Enabling Atrocity: U.S. Complicity in the Systematic Destruction of Gaza’s Healthcare System

Executive Summary

United States law prohibits taxpayer-funded assistance to foreign forces credibly implicated in gross violations of human rights.  Yet as the International Court of Justice investigates whether Israeli operations in Gaza constitute genocide, the United States continues to provide military and financial support for actions that have dismantled Gaza’s healthcare system.

As of May 2025, the World Health Organization confirmed that only 19 of Gaza’s 36 hospitals remain even partially operational.  Ninety-four percent of healthcare facilities have been damaged or destroyed.  Mass graves were discovered on hospital grounds.  Medical personnel have been killed, detained, or disappeared.  Ambulances have been targeted while responding to wounded civilians.  These are not isolated incidents but evidence of a systematic assault on healthcare infrastructure.

Despite extensive documentation, the United States has not suspended aid, conducted a legal review, or enforced safeguards required by law.  The Leahy Laws, Foreign Assistance Act, and Arms Export Control Act all mandate enforcement in such circumstances.  That enforcement has not occurred.

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Introduction

This brief asks a narrow but urgent legal question: Is the United States complying with its own foreign assistance laws in the face of credible, well-documented attacks on Gaza’s healthcare system?  It does not question Israel’s right to self-defense under Article 51 of the United Nations Charter.  It focuses on whether United States assistance violates legal frameworks designed to prevent complicity in gross human rights abuses, particularly those targeting civilian healthcare infrastructure.

Since October 2023, Israeli military operations have systematically devastated Gaza’s healthcare system.  The World Health Organization (WHO), International Committee of the Red Cross (ICRC), and United Nations agencies have verified the destruction of hospitals, obstruction of medical convoys, and killing or disappearance of medical personnel.  These acts violate the Geneva Conventions and customary international law.  United States military doctrine affirms that medical services are protected and may not be used as military targets.

Israeli officials argue that Hamas embeds military assets in civilian areas, including near medical facilities.  Even if true, international humanitarian law (IHL) imposes binding duties of proportionality, distinction, and precaution.  These rules apply to all conflicts.  Moreover, other countries have faced enforcement under far less visible circumstances.  Aid was suspended to Pakistan, Nigeria, El Salvador, and Egypt based on allegations with less documentation than what is available regarding Gaza.  

These statutes are meant to be enforced on the basis of credible information, not political expedience.  Yet entrenched alliances and executive deference have impeded their application.  This enforcement gap is not due to a lack of statutory clarity or evidentiary thresholds.  It is the result of political exceptionalism, where strategic partners are shielded from the consequences of documented abuses.  Failure to confront this structural barrier risks rendering U.S. human rights law a tool of convenience rather than a constraint of power.

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Legal Framework and Analysis

United States law prohibits military and security assistance to foreign actors credibly implicated in gross violations of human rights.  The Leahy Laws require suspension of aid to units engaged in extrajudicial killings or torture where credible information exists.  The Foreign Assistance Act (FAA) bars assistance to governments engaged in consistent patterns of abuse.  The Arms Export Control Act (AECA) limits arms transfers to lawful, proportionate uses consistent with international humanitarian law (IHL) and civilian protection.  These statutes are designed to function proactively on credible information, not await judicial adjudication.  The documented collapse of Gaza’s healthcare system satisfies these statutory thresholds.  Claims of non-state threats do not negate statutory duties or lawful conduct requirements under U.S. and international law.

Furthermore, in January 2024, the International Court of Justice (ICJ) issued provisional measures ordering Israel to prevent acts of genocide and ensure humanitarian access.  While the United States is not a party to the case, it remains legally bound under the Genocide Convention to avoid aiding or assisting acts that could violate peremptory norms.  That obligation exists independently of the ICJ’s jurisdictional reach.

The scale and consistency of these attacks on Gaza’s health system are extensively documented and already outlined above.  Yet the Department of State has not initiated a Section 502B review under the FAA.  One illustrative case occurred on March 23, 2025.  Israeli forces in Rafah struck a clearly marked medical convoy.  Fifteen medics were killed.  Video evidence and forensic reports confirmed the absence of weapons and the presence of Red Crescent markings.  Victims were buried in a mass grave discovered by UN and Palestinian rescue teams.  The Israeli military admitted a “professional failure.”  By any legal measure, this incident alone satisfies the Leahy threshold.  Yet the United States has taken no action.

Strikes using U.S.-origin Joint Direct Attack Munitions (JDAMs) and artillery have hit hospitals, United Nations Relief and Works Agency (UNRWA) shelters, and residential neighborhoods.  The Gaza Health Ministry reports over 54,000 Palestinian deaths, primarily women and children.  A peer-reviewed study in The Lancet estimates the total death toll, accounting for indirect fatalities, could exceed 186,000.  Civilian harm at this scale triggers legal scrutiny under both the AECA and binding international law.

The right to self-defense does not override obligations of proportionality, distinction, and precaution.  These are core principles of IHL, codified in the Geneva Conventions and Additional Protocol I.  U.S. military doctrine affirms that hospitals are presumptively protected unless direct military use is proven.  Generalized assertions of necessity are not a legal defense.  Continued transfers of U.S. weapons absent lawful use verification raise serious exposure under the AECA and call into question U.S. commitments to the laws of war.

Under the Supremacy Clause of the U.S. Constitution, ratified treaties such as the Geneva Conventions form part of federal law.  The Leahy Laws, FAA, and AECA implement those obligations.  They were enacted to prevent unchecked executive discretion in foreign policy. Legislative history reflects this concern: Section 502B was designed to force transparency in abusive contexts, and the AECA was reformed to tether arms sales to humanitarian compliance after the Vietnam War and Latin American atrocities.  Failure to enforce these statutes not only undermines the law, it threatens constitutional balance.  When the executive declines to apply laws passed by Congress for political reasons, it erodes legislative authority and the rule of law itself.  

Internationally, these patterns also implicate the United States in potential breaches of customary law.  Under Articles 1 and 16 of the International Law Commission’s Draft Articles on State Responsibility, no state may aid or assist another in maintaining a situation that violates peremptory norms.  If Gaza’s healthcare system was intentionally targeted or destroyed in violation of IHL or the Genocide Convention, continued U.S. support without due diligence may meet the threshold of complicity.  That exposure carries reputational, legal, and strategic consequences, including the potential for future claims before international tribunals, reputational loss in multilateral institutions, calls for sanctions, and universal jurisdiction litigation against U.S. officials.  Domestically, continued aid without public review violates core principles of democratic accountability. Congress holds the power of the purse for a reason.  When taxpayer funds are linked to potential war crimes and no transparency exists, the failure is not procedural.  It is constitutional.

The relevant question is not whether Israel faces threats.  It is whether the United States is obeying the laws it enacted to ensure its resources do not fund unlawful violence against civilians.  A legal system that applies its rules selectively cannot credibly claim to uphold the rule of law.

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Policy Recommendations

To restore legal compliance, mitigate reputational and fiscal liability, and prevent further complicity in grave violations of IHL, coordinated action is required across Congress, the Executive Branch, oversight institutions, and civil society.  

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1. Enforce the Leahy Laws Through Independent Certification

Congress should require the Office of the Inspector General or a special panel of independent experts to certify whether Leahy Law vetting has been conducted for Israeli military units operating in Gaza since October 2023.  Certification must be triggered by credible allegations of gross human rights violations, including strikes on hospitals and medical staff.  Where certification is incomplete, assistance should be partially withheld, with a 60-day deadline for compliance.  Civil society submissions, UN documentation, and third-party investigations must be accepted as valid triggers for review.  Conditioning a portion of military aid on public Leahy compliance restores transparency and aligns with precedent in Guatemala, Indonesia, and Nigeria.

2. Submit a Section 502B Report

The Secretary of State must submit a formal report under Section 502B of the FAA assessing whether Israeli conduct in Gaza reflects a consistent pattern of gross violations of human rights.  Civil society groups may initiate legal action if this statutory obligation is not fulfilled.  Congressional hearings should follow.  Pending a credible legal review, further aid should be paused.  This step reflects prior enforcement actions in Egypt and El Salvador and reasserts Congress’s constitutional role in foreign assistance oversight.

3. Enforce the Arms Export Control Act (AECA)

Under the AECA, U.S. weapons may only be transferred when used lawfully and in accordance with international humanitarian law.  The Departments of State and Defense are legally obligated to certify compliance under the AECA.  Congress should require the Departments of State and Defense to certify, within 60 days, that U.S.-origin arms have not been used in indiscriminate or disproportionate attacks.  Certification must be based on verified evidence from sources recognized by U.S. law and precedent, including U.S. intelligence assessments, Department of State human rights reporting, Congressional Research Service analyses, and peer-reviewed forensic investigations by reputable humanitarian actors.  Absent timely certification, transfers must be suspended.  Civil society organizations and courts may intervene if these duties are neglected.  This is not a punitive action but a compliance mechanism required by law.

4. Clarify and Codify Enforcement Standards

Congress must legislatively define key terms across the Leahy Laws, FAA, and AECA; specifically “credible information,” “consistent pattern,” and “proportional use.”  Clear thresholds, timelines for agency action, and mandatory public reporting must be included.  These amendments are necessary to insulate enforcement from political interference and ensure that laws operate as intended, regardless of recipient identity.

5. Establish a GAO-Based Compliance Oversight Unit

A new unit within the Government Accountability Office should be tasked with independently verifying U.S. compliance with foreign assistance laws.  This body must be empowered to receive evidence from humanitarian organizations, civil society, and international monitors, assess whether aid is triggering statutory violations, and publish quarterly findings to Congress.  This would close the enforcement gap and institutionalize accountability.  The Executive should cooperate fully in providing access to relevant data. Civil society groups should have standing to submit evidence directly to the oversight unit.

6. Mandate Transparency in Aid Compliance

All Leahy vetting records, FAA 502B reports, and AECA compliance reviews for major aid recipients must be publicly disclosed, with redactions limited to national security.  Export licenses should include legal findings related to humanitarian law.  Transparency is not ancillary.  It is essential for legal accountability.  Where records are withheld, judicial petitions under Freedom of Information Act (FOIA) or the Administrative Procedure Act (APA) may be warranted.

7. Restore U.S. Humanitarian Infrastructure

Congress must reverse the 2024 suspension of funding to the UNRWA and reinstate health-related USAID operations in Gaza.  These actions should include independent oversight mechanisms, but funding must not be contingent on unverified claims.  Retreating from humanitarian platforms during a healthcare collapse weakens both moral and strategic standing and deepens the vacuum filled by less accountable actors.

8. Conduct a Full Fiscal and Legal Accountability Audit

The Executive, under congressional oversight, should commission an interagency audit to track all U.S. assistance to Israel since October 2023, with disaggregation by weapon system, contractor involvement, and delivery channel.  Independent watchdogs and legal organizations should initiate FOIA requests and legal challenges to compel transparency where necessary.  Any assistance linked to unlawful acts should be subject to clawback provisions.  Legal risk assessments must also be conducted to evaluate exposure under international and domestic law, including individual liability under the Alien Tort Statute and foreign universal jurisdiction doctrines.

9. Convene a Congressional Commission on Enforcement Integrity

Congress should create a bipartisan commission to investigate structural failures in enforcement of U.S. foreign assistance laws.  The commission should propose durable reforms, including mandatory aid suspensions based on international fact-finding, legal thresholds for civil society-triggered reviews, and mechanisms for affected populations to seek redress.  This initiative would signal that U.S. law is not hostage to politics but anchored in enforceable principles.

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Selected References

• U.S. Department of State. Leahy Law Human Rights Vetting Guide. 2022.

• U.S. Department of Defense. Law of War Manual. Updated 2023.

• Foreign Assistance Act of 1961, Pub. L. No. 87-195, §§ 116, 502B.

• Arms Export Control Act of 1976, 22 U.S.C. § 2751 et seq.

• Geneva Conventions (1949), including Common Article 3 and Additional Protocol I.

• Congressional Research Service. U.S. Foreign Aid to Israel. April 2024.

• United Nations. Report of the Independent International Commission of Inquiry on the Occupied Palestinian Territory. 2024.

• World Health Organization. Emergency Situation Reports on Gaza. January–May 2025.

• International Committee of the Red Cross. Healthcare Under Fire: Gaza. Situation Briefs, 2024–2025.

• Office for the Coordination of Humanitarian Affairs (OCHA). Flash Updates on Gaza. 2023–2025.

• NPR. “Israeli Probe into Killing of 15 Palestinian Medics in Gaza Finds ‘Professional Failures’.” April 20, 2025.

• Associated Press. “Mass Graves Found at Gaza Hospitals.” April 23, 2025.

• Amnesty International. Documented Violations of International Humanitarian Law in Gaza. 2024.

• Human Rights Watch. Gaza: Attacks on Healthcare Infrastructure and Personnel. March 2025.

• Physicians for Human Rights – Israel. System Collapse: Gaza’s Health System Under Siege. March 2025.

• UNRWA. Humanitarian Needs and Access Constraints Report. January–April 2025.

• GAO. Oversight Mechanisms in U.S. Foreign Assistance Programs. 2022.

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