For the past week, one of Gaza’s biggest hospitals has been under Israeli attack. Now, Israel is planning to storm the building—claiming it is a Hamas headquarter. What happens next may prove to be a critical moment in the war for Israel. Here’s a quick guide to the battle over Al-Shifa.
Editor’s note: For more context on the Israel-Palestine war, check out our two-part series on the Hamas attack on Israel: part one lays out the Hamas offensive and failures of Israeli intelligence; part two explains the big picture—and Hamas’ motive driving what seems like a suicidal attack. Also read: our Big Story on the ground offensive by Israel, which will decide the fate of Gaza and the power balance in the Middle East. We look at the larger geopolitical picture in the region in this Big Story.
First, the death toll
11,320 people have been killed in Gaza—of them 4,650 are children and 3,145 are women. This powerful interactive feature from the Washington Post shows that 0.5% of Gaza’s total population have been killed since October 7. One in 200 residents of the strip. What we appreciated: The Post gives many of the victims faces and names—so they are not reduced to body count.
Ok, tell me about Al-Shifa…
The hospital: It is one of the biggest hospitals in Gaza. Located in the north, the Dar al-Shifa (House of Healing) hospital is a sprawling complex—made up of a group of six-storey buildings. It houses between 600 and 900 beds, and thousands of staff. And it offers a range of services—such as facilities for premature babies, oncology etc—that few other hospitals in Gaza offer. Most importantly, thousands of Gazans have taken shelter in Al-Shifa and other hospitals—to save themselves from the Israeli airstrikes.
The map below shows you where Al-Shifa and the other major hospitals are located:
Point to note: Over the past weeks, the Israeli Defence Forces has issued multiple warnings to the hospitals in north Gaza—telling them to evacuate or face the risk of becoming collateral damage. But doctors have refused—pointing out that it will be very difficult to evacuate the patients—many of whom may die while being relocated.
The numbers: There are 650 patients and 5,000-7,000 other civilians trapped inside the hospital grounds at Al-Shifa. These include a number of premature babies that have been taken off the incubator due to lack of fuel. According to Gaza authorities, 40 patients have died over the past couple of days—including three babies.
You can see a satellite image of the hospital below:
Also notable: The hospital is extremely low on fuel—and relies on one generator. On Monday, Israel destroyed its remaining energy supply. According to Al Jazeera:
On Monday, it was reported that Israeli forces had again targeted the hospital, this time hitting a solar panel system that provided electricity to its main departments. With barely any fuel left in its tanks to keep its one generator running, it’s now only a matter of time before the hospital is forced to switch off vital equipment like ventilators and dialysis machines, leaving patients to die.
And why is it being targeted?
Israel claims that Al-Shifa sits on top of an extensive network of tunnels—which houses Hamas’ headquarters in Gaza:
The military spokesperson said Israel has “concrete evidence” that “hundreds of terrorists flooded into the hospital to hide” following the October 7 massacre… The hospital’s energy infrastructure is also used by Hamas’s underground base, Hagari said, accusing the terror group of using the hospital and its occupants — with 1,500 beds and some 4,000 staff — as human shields.
It is therefore a legitimate military target, according to the IDF. It has provided visual evidence and intercepted audio to back up its claim. See one of the clips below:
White House confirmation: US officials say their intelligence confirms Israel’s claims:
"We have information that confirms that Hamas is using that particular hospital for a command and control mode [and probably to store weapons]. That is a war crime."
But, but, but: Washington also does not want to be seen as greenlighting any attack on the hospital. In the same press conference, National Security Council spokesman John Kirby said:
To be clear, we do not support striking a hospital from the air. We do not want to see a firefight in a hospital where innocent people, helpless people, sick people are simply trying to get the medical care they deserve… We have been clear on multiple occasions - Hamas actions do not lessen Israel's responsibilities to protect civilians in Gaza, and this is something we're going to continue to have an active conversation with our counterparts about.
It is typical of the diplomatic tightrope the US has tried to tread—both backing up its closest ally and making sure it isn’t blamed for Israeli excesses.
Point to note: There is some independent confirmation that Al-Shifa has been used for Hamas’ purposes in the past:
This is not the first time that Hamas has been linked with Al Shifa. Amnesty International accused the militant group of abductions and the unlawful killings of Palestinians in 2014, some of whom were “interrogated and tortured or otherwise ill-treated in a disused outpatient’s clinic“ within the hospital grounds.
What the hospital says: Hamas health ministry has, of course, strongly denied Tel Aviv’s claims—as have the hospital staff. And independent experts say there is simply not enough evidence for them. The New York Times was not able to verify the photographs provided to it by the IDF:
Senior Israeli intelligence officials allowed The Times to review photographs that purported to show secret entrances to the compound from inside the hospital. Signs identifying the location as Al Shifa were clearly visible in the photographs, though their authenticity could not be independently verified.
The lack of independent verification: The problem is that Israel has not allowed anyone close to the hospital. Red Cross vans have not been able to enter north Gaza—and all humanitarian aid has been blocked. As one military expert says:
It is very, very hard to verify much of the narrative that the Israelis want to present when they don't allow independent journalists into Gaza to actually give first-hand witness accounts about what is actually happening on the ground. Unless both sides are prepared to let independent observers to go in and verify the claims of each other then all we have is narratives and counter-narratives.
What does the international law say about hospitals?
Hospitals receive special protection under the law—but can lose it if they are used as a military base to hide fighters or store weapons. Even so, the hospital must receive plenty of advance warning. But the burden of proof lies on Israel—and the bar is high, according to International Criminal Court prosecutor Karim Khan:
If there is a doubt that a civilian object has lost its protective status, the attacker must assume that it is protected. The burden of demonstrating that this protective status is lost rests with those who fire the gun, the missile, or the rocket in question.
The definition of ‘evidence’: The problem is that it is very hard to verify evidence when both sides are engaged in a propaganda war, as well. Example: IDF released videos that show an alleged Hamas hideout inside the basement of a paediatric hospital—Rantissi Hospital. The clip below claims to show an armoury of weapons and evidence that hostages were held there. The soldier also points to a list in Arabic assigning guard duty to Hamas members:
But a prominent human rights expert says “the ONLY thing on that ‘list’ is literally the days of the week (Saturday-Friday)”—and the weapons can just as easily be planted—as there are documented instances of Israelis having done so before. There are no certainties in the fog of war.
Ok, so what’s happening now?
The Israelis entered the hospital this morning—as part of what the military calls a “precise and targeted operation against Hamas in a specified area.” It has urged all members of Hamas to surrender. The IDF has also taken great pains to show that it is not targeting patients:
In the statement, the Israeli military said that the aim of the raid was not to harm civilians, and the force that went into the hospital included medical teams and Arabic speakers. “Israel is at war with Hamas, not with the civilians in Gaza,” the announcement said. Rear Adm. Daniel Hagari, the spokesman for the Israeli military, said on social media that the military would transfer incubators, medical equipment and baby food to the hospital. He claimed that, before the raid, Israel had tried to evacuate the hospital’s patients and the people who had taken shelter there, creating a safe route for them to leave.
OTOH, the Hamas health ministry says, “We hold Israel’s raiding forces fully responsible for the lives of medical staff, patients and displaced people in Gaza Al Shifa hospital.”
Point to note: The IDF has claimed that it made great efforts to help the doctors and patients in Al-Shifa—but they were forced by Hamas to reject their assistance. This too has become a he said/he said situation—with doctors directly contradicting the Israelis:
But Mokhallalati told ABC News on Monday that they had not received a serious offer from the Israelis, saying: "We were not offered proper evacuation for the kids and no proper petrol." The IDF said over the weekend it had provided 300 litres of fuel for Al-Shifa Hospital but, according to Mokhallalati, the staff calculated it was not worth the risk of retrieving this fuel, which he said the Israelis had left 1 kilometre away from the gates… "We feel it would be unsafe to get these 300 litres," Mokhallalati said, adding: "They are nothing, because Shifa consumes 10,000 litres of fuel a day, so this is a stupid number ... it won't be enough for more than an hour."
The bottomline: What happens inside the hospital carries great risks and rewards for Tel Aviv. If the IDF can definitively prove the presence of Hamas—it will have free rein to target any civilian target for the rest of the war.
But, but, but: "One wrong move or one video from Hamas showing Israeli soldiers shooting inside the hospital would be very damaging.” Even if there is no such video, and all the troops find is a humanitarian nightmare, it will be a significant setback to Israel in the eyes of the world. Wars are not just fought on the battlefield.
Reading list
The Guardian and Al Jazeera are best on Al-Shifa—and why the battle over it matters. The New York Times and Times of Israel lay out the Israeli claims about the hospital being a Hamas base at great length. Reuters has the most details on the US position on Al-Shifa. France24 looks at the evidence offered by both sides—while PBS has more on international law. ABC News reports on the competing claims over IDF’s efforts to help Al-Shifa. In related news, Washington Post and Reuters have more on a possible hostages-for-aid deal. Also in Reuters: Jordan’s strong stance against a possible Israeli occupation of Gaza.
