SPECIAL REPORT: The Humanitarian Cost of the US/Israel–Iran War
By MUKHTAR Ya’u Madobi,
Barely less than two weeks after the outbreak of direct military confrontation between the US, Israel and the Islamic Republic of Iran, the Middle East is witnessing one of the most dangerous escalations in recent geopolitical history.
What began as coordinated US/Israeli airstrikes on Iranian strategic and military infrastructure has rapidly evolved into a cycle of retaliatory attacks involving ballistic missiles, drone strikes and aerial bombardments across multiple locations in the region.
The conflict reportedly intensified after a series of coordinated strikes across Iran cities, an operation that Iranian authorities say resulted in the killing of Iran’s Supreme Leader, Ayatollah Ali Khamenei, alongside other senior members of Islamic Revolutionary Guard Corps (IRGC) and civilians.
Against this backdrop, Tehran responded with a wave of retaliatory missile attacks directed at Israeli cities including Tel Aviv and Haifa, while also launching strikes on U.S. military installations across Gulf states such as Jordan, Bahrain, Saudi Arabia, Qatar, the United Arab Emirates, and Oman.
While strategic and geopolitical considerations continue to dominate diplomatic debates, the humanitarian implications of the war are becoming increasingly severe. Civilian casualties are rising, vital infrastructure is being destroyed, and large populations are fleeing urban centers in search of safety.
From the early days of the confrontation, Iranian cities have borne the brunt of sustained aerial bombardments. According to report by Aljazeera, at least 1,332 civilians have been killed, while thousands more have been injured since the strikes began over the past week. Also, schools, hospitals and other infrastructure reportedly hit. More than 200 people have been killed in Lebanon. Subsequently, 11 have been killed in Israel, and six (06) US soldiers have also died. Other people have either been killed or injured across Middle East States.
One of the most disturbing incidents occurred in Minab, southern Iran, where a missile reportedly struck a girls’ primary school, killing approximately 180 civilians and injuring nearly 100 others. Many of the victims were believed to be students. The attack has drawn strong condemnation from humanitarian organizations and global observers because schools are explicitly protected under international humanitarian law.
Another critical institutions targeted is the Gandhi Hospital in Tehran, where a missile strike destroyed parts of the hospital’s in-vitro fertilization department. Commenting on the incident, the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, described the destruction of health facilities as “extremely worrying,” emphasizing that hospitals and medical infrastructure are protected under international humanitarian law.
Nevertheless, the humanitarian toll of the conflict is not confined to Iran alone. Iranian retaliatory missile strikes targeting Israeli cities such as Tel Aviv and Haifa have resulted in civilian casualties and damage to residential areas, despite Israel’s sophisticated missile defense systems intercepting many of the incoming projectiles.
As the exchange of strikes intensifies, displacement has emerged as one of the most immediate humanitarian consequences of the conflict. According to the United Nations High Commissioner for Refugees (UNHCR), approximately 100,000 residents fled Tehran within the first 48 hours of the attacks. Reports indicate that between 1,000 and 2,000 vehicles were leaving the capital daily, with most civilians heading toward northern provinces considered relatively safer.
Humanitarian agencies warn that if hostilities continue at their current pace, the number of internally displaced persons in Iran could rise dramatically. Major cities such as Tehran, Urmia, and others remain vulnerable to further strikes, raising fears that millions of civilians could eventually be forced to relocate within the country.
Across the wider region, the United Nations estimates that over 330,000 people have already been displaced due to the current escalation affecting Iran, Israel, Lebanon and neighboring states.
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Similarly, Israel is also experiencing localized displacement. Residents in missile-targeted areas around Tel Aviv, Haifa, and surrounding urban zones have temporarily relocated or taken refuge in government-designated shelters and fortified safe rooms. Although the scale of displacement in Israel is smaller compared to Iran, the psychological impact of sustained missile alerts and civilian insecurity is becoming increasingly evident.
Compounding the humanitarian crisis is the widening geographic scope of the conflict. Iranian retaliatory strikes on U.S. military bases across Gulf States have heightened regional tensions and exposed civilian populations to secondary risks associated with missile interceptions and aerial warfare.
Moreover, attacks on oil facilities, ports and strategic infrastructure across the Gulf region threaten essential services such as electricity generation, water desalination and fuel supply.
The economic implications of these disruptions could be significant. The Gulf region hosts millions of migrant workers who depend heavily on stable economic conditions for their livelihoods. Any prolonged disruption to oil production, maritime trade or energy infrastructure could trigger widespread economic hardship, including job losses and inflationary pressures affecting civilian populations across the region.
Equally concerning is the growing pressure on healthcare systems. Hospitals in affected areas may be facing shortages of medicines, medical equipment and electricity supply. Damage to healthcare facilities not only reduces immediate treatment capacity but also threatens long-term healthcare services for vulnerable populations.
The unfolding humanitarian crisis has also revived international debate about the legal conduct of warfare. Under Geneva Conventions and their Additional Protocols, parties engaged in armed conflict are obligated to protect civilians and civilian infrastructure. The principle of distinction requires combatants to differentiate between military targets and civilian populations, while the principle of proportionality prohibits attacks in which expected civilian harm would be excessive relative to the anticipated military advantage.
Furthermore, the targeting of hospitals, schools, religious institutions and humanitarian facilities is strictly prohibited unless such locations are being used for military purposes. These protections are reinforced under the Rome Statute of the International Criminal Court, which recognizes deliberate attacks on civilians and civilian infrastructure as potential war crimes.
Beyond the immediate humanitarian suffering, the broader socio-economic consequences of the conflict are also becoming increasingly visible. Disruptions to air travel, maritime shipping and regional trade are affecting economic stability across the Middle East. Perhaps more significantly, the escalating confrontation threatens the security of the Strait of Hormuz, through which about 20% of the world’s oil supply passes.
Nonetheless, any sustained disruption to this vital maritime corridor could trigger global economic repercussions, including rising fuel prices and inflationary pressures across international markets.
For civilians living in cities from Tehran to Tel Aviv, however, the most immediate concern remains survival amid escalating hostilities. Families are abandoning homes, children are experiencing the trauma of airstrikes and displacement, and communities that once functioned as vibrant urban centers are rapidly transforming into zones of uncertainty and fear.
Against this backdrop, humanitarian organizations and international diplomatic actors are intensifying calls for immediate de-escalation and renewed diplomatic engagement. Protecting civilian populations remains a central obligation under international humanitarian law, regardless of the political or military objectives pursued by any party to the conflict.
Ultimately, the longer this confrontation continues, the greater the risk that the humanitarian crisis will deepen and spread across the region.
Without urgent diplomacy, the military confrontation could escalate into a prolonged regional conflict, leaving millions of civilians suffering alongside widespread destruction and deepening geopolitical tensions.
MUKHTAR Ya’u Madobi is a Research Fellow at the Centre for Crisis Communication. He writes via [email protected].
