Battles between Israel and Hamas around hospitals forced thousands of Palestinians to flee from some of the last perceived safe places in northern Gaza, stranding critically wounded patients, newborns and their caregivers with dwindling supplies and no electricity, health officials said Monday. Gaza’s Shifa Hospital has become the focus of a days-long stalemate in Israel’s war against the Hamas militant group. Shifa is Gaza’s largest and best-equipped hospital. But Israel claims the facility also is used by Hamas for military purposes. It says Hamas has built a vast underground command complex center below the hospital, connected by tunnels. Since Israel declared war against Hamas in response to a bloody cross-border attack by the Islamic group on Oct. 7, its forces have moved in on Shifa. While Israel says it is willing to allow staff and patients to evacuate, Palestinians say Israeli forces have fired at evacuees and that it is too dangerous to move the most vulnerable patients. Meanwhile, doctors say the facility has run out of fuel and that patients are beginning to die.
Here is a closer look at the Shifa standoff.
Quick Read
- Fleeing Civilians in Gaza: Thousands of Palestinians have fled hospitals in northern Gaza, previously seen as safe havens, due to battles between Israel and Hamas.
- Israeli Forces in Gaza City: Israeli forces are currently fighting in central Gaza City, with Shifa hospital encircled, leading to thousands of civilian deaths.
- Hamas’ Use of Hospitals: Israel accuses Hamas of using hospitals for military purposes, claiming to find weapons in a children’s hospital and alleging a command center beneath Shifa hospital.
- Conditions at Shifa Hospital: With no electricity or water, Shifa hospital is struggling to function, leading to deaths of patients including newborns.
- International Law on Hospitals: Hospitals enjoy special protections in war, but can lose these if used for military purposes. The law requires warning and proportionality in attacks.
- Fuel Shortage at Shifa: The hospital’s emergency generator ran out of fuel, endangering patients. Israel claims to have provided fuel, which Hamas allegedly blocked.
- US Push for Temporary Pauses: The U.S. has advocated for pauses in hostilities to allow aid distribution, but Israel has limited this to evacuation windows.
- Civilian Toll in Gaza: Over 11,000 Palestinians, primarily women and minors, have been killed since the conflict began. The toll includes around 2,700 missing people.
- Israeli Casualties and Hostages: On the Israeli side, there have been 1,200 deaths, mostly civilians, and nearly 240 hostages are held by Palestinian militants.
- Displacement and Rocket Attacks: Around 250,000 Israelis have evacuated from areas near Gaza and the northern border due to ongoing rocket attacks and exchanges with Hezbollah.
- Shifa Hospital’s Importance: Shifa is Gaza’s primary hospital, offering vital services. It has been overwhelmed by the conflict, with thousands seeking shelter there.
- Shifa Hospital’s Current State: The hospital is facing a crisis, with no fuel, leading to the deaths of patients, including infants. It is struggling to provide basic care amid the war.
- International Law and Hospitals: Hospitals are protected under international law during conflicts but can lose this protection if used for military purposes. However, any attack must be proportional and give warning.
- Israel Accuses Hamas of Using Hospitals: Israel alleges Hamas is using hospitals like Shifa for military purposes, with claims of weapons caches and command centers. However, concrete evidence has been limited.
- Evidence of Hamas Activities: Israel presented footage and testimonies suggesting militant activities in hospitals, but these have been difficult to verify and lack concrete proof.
- Hamas Denies Allegations: Hamas refutes Israel’s claims of using hospitals for military purposes, stating it goes against their principles.
- Dilemma of Fuel Delivery to Shifa: Israel’s offer to deliver fuel to Shifa was complicated by logistics and insufficient quantities, with accusations of Hamas interference.
- U.S. President’s Stance: President Joe Biden emphasized the need to protect Shifa Hospital and called for less intrusive actions by Israeli forces.
- Israeli Military Strategy: Israel asserts it aims to dismantle Hamas’ infrastructure in hospitals without taking control, but the approach remains uncertain.
The Associated Press has the story:
Israel says Hamas is using Gaza’s Shifa hospital for cover. Hundreds of people are trapped inside
Newslooks- KHAN YOUNIS, Gaza Strip (AP)
Battles between Israel and Hamas around hospitals forced thousands of Palestinians to flee from some of the last perceived safe places in northern Gaza, stranding critically wounded patients, newborns and their caregivers with dwindling supplies and no electricity, health officials said Monday.
With Israeli forces fighting in the center of Gaza City, the territory’s main city, both sides have seized on the plight of hospitals as a symbol of the larger war, now in its sixth week. The fighting was triggered by Hamas’ Oct. 7 surprise attack into Israel, whose response has led to thousands of deaths — and much destruction — across Gaza.
Israel accuses Hamas of using hospitals as cover for its fighters. On Monday, the military released footage of a children’s hospital that its forces moved into over the weekend, showing weapons it said it found inside, as well as rooms in the basement where it believes the militants were holding some of the around 240 hostages they abducted during the initial attack.
“Hamas uses hospitals as an instrument of war,” said Rear Adm. Daniel Hagari, the army’s chief spokesman, standing in a room of the Rantisi Children’s Hospital decorated with a colorful children’s drawing of a tree, with explosive vests, grenades and RPGs displayed on the floor.
Meanwhile, gunfire and explosions raged Monday around Gaza City’s main hospital, Shifa, which has been encircled by Israeli troops for days. Tens of thousands of people have fled the hospital in the past few days and headed to the southern Gaza Strip, including large numbers of displaced people who had taken shelter there, as well as patients who could move.
For Palestinians, Shifa evokes the suffering of civilians. For weeks, staff running low on supplies have performed surgery there on war-wounded patients, including children, without anesthesia. After the weekend’s mass exodus, about 650 patients and 500 staff remain in the hospital, which can no longer function, along with around 2,500 displaced Palestinians sheltering inside with little food or water.
After power for Shifa’s incubators went out days ago, the Health Ministry in Hamas-ruled Gaza on Monday released a photo it says shows about a dozen premature babies wrapped in blankets together on a bed to keep them at a proper temperature. Otherwise, “they immediately die,” said the Health Ministry’s director general, Medhat Abbas, who added that four of the babies had been delivered by cesarean section after their mothers died.
The Israeli military says Hamas has set up its main command center in and beneath the Shifa compound, though it has provided little evidence. Both Hamas and Shifa hospital staff deny the Israeli allegations.
U.S. President Joe Biden said Monday that Shifa “must be protected.”
“It is my hope and expectation that there will be less intrusive action,” Biden said in the Oval Office.
International law gives hospitals special protections during war. But hospitals can lose those protections if combatants use them to hide fighters or store weapons, according to the International Committee of the Red Cross.
Still, there must be plenty of warning to allow evacuation of staff and patients, and if harm to civilians from an attack is disproportionate to the military objective, it is illegal under international law. In an editorial published Friday in Britain’s The Guardian newspaper, International Criminal Court prosecutor Karim Khan said the attacker must meet a high burden of proof to show that a hospital has lost its protections.
The Red Cross was attempting Monday to evacuate some 6,000 patients, staff and displaced people from another hospital, Al-Quds, after it shut down for lack of fuel, but the Red Cross said its convoy had to turn back because of shelling and fighting. On Monday, Israel released a video showing what it said was a militant with a rocket-propelled grenade launcher entering Al-Quds hospital. An Israeli tank was stationed nearby.
At Shifa Hospital, the Health Ministry said 32 patients, including three babies, have died since its emergency generator ran out of fuel Saturday. It said 36 babies, as well as other patients, are at risk of dying because life-saving equipment cannot function.
Goudat Samy al-Madhoun, a health care worker, said he was among around 50 patients, staff and displaced people who made it out of Shifa and to the south Monday, including a woman who had been receiving kidney dialysis. He said those remaining in the hospital were mainly eating dates.
Al-Madhoun said Israeli forces fired on the group several times, wounding one man who had to be left behind. The dialysis patient’s son was detained at an Israeli checkpoint on the road south, he said.
The military said it placed 300 liters (79 gallons) of fuel several blocks from Shifa, but Hamas militants prevented staff from reaching it. The Health Ministry disputed that, saying Israel refused its request that the Red Crescent bring them the fuel rather than staff venturing out for it. The fuel would have provided less than an hour of electricity, it said.
The U.S. has pushed for temporary pauses to allow wider distribution of badly needed aid. Israel has agreed only to daily windows during which civilians can flee northern Gaza along two main roads. It continues to strike what it says are militant targets across the territory, often killing women and children.
The Israeli military has urged Palestinians to flee south on foot through what it calls safe corridors. But its stated goal of separating civilians from Hamas militants has come at a heavy cost: More than two-thirds of Gaza’s 2.3 million people have fled their homes.
Those who make it south face a host of other difficulties. U.N.-run shelters are overflowing, and the lack of fuel has paralyzed water treatment systems, leaving taps dry and sending sewage into the streets. Israel has barred the import of fuel for generators.
As of last Friday, more than 11,000 Palestinians, two-thirds of them women and minors, have been killed since the war began, according to the Health Ministry in Gaza, which does not differentiate between civilian and militant deaths. About 2,700 people have been reported missing.
Health officials have not updated the toll, citing the difficulty of collecting information.
At least 1,200 people have died on the Israeli side, mostly civilians killed in the initial Hamas attack. Palestinian militants are holding nearly 240 hostages seized in the raid, including men, women, children and older adults. The military says 44 soldiers have been killed in ground operations in Gaza.
About 250,000 Israelis have evacuated from communities near Gaza, where Palestinian militants still fire barrages of rockets, and along the northern border, where Israel and Lebanon’s Hezbollah militant group repeatedly trade fire, including on Monday.
A HOSPITAL AND A SHELTER
Shifa is the leading hospital in a health care system that has largely collapsed after years of conflict, chronic underfunding and an Israeli-Egyptian blockade aimed at weakening Hamas.
Shifa boasts over 500 beds and services like MRI scans, dialysis and an intensive care unit. It conducts roughly half of all the medical operations that take place in Gaza, according to the Health Ministry in the Hamas-run territory.
After the war erupted, tens of thousands crammed into the hospital grounds to seek shelter. As the war has moved closer to the hospital, most of those huddling there have fled south — joining some two-thirds of the territory’s 2.3 million residents who have left their homes.
But hundreds of people, including medical workers, premature babies and other vulnerable patients, remain, staffers say.
On Saturday, the hospital announced that it had run out of fuel. Health officials say at least 32 patients, including three babies, have died. They say 36 other babies are at risk of dying because life-saving equipment can’t function.
The Health Ministry released a photo Monday showing about a dozen premature babies wrapped in blankets on a bed to keep them warm. “I hope that they will remain alive despite the disaster in which this hospital is passing through,” said ministry spokesman Medhat Abbas.
International law gives hospitals special protections during war. But hospitals can lose those protections if combatants use them to hide fighters or store weapons, according to the International Committee of the Red Cross.
Still, there must be plenty of warning to allow evacuation of staff and patients. If harm to civilians from an attack is disproportionate to the military objective, it is illegal under international law.
ISRAEL’S CASE AGAINST HAMAS
Israel has long accused Hamas of using civilians as human shields. The group often fires rockets toward Israel from crowded residential areas, and its fighters have battled Israeli troops inside densely populated neighborhoods.
Throughout the war, Israel has released photos and video footage showing what it says are weapons and other military installations inside or next to mosques, schools and hospitals.
Late Monday, Israel’s chief military spokesman, Rear Adm. Daniel Hagari, showed footage of what he said was a Hamas weapons cache found in the basement of Gaza’s Rantisi Hospital for Children.
Hagari said he had entered the hospital with Israeli troops on Monday, a day after the facility’s last patients were evacuated. The hospital ran out of fuel last week, and Israel had ordered people to leave as it conducts its ground offensive.
Hagari entered a room decorated with a colorful children’s drawing of a tree, with weapons lying across the floor. He said they included explosive vests, automatic rifles, bombs and rocket propelled grenades.
“Hamas uses hospitals as an instrument of war,” he said.
He showed another area that he said appears to have been used to hold hostages.
It included what appeared to be a hastily installed toilet and air vent, a baby bottle and a motorcycle — scarred by a bullet hole and apparently used to carry hostages. One windowless room had curtains on the wall which he said could be used as a backdrop in a video. Hagari said forensic experts were examining the scenes.
“This is not the last hospital like this in Gaza and the world should know that,” Hagari said.
The army has claimed that Hamas is operating inside Shifa and underneath it in bunkers, some of which it says are accessible from the hospital itself. It also claims hundreds of Hamas fighters sought shelter at Shifa after the Oct. 7 massacre, in which at least 1,200 people in Israel were killed.
Israel says these claims are based on intelligence. However, it has released little evidence to support the claims. Hagari last month unveiled maps showing where Israel believes Hamas’ underground command centers are located, including one next to hospital’s reception area and another next to the dialysis department.
He also showed off simulated illustrations of what these centers allegedly look like, but acknowledged: “This is only an illustration.”
Other Israeli evidence has been equally difficult to verify.
Israel released a video of what it said was a captured militant answering questions during an interrogation. The militant, speaking quietly but clearly under duress, says that most tunnels are “hidden in hospitals.”
“At Shifa, for example, there are underground levels,” the militant says. “Shifa is not small. It’s a big place that can hide things.”
The army also released a voice recording of what it says are two anonymous Palestinians in Gaza discussing the presence of a tunnel under Shifa. The recording could not be verified.
Ghazi Hamad, a senior Hamas official, rejected the Israeli claims about Shifa as “false and misleading propaganda.”
“The occupying forces have no evidence to prove it,” Hamad said. “We have never used civilians as human shields because it goes against our religion, morality and principles.”
HOW WILL THE STANDOFF END?
Israel on Sunday said it had tried to deliver some 300 liters (about 80 gallons) of fuel to the hospital in plastic containers several hundred meters (yards) from the facility. But as of Monday, the fuel had apparently not been taken.
Israel accused Hamas of preventing medical workers from retrieving the containers. Hospital officials said the fuel should be delivered by the Palestinian Red Crescent and that the quantity of fuel was insufficient in any case.
Israel offered safe passage for people to leave. But those who tried to go described a terrifying experience.
Goudhat Samy al-Madhoun, a health care worker, said some 50 people left the facility on Monday, including a woman who had been receiving kidney dialysis. He said Israeli forces fired on the group several times, wounding one man who had to be left behind.
U.S. President Joe Biden on Monday said the hospital “must be protected,” and called for “less intrusive action” by Israeli forces.
“It is my hope and expectation that there will be less intrusive action,” Biden said in the Oval Office.
The Israeli army has said it is aware of the complexities, but says Hamas should not expect immunity.
“We’re not looking to take control of hospitals. We’re looking to dismantle their infrastructure,” said Lt. Col. Richard Hecht, another Israeli army spokesman.
“We’ll go in, we’ll do what we have to do and leave,” he said. “What it’s going to look like, it’s hard to say.”
