Paramedics of the Palestinian Red Crescent Society (PRCS) and of the Ministry of Health’s Ambulance and Emergency Management Department respond to emergency calls, including those involving victims of Israeli military operations. There is no direct line of communication between the Palestinian ambulance services and the Israeli military, Dr. Muhammad al-Bardawil, head of the PRCS ambulance services, told Human Rights Watch. They must rely on their clear markings and distinction as medical personnel for their own safety or wait for a green light from the IDF via ICRC. 
 
The International Committee of the Red Cross in Gaza told Human Rights Watch that they act as liaison with the IDF for the Palestinian Red Crescent Society for “extremely urgent cases.” In these cases, the ICRC relays a PRCS request to enter an area to attend to a medical emergency to the IDF and the IDF then gives the ICRC assurances for the PRCS to proceed to a specific area. This process can take minutes or hours. 
 
In all six cases Human Rights Watch investigated, the paramedics and ambulances had waited for ongoing hostilities to cease and had taken precautions to safeguard the ambulances and their personnel from the risk of being caught in fighting. The PRCS and the Ministry of Health’s Ambulance and Emergency Management Department have extensive experience operating in zones where military operations are being conducted. 
 
International humanitarian law includes provisions of customary international law which all parties to an armed conflict must follow. The rules of customary international law that protect medical units, including paramedics and ambulances, state that these units “must be respected and protected in all circumstances.” Equally, “medical transports assigned exclusively to medical transportation must be respected and protected in all circumstances.” Medical workers engaging exclusively in medical work in the presence of combatants do not forfeit their protected status, but “they lose their protection if they commit, outside their humanitarian function, acts harmful to the enemy.” 
 
“It is unacceptable that paramedics and ambulance drivers, whose humanitarian task is to recover causalities and assist the injured, should themselves need to be hospitalized for carrying out their jobs,” said Stork. “All parties to a conflict must respect medical personnel, and in these cases where the shelling and gunfire apparently came from Israeli sources, a prompt and credible investigation and sanctions, where appropriate, must follow.” 
 
Testimonies 
 
Human Rights Watch investigated the following six incidents:
 

At around 1 a.m. on May 30, after a period of IDF shelling in the northern Gaza town of Bait Lahiya, paramedic Muhammad al-Muqayyid and colleagues in another ambulance responded to an emergency call. Residents had summoned an ambulance after two armed militants who had earlier entered a dirt road opposite the American School did not re-emerge. Al-Muqayyid said he and his colleagues waited for 15 minutes to make sure it was safe to follow the dirt road on foot to look for casualties. He said there were no aircraft and no Israeli shelling while they waited and when they entered, one holding a bright torch illuminating the way and both wearing fluorescent paramedic uniforms. Several journalists were also present. After some minutes the paramedics found one unconscious man; video footage taken by a Palestinian news agency and viewed by Human Rights Watch showed that he was holding an automatic rifle. The paramedics took him to the ambulance and returned to look for the second casualty when they heard the sound of incoming shelling. Palestinian militants are not known to possess heavy artillery. The video showed them racing back to their parked ambulances with lights flashing when a loud detonation occurred. Al-Muqayyid said: “The shell hit between us and our ambulances, about 20 meters away. I knew immediately that I was hurt. I felt it in my head, chest, abdomen and my leg, but I did not lose consciousness and continued to run. When I got to the ambulance, I could not breathe, but I managed to put on an oxygen mask. Around the area, there were journalists filming and also a radio journalist. They were also injured.” 
 

On July 12, between 1- 2 p.m., paramedic Jihad Salim responded to a call in al-Qarrara, northeast of Khan Yunis in the southern Gaza Strip, together with a volunteer and ambulance driver. Three ambulances, he said, arrived several minutes after what he understood to be a shell had exploded in an open area close to the local flour mill, reportedly causing casualties. The area where the ambulance stopped, on a dirt road a short distance from the main Salah al-Din road, was surrounded by IDF tanks on three sides, to the north, west and south, about 100 to 300 meters away. There were no militants firing in the area as he arrived, Salim said, and a group of children had gathered around the bodies of three casualties. Salim said that the casualties appeared to be around 17 years old, including one disabled boy, and that when he saw them they were not bearing any arms. (An Associated Press report on July 12 cited the Israeli army as saying that “troops opened fire on Palestinian gunmen planting explosives on a road used by the army to enter the central Gaza Strip,” killing four persons near the flour mill.) 
 
The first two ambulances loaded two of the three casualties without incident. Salim said that when his ambulance approached and he stepped down to load the last casualty, he came under gunfire. The crowd disbursed and there was no one else there, Salim said. He said that his dispatcher had made contact with the ICRC but had not yet received clearance to proceed. He said that he and his colleagues had taken precautions and checked the area beforehand, and that they would not have entered the area had they thought it unsafe. “When the bullets started flying, we quickly lay down and pressed ourselves on the ground. Bullets were dancing in the sand in front of me. We stayed like that for about 10 minutes. The firing came in slow bursts, every twenty seconds or so, from the west…. Six bullets hit the ambulance, but we remained unhurt. We stayed on the ground until the shooting lightened up, then went to the ambulance and left.” Muhammad Bardawil, the manager of the PRCS Gaza, showed Human Rights Watch an ambulance with bullet holes that he said was the one involved in this incident.