The paper by Kunichoff et al. published in Plos Global Public Health and making ingenious use of satellite images previously published in the mainstream press, describes how between October and mid-November 2023 hundreds of Mark-84 bombs (with enormous destructive capacity, even hundreds of meters from the blast site) were detonated close enough to 84% of Gaza hospitals to cause 'damage and injury' (less than 800 meters) and at a 'lethal' distance (less than 350 meters) from 25% of those hospitals. And both in the north of the Strip and in the supposedly safe evacuation zone defined by Israel.

Hospitals within these distance ranges will have suffered damage to their infrastructures and human casualties, both among patients and health professionals and among the civilian population that (in vain) sought refuge in their vicinity because they are infrastructures specially protected by international humanitarian law. In addition, damage to roads, electricity or water facilities, etc., will have affected access to hospitals and their supplies, and hindered the care of many seriously ill patients.

In summary, the above study proves that Israel, ignoring the most basic international law thanks to the impunity that the United States is guaranteeing it, has been considering hospitals, health professionals and patients as a legitimate military target. Crimes against humanity. No palliatives.

The study is of good quality. It is supported above all by the reputation of its own researchers, some of whom I know personally.

The main added value is that it brings to the table the problem of attacks on healthcare centers and healthcare personnel, something that is happening more and more frequently in conflicts. Moreover, it does so with objective data and in a structured manner.

The main limitation of the study is that it works with secondary sources, although this is a limitation that always exists in these cases. There is also a lack of more concrete information on the estimates of 360 and 800 meters: mortality depends on many factors. There may be problems in interpreting the results and reaching conclusions that are too simple.

In general, the article is interesting and provides knowledge from a scientific point of view, which, on occasions, should not be left aside from political aspects.

Although their causes may be political, wars are an increasingly relevant public health problem. They are increasingly affecting the civilian population. And what is alarming is no longer that the main victims are women and children, but that, based on data provided by researchers, there is no longer respect for hospitals, health professionals, or the sick or vulnerable population being cared for in health facilities or in refugee camps. In the case of Gaza, in full view of the whole world, including the major regional and world political leaders, and international organizations such as the UN, which, after a year since the conflict began to worsen, not only continue to allow the massacre, but accept that it is spreading.

The most telling sentence in the article, in my opinion, is not in the conclusion, but when it states that 'damage to infrastructure and injury or death of human beings within the lethal range of antibunker bombs are not truly collateral, but are in fact an anticipated effect of those bombs when chosen in place of smaller munitions'. To put it plainly, not many more words are needed. Another 'message' that the article leaves is about the client for whom these bombs are manufactured: the U.S. Department of Defense.

The study, led by researchers from Harvard University, in collaboration with other American, Palestinian and Lebanese institutions, provides arguments and data to try to demonstrate that Israel has been violating international humanitarian law during the current conflict in Gaza by dropping anti-bunker bombs in the vicinity of hospitals within the lethal range of these bombs.

The study is pioneering and original in its methodology combined with the objective, and provides relatively robust data to support its conclusions. Geospatial data on bomb craters from publicly available satellite imagery from media with little suspicion of being anti-Semitic (CNN and New York Times), and geolocation data on hospital facilities provided by the United Nations, combined with artificial intelligence data analysis strategy, ensure the reproducibility of the study by third parties.

The results are in line with official accounts from UN representatives such as Francesca Albanese, UN Special Rapporteur for the Occupied Palestinian Territories, or the World Health Organization's Regional Office for the Eastern Mediterranean.

The article is relevant because it discusses the risk, in this case indirect, of Israeli bombardment of areas near Gaza hospitals. In fact, Israel has bombed 'directly', and against all international humanitarian law, many of Gaza's hospitals with devastating impact. At least 17 of the 36 existing hospitals have been completely disabled by direct bombardment. Both in terms of infrastructure, medical care and the health of the population this impact is enormous and is both short, medium and long term.

Hospitals in Gaza were already operating under extremely difficult conditions due to the Israeli blockade for more than 15 years, which systematically prevents access to medical supplies, fuel and other essential resources.

The study is of high quality, with a well-defined, structured and innovative methodology, using reliable, official sources and data both journalistic and published in networks.

The results and conclusions are solid, in accordance with the objectives and the methodology used: the destruction caused by the bombs and the effect according to the distance in the destruction, affectation of sanitary structures, hospitals....

It is a novel work since the description of the type of bombs, number of craters (indicating the lethal impact or not), the affected areas, allow us to situate the consequences of the conflict for Gaza without going into details of the number of victims, although it is cited in the bibliography (e.g. 40, 41, 42 and 43). In addition to the reports of the UN and human rights bodies.

Limitations have been described as there are geolocations that have been lost, as well as the quantitative impact of all victims, counting hospitalized people, refugees, health professionals and the lack of supplies so that health infrastructures can continue to function (electricity and water).

This study provides scientific evidence of the negative impact of this conflict and the non-respect of international human rights conventions, including the non-destruction and non-attack of health infrastructures and civilian population.