On 2 January 2017, a car bomb exploded in the eastern district of Sadr City, killing at least 39 people and wounding 61 others. The bombing was followed by another car bomb set off in the parking lot of the nearby al-Kindi Teaching hospital. Three civilians died in the second attack. The militant group Islamic State, also known as ISIS, claimed responsibility for the attacks in a statement distributed by ISIS-affiliated Amaq news outlet.

These attacks appear to have been carried out in a double-tap manner, “where one area is bombed and then a second bombing hits the paramedic response teams or the nearest hospital providing care.” The Syrian government is well known for its double-tap strikes on medical units in opposition-controlled neighborhoods. The Saudi-led coalition also resorted to double-tap attacks in Yemen, killing first responders. ISIS’ use of a double-tap tactic on 2 January is a violation of the principle of medical impartiality, which is defined as the international principle that no person or group shall interfere with the access to or delivery of medical services in times of conflict or political unrest. The attack, which is part of a widespread campaign to murder civilians, can constitute a crime against humanity.

Between 31 December 2016 and 8 January 2017, ISIS launched a series of eight suicide bomb attacks in Baghdad that have killed at least 100 people and injured more than 118. Similar suicide attacks have hit the city of Fallujah and Ain al-Tamer. According to the U.N., 926 civilians were killed and 930 wounded in November 2016 in Iraq in acts of terrorism, violence and armed conflict. Of those, 332 were killed and 114 injured in Ninewa, the governorate that includes Mosul. ISIS unlawfully used a functioning hospital in Mosul to fire heavy machine guns and rocket-propelled grenades at the Iraqi Security Forces, putting the lives of patients and medics in harm’s way. The U.S.-led coalition later bombed the hospital without giving an adequate warning.

Whether carried out by state or non-state actors or committed in the context of armed conflict or political unrest, attacks on health workers, services, and infrastructure violate medical impartiality. In times of conflict, these attacks may amount to war crime. The Iraqi government must ensure that those involved in the planning and execution of the car bomb attacks are brought to justice.