Al-Shifa Hospital, the largest medical complex in Gaza, was placed under siege by Israel in mid-November 2023 during the Gaza war, after saying it had contained a Hamas command and control center beneath it. The incident was followed by a second major raid by Israeli forces in March 2024.
On 11 November, the hospital was completely encircled, cutting it off from the rest of Gaza City. According to Gazan health officials, the hospital contained 1,500 patients, 1,500 medical workers and around 15,000 displaced people who were seeking shelter in the hospital. Both Israel and the United States have said that Hamas maintained command centers or command "nodes" below the hospital. Both the hospital's administration and Hamas denied that, with the former asking the international community to send security experts to verify the Israeli allegations. There were over 100 dead bodies placed in the courtyard and later buried by medical staff in a mass grave due to the siege. On 15 November, Israeli forces said they entered the hospital after killing militants outside, and that they had discovered a Hamas command centre, weaponry, and tactical gear.
After a media tour, The Guardian and CNN reported that the Israeli army had rearranged or doubled weapons for the tour and that an Israeli video showing the discoveries had been edited. NBC News said that Israel released several pieces of inaccurate or disputed information, which weakened Israel's credibility. Al Jazeera said that "many experts" accused Israel of fabricating evidence. On 22 November, Israel published video showing multiple tunnels beneath the hospital; The Wall Street Journal and The Guardian reported that this fell short of the original command center claims. Israel published surveillance footage taken by the hospital's cameras, appearing to show two hostages being taken into the hospital. The Guardian reported that Hamas had previously publicized taking hostages to receive medical treatment. On 21 December, The Washington Post published analysis concluding that the hospital buildings in question were not actually connected to the tunnels. On 2 January 2024, the United States released newly declassified documents showing that its spy agencies continued to express confidence that the hospital had been used as a command and control centre while providing no visual evidence, and the following day Israel announced that it had dismantled a tunnel beneath the hospital. News reports the next day said that both Israeli and US statements are not considered as conclusive proof of Hamas use of al-Shifa.
The raid on the hospital and Israel's limited findings of military infrastructure led to international criticism, including by UN High Commissioner for Human Rights Volker Türk who called for an independent investigation. International law prohibits the targeting of hospitals unless they are being used for a military purpose that is "harmful to the enemy", though the attacking force has to give civilians the chance to evacuate and there are strict rules of proportionality as to how force can be used. The use of hospital staff or patients as human shields is also prohibited. Jeremy Scahill accused Israel of waging a propaganda war to detract from accusations that its actions at al-Shifa constitute violations of international law. Medical staff at al-Shifa have accused Israel of directly causing the deaths of civilians being treated at al-Shifa, including prematurely born babies. The head of the World Health Organization said, "hospitals are not battlegrounds," and that Israel's action was "totally unacceptable." On 18 March 2024, Israeli forces conducted an overnight raid on Al-Shifa hospital following claims that senior Hamas officials had regrouped and were using the hospital "to command attacks". After a two-week siege that ended on 1 April 2024, the Al-Shifa hospital was mostly destroyed, and hundreds of dead Palestinians were found in and around the hospital, including in mass graves.
Background
Since 2007, the Gaza Strip has been under blockade by Israel and Egypt. On 7 October 2023, Hamas attacked Israeli civilian communities and military bases, killing around 1,200 Israelis, the majority of whom were civilians, and taking about 250 hostages into Gaza. Israel conducted a counterattack. Israel also imposed a total blockade on Gaza, invaded the Gaza Strip on 27 October, and surrounded Gaza City on 2 November.
Al-Shifa is the largest hospital in the Gaza Strip; it was originally a British army barracks but was converted into a hospital in 1946.
Hamas's presence in the hospital during the 2014 Gaza War is disputed. Israel has stated that the hospital was a Hamas control and command centre, and The Washington Post reported it had "become a de facto headquarters for Hamas leaders, who can be seen in the hallways and offices." By contrast, doctors Erik Fosse and Mads Gilbert, who were working at the hospital, stated that they did not see any evidence of military activity at the hospital during the war. Professor Sara Roy stated that military use of the hospital was "highly improbable". Amnesty International reported in 2015 that Hamas had used abandoned areas of the hospital to "detain, interrogate, torture and otherwise ill-treat suspects" while the hospital was operational.
The Israeli military had ordered all civilians in the region to evacuate on 13 October. The IDF reported that Hamas was preventing the evacuation of civilians from the area and particularly from Al Shifa hospital, with the IDF stating that Hamas was using civilians as human shields.
The IDF again requested all civilians in Northern Gaza and specifically Al-Shifa hospital to evacuate on 9 November. Thousands of displaced civilians were sheltering in the hospital at the time of the attacks on 11 November.
Legal status
Under the laws of war, hospitals normally enjoy protected status, making it forbidden to turn them into a conflict zone. That status is lost if there is evidence that the hospital is being used to make an "effective contribution to military action"; examples provided by Israel in its 2006 Rules of Warfare manual where a protected civilian structure loses its status include an anti-aircraft battery on the roof of a school, or a sniper in a mosque. According to the International Committee of the Red Cross (ICRC), this rule "has few exceptions". The exceptions include "carrying or using of individual light weapon in self-defense or defense of wounded and sick; armed guarding of a medical facility; or the presence in a medical facility of sick or wounded combatants no longer taking part in hostilities", which do not negate protected status as a medical facility.
According to Israel and the United States, conclusive evidence exists that Hamas used the building for military purposes; Hamas denies this. According to the ICRC, if there is doubt about whether a hospital is being used for military purposes, it should be presumed not to be being used militarily.
It does not negate protected status if a hospital has "small arms and ammunition taken from the wounded and sick and not yet handed to the proper service", and there is also a narrow exception for the use of small firearms by medical facilities in war zones if "they use the arms in their own defence, or in that of the wounded and sick in their charge".
Even if there is strong evidence of military activity at the hospital that substantially exceeds these exemptions, strict rules that limit how force can be used still apply; civilians must be given the chance to evacuate, and civilians who remain in the building are still protected and cannot be targeted directly. Prior to the raid, Israel called for the evacuation of the hospital, but on 13 November doctors refused to do so, saying that they had to remain in order to tend to over 700 at risk patients. According to Hamas, civilians were unable to evacuate due to sniper fire and drone attacks.
Initial clashes and siege
On 3 November, an Israeli airstrike targeted an ambulance convoy leaving the hospital. The attack killed 15 and wounded 60. Israel stated that Hamas was using the ambulances. Neither the Washington Post nor the Human Rights Watch found any evidence to support the Israeli statements. The Palestine Red Crescent Society (PRCS) stated that Israel had targeted Al-Shifa ambulances 7 times prior and had killed 4 of their personnel. On 6 November, Israeli forces struck and destroyed the solar panels atop the hospital, leaving it fully reliant on back-up generators powered by rapidly dwindling fuel supplies.
On 10 November, at least four strikes hit various areas of the hospital with various projectiles. Israel stated that at least one projectile was a misfired militant rocket, but did not elaborate further. The Gaza Health Ministry (GHM) stated that there were at least four strikes damaging parts of the hospital complex—two, at 2 and 8 am., hitting the maternity ward located on the upper floors— stating that 14 people had been killed. Later a Palestinian doctor stated that 7 people had died following the strikes. The next day, it was reported that Israeli forces were at the gates of the hospital. According to a follow-up investigation commissioned by the New York Times from experts who examined videos and remnants of the munitions, three of the projectiles fired at the hospital were Israeli.
On 11 November, the GHM stated that an evacuation was underway, that 50,000–60,000 people were sheltering in the hospital before, and that fewer than 3,000 people remained. Later that day, the PRCS stated that Israeli tanks were 20 meters away from the hospital. Doctors Without Borders (DWB) and the World Health Organization (WHO) stated that Israeli troops were shooting at those trying to exit the hospital, which Israel denied. Israel stated that they were letting people leave the hospital, which DWB denied. By this time, Al-Shifa ran out of fuel and had suspended some operations. As a result, 2 babies in incubators and two other patients died. The hospital director said that the hospital had electricity until the morning of 12 November, meaning that 37 babies in incubators are at risk of dying.
In a series of comments with The New Arab, Muhammad Abu Salmiya, the director of the hospital, said that the hospital was cut off from the rest of the city, trapping a reported 15,000 people inside. He also added that "patients were dying by the minute, victims and wounded were also dying, even babies in incubators."
The Israeli military denied it had placed the Al-Shifa hospital under siege, stating that there wasn't any shooting or siege, and that the east side remained open. On the same day, the WHO reported that it had lost contact with the hospital. The hospital director said that premature babies were in a 'precarious situation' and that they were transferred to an 'unhealthy location'. At this time, power was completely cut off in the hospital. Minister of Health Mai Al-Kalia stated that over 100 bodies were in the courtyard and that the medical teams were unable to make a mass grave in the courtyard due to the 'seriousness of the field situation.' She also added that 39 babies were at risk of death and that one baby died that morning due to lack of fuel. Stray dogs had also begun to "snap" and eat the corpses. Doctors in Al-Shifa Hospital reported snipers at the outskirts of the complex were firing at "any moving person".
A Hamas health official reported to Agence France-Presse that the cardiac ward was struck by Israeli air strikes, which was confirmed by witnesses but not by AFP.
On 12 November, Israel attempted to provide 300 litres of fuel to the hospital, which they say was blocked by Hamas. In response, a spokesperson for the health ministry stated that Al-Shifa needed 8000-12000 litres of fuel to run for a day, and that 300 litres would keep the hospital running for half an hour. Additionally, hospital staff noted there was no way to receive this fuel, as no ambulances were arriving at Al-Shifa and risk getting caught in crossfire, urging that the only way to safely access the fuel was with a pause in fighting.
On 13 November, about 50 people tried to evacuate from the hospital, but they said that Israeli forces fired at them, wounding one man.
On 14 November, a Gaza health official said that medical staff had buried 179 dead patients in a mass grave in the hospital's courtyard as the bodies had begun to decompose after the hospital's mortuary lost electricity. A witness reported "wild dogs" had been eating the unburied dead bodies.
15 November raid
Just after midnight on 15 November, Israeli forces informed officials that they would shortly be raiding the hospital. Hospital staff reported sounds of clashes from outside the grounds, and Israel reported killing several Hamas militants outside of the grounds.
Following the raid, Israel stated that they had delivered supplies to the hospital, including medical supplies and baby food, and would provide battery-powered incubators to assist in transferring babies. There was no confirmation from Reuters regarding the incubators, and NBC was "unable to verify when the incubators might be delivered or how the Israeli army would get them to Al-Shifa amid the violence in the area". The IDF released a photo of a soldier standing beside boxes labelled as medical supplies and baby food and Reuters confirmed that the location was inside Al Shifa. Reuters reported the IDF said that three battery powered incubators were on standby outside Gaza. The IDF released a video showing them depositing at the front gate of al-Shifa 300 litres of fuel and a photo of a soldier loading mobile incubators. Israel also reported finding weapons and other "terror infrastructure" within the hospital; "concrete evidence", they said, of Hamas using the hospital as a "terror headquarter". According to the BBC, an Israeli official said that Israel had found weapons and terror infrastructure but did not immediately provide evidence.
According to a journalist inside the hospital, Israel was interrogating people within the hospital on Wednesday morning, including doctors and patients. According to a witness, Israeli forces fired a smoke bomb into the hospital that "caused people to suffocate", while a spokesperson for the Gaza Health Ministry said "The occupation army is now in the basement and searching the basement. They are inside the complex, shooting and carrying out bombings." Munir al-Bursh, the general director of Gaza hospitals, told Al Jazeera, "Patients, women and children are terrified."
16 and 17 November
Netanyahu stated in an interview with CBS that the Israeli government had "strong indications" that hostages were in al-Shifa, which was one of the reasons they entered the hospital, adding that "I think the less I say about it, the better." On 16 November, the IDF reported that the body of Yehudit Weiss, a 65-year-old woman who was captured from Be'eri kibbutz, had been located in a structure nearby to the hospital. On 17 November, the IDF had discovered the body of 19-year-old Cpl Noa Marciano in a building next to the hospital.
Evacuation
On 19 November, the World Health Organization evacuated 31 premature babies while more than 250 critically ill or wounded patients remain trapped at the hospital. Doctors Without Borders said Israeli forces had on 18 November fired "deliberately" on a clearly marked convoy carrying 140 of the organization's employees and family members. More than 2,500 people were also evacuated.
Alleged military use
There have been allegations that Hamas has been using the Al-Shifa Hospital for military purposes. Izzat al-Risheq, a Hamas official, denied allegations that the group was using Shifa Hospital as a shield for its underground military structures, saying there was no truth to the statements.