Why is Gaza’s al-Shifa hospital at the heart of Israel’s war?

For Palestinians in Gaza, it’s the “house of healing”. For Israel, it’s Hamas’s main command centre.

Al-Shifa, the biggest hospital in the enclave, is now at breaking point, battling to treat thousands of patients as it comes under direct attack from the Israeli military.

Last week, the Israeli army bombed an ambulance outside the hospital, part of a convoy that was meant to carry patients from Gaza City to the Rafah border crossing, so they could be treated in Egypt. Fifteen people were killed in the attack, according to the Palestinian Ministry of Health, which had coordinated the journey with the International Committee of the Red Cross (ICRC) in Gaza.

Human Rights Watch (HRW) said the attack, which killed people inside and around the ambulance, should be investigated as a possible war crime.

Deadly Israeli strike on ambulance near alShifa Hospital should be investigated as possible war crime. @hrw verified video showing woman in stretcher in ambulance & found no evidence of its use militarily. Int’l law protects ambulances in all circumstanceshttps://t.co/ZeaUk93GDg pic.twitter.com/sW95FjWNCN

— Omar Shakir (@OmarSShakir) November 8, 2023

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.

Here’s what you need to know about al-Shifa and why is it being targeted:

What is al-Shifa?

Dar al-Shifa, literally translated as “house of healing”, is the largest and most extensive medical complex in the strip, comprising three specialised facilities: surgical, internal medicine, and obstetrics and gynaecology.

Located in the northern Remal neighbourhood, close to the port, the site originally housed British Army barracks. It became a hospital in 1946, undergoing successive expansions under Egyptian rule and during the Israeli occupation in the 1980s.

The hospital has become a lifeline for people seeking urgent medical intervention. Like all hospitals in the besieged strip – bar the Jordanian field hospital, which received an airdrop of medical aid at midnight on Sunday –  it has been denied urgently needed supplies of medicine and fuel.

It has the capacity to treat 700 patients, but right now doctors are treating approximately 5,000, according to a recent report by Doctors Without Borders, known by its French initials MSF. Thousands of people who have lost their homes are living in the hospital corridors and in the courtyard.

Already overwhelmed, the hospital has been flooded with bodies and wounded patients since last week’s bombing of the Abu Assi school, run by the United Nations Relief and Works Agency (UNRWA). Casualties mounted on Sunday, following one of the heaviest nights of bombardment seen so far, which saw the Israeli military hit 450 targets in the north – including the nearby Shati refugee camp.

Dr Marwan Abusada, the hospital’s head of surgery, said that al-Shifa can offer 210 beds on normal days. Currently, 800 patients are waiting to be admitted, he said in a statement relayed to Al Jazeera by NGO Medical Aid for Palestinians (MAP).

The hospital is also low on personnel. Israeli air attacks have killed 150 medical staff in the strip.

What are conditions like right now?

“At all levels, we are dealing with a health disaster,” said Dr Abusada.

MSF, which supplied al-Shifa with the medicines and equipment that it still has in its stock, has reported that surgeons at the hospital are operating on patients without painkillers. Short on beds, surgeons have amputated limbs as patients lie on the floor.

With nowhere to keep patients in the unhygienic conditions, patients who have undergone surgical procedures run a high risk of infection. “We have a type of worm, called white flies, covering the wounds after the surgery. They appear after one day,” said Dr Abusada.

Running on empty, the hospital is barely able to deliver needs, conserving its electricity supply for its emergency unit, intensive care and operating rooms. “We are trying hard to continue delivering services to the patients who need kidney dialysis, urgent catheterisation and … incubators, but we are delivering the bare minimum,” said the doctor.

On Monday, an Al Jazeera report depicted scenes of chaos outside and inside the hospital, with bloodied patients lining the corridors. Having just pronounced a man dead, surgeon Sara Al Saqqa spoke of living, sleeping and waking at the hospital, working as many as 72 consecutive hours.

“Every day, we say today was the worst ever, then the next day is worse,” she said, adding later that there aren’t enough freezers to keep the corpses.

At the weekend, the hospital was forced to transfer its maternity ward to the private Al Helou International Hospital in Gaza City. An estimated 50,000 pregnant women are caught up in the conflict, according to the United Nations Population Fund in Palestine. Premature births and miscarriages are on the rise, owing to the fear and panic caused by bombardment.

In northern Gaza, where the hospital is located, the main sources of water – a desalination plant and the pipeline from Israel – have been shut down since the start of the war. At present, the hospital only receives salty groundwater, unsuitable for drinking and hygiene. According to the UN, only 5 percent of Gaza’s water needs are being met.

Why is it under attack?

Al-Shifa is a prime target for Israeli forces, which claim the hospital is located above the headquarters of Hamas, the armed group that has governed Gaza since 2007.

Last month, the Israeli military released a video that used a combination of satellite imagery and animated graphics to claim that it had intelligence-based proof of Hamas’s purported use of the hospital below ground, with tunnels, facilities and meeting rooms. Hamas has rejected those claims, which it said is sheltering more than 40,000 displaced people.

It’s not the first time that links have been drawn between Hamas and al-Shifa. Following Israel’s 2014 ground offensive in Gaza, Amnesty International accused Hamas of committing “spine-chilling” atrocities against political rivals in abandoned areas of the hospital to extract confessions of collaboration. In an earlier report, the rights group had also accused Israel of war crimes during its incursion, which killed more than 2100 people.

Back then, too, the hospital had come under attack. Israel and Hamas traded blame for an explosion at the hospital that reportedly killed at least 10 children. Hamas blamed the blast on an Israeli drone attack, while Israel claimed it had been caused by a failed Palestinian rocket. The episode had shades of a similarly disputed, but much deadlier explosion at al-Ahli Arab Hospital last month.

In the current conflict, Israel has accused Hamas of storing fuel for its own operations, preventing more supplies from entering in the limited number of humanitarian convoys crossing into the strip. With no power, 16 out of the 35 hospitals in the Gaza Strip have stopped working.

What next for al-Shifa?

As Israeli forces close in, the outlook is bleak for al-Shifa. At the time of writing, Israeli troops had severed northern Gaza from the rest of the enclave and were engaging Hamas fighters in the heart of Gaza City.

Israel has insisted that it wants to rout Hamas, destroy the alleged headquarters below the hospital and hunt down the group’s fighters. It has also said it wants to assume control of the strip’s security for the foreseeable future.

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