得。