Why Gaza's under-siege Al Shifa Hospital has reached grim turning point

Largest hospital in Gaza is under siege from Israeli forces

Newborns are placed in bed after being taken off incubators in Gaza's Al Shifa Hospital due to the power running out. Reuters

Patients and staff at Al Shifa Hospital in Gaza city, which is under siege. AFP

Patients and internally displaced people at Al Shifa. AFP

Israel claims Hamas is using the hospital as a command centre. AFP

This claim is denied by those associated with the hospital. AFP

Al Shifa Hospital has been hit by Israeli shelling. AFP

Conditions at the hospital have been described as 'disastrous'. Reuters

Thousands of internally displaced Palestinians have sought shelter at the hospital complex. AFP

Patients and internally displaced people are pictured at Al-Shifa hospital in Gaza City on November 10, 2023, amid ongoing battles between Israel and the Palestinian Hamas movement. Heavy fighting was raging near Al-Shifa hospital, with Israel saying it had killed dozens of militants and destroyed tunnels that are key to Hamas's capacity to fight. Israel launched an offensive in Gaza after Hamas fighters poured across the heavily militarised border on October 7, killing 1,400 people, mostly civilians, and taking around 240 hostages. (Photo by Ismail Zanoun / AFP)

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Israeli forces are closing in on Gaza’s main Al Shifa Hospital, housing as many as 15,000 people seeking shelter from fighting in the enclave, including about 1,500 patients and a similar number of medical staff.

Conditions at the hospital are grim as fuel is running out, meaning there is not enough power to keep babies alive in incubators.

Here’s what you need to know about the crisis at the hospital that has become the scene of one of the most bleak episodes of the war so far.

What has happened at Al Shifa?

Israel has already hit the structure with an air strike on the building's cardiology ward, the Health Ministry in Gaza said.

Scores of civilians have died in strikes just metres from the hospital entrance, where thousands are often crowded in car parks and other outside areas.

Dr Mohammad Abu Silmeyye, director of the hospital, on Monday told The National two people had been shot dead trying to leave the hospital.

Doctors Without Borders (MSF) surgeon Mohammed Obeid said on social media that two babies had already died in the neonatal clinic. The World Health Organisation (WHO) said at least 36 more babies could die and the hospital is out of water.

Israeli air strikes on hospitals in Gaza have drawn global condemnation because of the humanitarian suffering caused.

Israel has long insisted that Hamas has a bunker housing its main command centre under the building.

Experts say the group would be breaching international law by using human shields, while others say bombing a hospital could violate the principle of “proportionality” in international humanitarian law, making any Israeli attack a war crime.

“The ability of hospitals and medical facilities to operate is paramount, especially during conflicts,” the WHO said last week in reference to Al Shifa. "In line with international humanitarian law, we call for the protection of all medical facilities, personnel, patients and the wounded."

More than a month into the war, more than 11,000 Gazans have been killed in Israeli bombardments – more than five times the death toll of the Israel-Hamas war in 2014.

Why is Israel attacking the hospital?

Israel’s army said on October 27 that “hundreds of terrorists flooded into the hospital to hide” after Hamas’s October 7 attack in Israel that killed about 1,200 people, down from an initial estimate of 1,400.

They say Hamas has used the complex for years, first making the allegations during the 2009 Gaza war. Israeli commanders allege it has been incorporated into a vast tunnel complex across Gaza, said to comprise as much as 500 kilometres of concrete passages.

Hamas strongly denies the claim, while Israel has produced maps and graphics attempting to justify their claims, but no defining evidence.

The WHO on Sunday said that in the previous 48 hours the hospital had been attacked many times, leaving several dead and many others injured.

The intensive care unit suffered damage from bombardment, it said, while areas of the hospital where displaced people were sheltering have also been damaged.

One patient using an incubator to help them breathe reportedly died when electricity was cut, the WHO said.

Israel claims it has offered fuel for the hospital – although health officials say it is not nearly enough – as well as safe corridors to evacuate civilians.

The hospital was last bombed in 2014, during a month-long battle between Israel and Hamas that left about 2,000 people dead.

Doctors Without Borders said at the time that targeting hospitals and their surroundings was "completely unacceptable and a serious violation of international humanitarian Law”.

The hospital was also the site of fighting between Hamas and Fatah in 2007, when the former took over Gaza, Human Rights Watch said, but the organisation did not specify whether it was being used as a base for Hamas.

What have world leaders said about Al Shifa?

So far, only US National Security Adviser Jake Sullivan has directly commented on the situation on the hospital, as most world leaders focus on overall condemnation of Israel’s massive bombardment of Gaza.

On Saturday, France’s President Emmanuel Macron, while urging Israel to stop its attacks, said: “These babies, these ladies, these old people are bombed and killed” without giving more details.

Mr Sullivan said on Sunday on CBS show Face the Nation that Washington “does not want to see firefights in hospitals where innocent people, patients receiving medical care, are caught in the crossfire".

He said the US had had "active consultations" with the Israel army. He said the US believed Hamas was using hospitals for “command and control” in “a violation of the laws of war”.

Prime Minister Benjamin Netanyahu on Sunday followed Israeli President Isaac Herzog’s denial that the hospital had been bombed, saying Israel had offered “to give them enough fuel to operate the hospital, operate the incubators and so on, because we have no battle with patients or civilians at all”.

The WHO last week said only two deliveries of “life-saving” supplies had reached the hospital, calling conditions at Al Shifa "disastrous”.