Lebanese healthcare workers and officials say Israeli bombings have deliberately targeted medical workers and facilities in south Lebanon, including through the use of double-tap strikes, in what they describe as a systematic effort to make the area unlivable.

Since the war began on 2 March, Israel has struck at least 128 medical facilities and ambulances across south Lebanon, killing 40 healthcare workers and wounding 107, according to the Lebanese ministry of health. The war started when Hezbollah launched rockets at Israel, triggering an Israeli military campaign.

Most of the strikes on medics happened while they were sitting in ambulances or at first aid centres, several of which have been destroyed in south Lebanon. Israel has also carried out at least five double-tap strikes, a tactic in which an initial strike is followed by a pause, allowing medical workers to arrive before the area is bombed for a second time.

Medical workers and hospitals are protected under international law and deliberately targeting them could constitute a war crime. Amnesty International said on Thursday that, regardless of political affiliation, medical workers are considered civilians and targeting them is unlawful.

The Guardian conducted interviews with nine medical workers, including eyewitnesses of Israeli strikes on three separate medical facilities, visited three destroyed medical centres in the Nabatieh and Tyre governorates and inspected two damaged ambulances. None of the sites showed evidence of military use.

The Israeli military accused Hezbollah of using ambulances for military purposes last week, saying it would “act in accordance with international law” if the practice continued. The Israeli army made the same accusation in 2024; it has not provided any evidence or proof for its claims. The Lebanese ministry of health condemned the accusation, calling it an attempt to provide justification for war crimes.

The Israeli military did not respond to a request for a comment on the specific strikes at the medical centres visited by the Guardian, nor on the allegations that it deliberately struck medical workers or employed double-tap strikes.

The vast majority of attacks have been against the Islamic Health Association (IHA), a health service affiliated with Hezbollah that works with the Lebanese ministry of health. Israeli strikes have also hit the state civil defence service, the Amal movement’s Islamic Scouts Association health service, a local healthcare charity and the Lebanese Red Cross.

According to medical workers in the region, the attacks were designed to make life “uninhabitable” in south Lebanon and should be viewed as part and parcel of other Israeli attacks on civilian infrastructure. During the last Hezbollah-Israel war in 2024, nearly 230 medical workers were killed by Israel in Lebanon.

“The Israeli enemy is trying as much as possible to prevent life in our region and push people to flee. Our role is to help people, to stand by them and to provide services so they can remain on their land,” said Abdullah Nour el-Din, the head of IHA emergency response south of the Litani River, while standing in front of a dozen destroyed ambulances.

He recounted how, unable to find accommodation in cities farther north, many displaced people had returned to their homes – despite being in an area the Israeli army ordered to be evacuated. Shortly after returning home, bombs hit their houses.

When first responders went to rescue the wounded, they too were struck.

Nour el-Din said: “We have seen what look like double-tap strikes – striking, waiting for paramedics, then striking again. In Seddiqin, they were putting out a blaze and were hit again. In Nabatieh, they were rescuing civilians when they were attacked.”

Healthcare workers also said they had noticed a pattern of Israeli strikes targeting healthcare facilities and ambulances when first responders gathered to break the Ramadan fast at sundown.

An Israeli airstrike hit an IHA emergency response centre on 8 March in the southern town of Zifta, completely destroying it, killing two employees and paralysing another. Hussein Moshawrab, the new head of the centre, recalled how he had FaceTimed with the staff there shortly before the strike, discussing what they were eating for dinner.

“I did a video call with them at iftar, because we can’t all gather due to the danger of being struck. The next time I saw them was when they were under the rubble,” Moshawrab said, recalling how he raced to arrive at the scene. The two-storey centre is now completely collapsed, the section of the roof where the employees were eating now on the ground. The building also hosted a municipal police station.

Paramedics said that because they may be targeted by Israeli strikes, they have begun taking precautions so that if they are killed, others do not die alongside them.

The number of people in each medical team has been reduced from three to two. First responders are not allowed to visit family or friends during working hours and must keep their distance from others. They sleep in ambulances parked far apart, so a single strike does not kill them all.

“We try not to behave unusually, not do anything out of the ordinary, and remain as conspicuous as possible to the drone above, so that it’s clear that you’re a medic and there’s no excuse to hit us,” said Ali Nasr al-Din, his eyes red-rimmed from lack of sleep. He had spent the night pulling out his colleagues from the rubble after Israel struck the civil defence centre he runs.

“You can take as many precautions as you want, but if in the end, the other party doesn’t care about ethics, it won’t matter,” he said. “Your mind starts to wonder: what if they categorised us as a target, what if they hit us? But you can’t think about that.”

Medical sectors are being attacked as hospitals in south Lebanon are facing a flood of wounded. In 17 days of fighting, more than 1,000 people have been killed and 2,584 wounded by Israeli strikes, the Lebanese health ministry said.

In the Nabih Berri governmental hospital in Nabatieh on Wednesday, a man screamed in pain as he was wheeled into the operating room. The smell of burning flesh filled the room as he passed. He was standing next to a petrol station when it was struck by Israel and most of his body was covered in burns.

Ali Tfyali, a 26-year-old cinema graduate, stood outside the operating room, shaking with each thud of an airstrike outside. His brother and sister had been killed by a strike on their home 90 minutes earlier while he stopped by the neighbours’ house to feed their livestock.

“It’s tougher this time. The bombing seems more vicious. We are getting less wounded people coming in, and more already dead,” said Dr Hassan Wazni, the head of the Nabatieh governmental hospital. A day earlier, two of his staff were injured as an airstrike hit the hospital perimeter, showering them with glass.

The pressure on first responders is immense. One paramedic, Nidal Jafal, was recording a video as he raced to an airstrike. He began to scream when he reached the collapsed house. “My mother and father are gone!” he cried out, realising it was his parents’ house that was struck.

“If you asked me before the war, will I return to work as a paramedic again, I would have said, ‘Hell, no’. We all would have,” said Ali Nasr al-Din. “But then the war started again and all of a sudden we found ourselves helping. What else can we do? This is our home.”