Hospitals have special protection under international humanitarian law for an important reason – their purpose is to save lives, and IHL’s purpose is to reduce unnecessary suffering as much as possible in the context of the horror of war. Unfortunately, Hamas has long sought to exploit the specially protected status of hospitals under international humanitarian law and to use them to shield their activities from counterattack by Israel.

As the IDF has reported and U.S. intelligence has confirmed, Hamas has integrated its operations in and around hospitals throughout Gaza. Hamas does this knowing that it could paint any Israeli action against them as yet more evidence of Israel’s desire to harm Palestinian civilians.  

Yet Israel’s actions before, during, and simultaneous with its military operation against Hamas infrastructure at and under Al-Shifa hospital in Gaza City on November 14 reflect precisely the opposite: Israel’s effort to comply with the most protective rules of international humanitarian law while confronting an enemy that is systematically and flagrantly violating it.

The IDF entered Al-Shifa Hospital and found weapons and uniforms that confirmed Hamas was using the hospital for terror, violating the laws of war. Israel also found the bodies of two Israeli hostages abducted by Hamas on October 7, from the area of Al-Shifa Hospital. Additional surveillance video released by Israel purportedly shows Hamas terrorists bringing a Nepali and Thai citizen who was abducted from Israel on October 7 into the hospital. This evidence, alongside new footage of a 50-meter section of Hamas’ tunnel system underneath the hospital, further confirms the terror group’s use of the hospital as a terrorist infrastructure, breaking the laws of war. 

During the beginning of the operation, the IDF brought with it urgently needed medical supplies, including incubators for babies, and a medical team to help patients. On November 18, it was reported that the hospital was almost completely evacuated, with only limited medical personnel remaining to support patients who could not be moved. The IDF is reportedly continuing targeted operations to uncover Hamas terrorists and destroy its terror network at the hospital. 

Here is what you need to know about Gaza’s hospitals, Israel’s operation, and how Hamas uses hospitals as a base for its terrorism. 

Hamas’ history of using hospitals for terrorism

Under international humanitarian law, hospitals are given special protections during war. Hospitals are protected from attack by international humanitarian law even in circumstances when other non-military buildings would not be. That protection only ceases if hospitals “are used by a party to the conflict to commit, outside their humanitarian functions, an “’act harmful to the enemy.’” Injured fighters are allowed to be inside them.

Hamas has a long history of using civilian areas such as homes, hospitals, and schools to carry out its terror operations. Hamas stores weapons in residential areas and even schools and hospitals, firing rockets from densely populated zones, operating command centers in civilian areas like hospitals, and sometimes using civilian clothing to blend in. 

Hamas has also used ambulances to evacuate fighters and operatives as well as transport food, IEDs, and weapons. Such practices make it challenging for the Israeli military to take action against legitimate military targets without risking civilian casualties.

Gaza’s Al-Shifa Hospital as a terror base

Located in Gaza City, Al-Shifa Hospital, which means “healing” in Arabic, was built by the British in 1946 when they governed what was then the Mandate of Palestine. Later, when Israel gained control of the Gaza Strip from Egypt following the 1967 Six-Day War, Israel, with American support, worked on a large-scale renovation to enlarge and modernize Al-Shifa in the 1980s, including the installation of a subterranean concrete floor. The hospital is the largest in the Gaza Strip today, the sprawling complex has over 1,500 beds and 4,000 employees.

Following Israel’s withdrawal from the Gaza Strip in 2005, Israeli intelligence believed that Hamas began to use the hospital complex, including its extensive basement corridors, as its command and control centers. In 2014 during Israel’s Operation Protective Edge -- which was launched following Hamas rocket attacks and the kidnapping and murder of three Israeli teenagers in the West Bank -- the Washington Post reported that Hamas designated buildings in Al-Shifa as their primary command center, and Hamas terrorists were seen moving freely around the hospital hallways and offices. 

Al-Shifa Hospital as a shield for Hamas terror

In October of 2023, the IDF detailed how Hamas uses Al-Shifa as its main base of operations. Hamas reportedly has several underground complexes under the hospital enabling the terror group to direct attacks against Israel. There are several tunnels leading to the underground base from outside the hospital, so that Hamas terrorists do not need to enter the hospital to reach it. The IDF said that there is also an entrance to the underground complex from within one of the wards.

Additionally, Hamas’ internal security reportedly has a command center inside the hospital, which directs rocket fire on Israel and stores weapons. 

“Hamas uses Shifa hospital as a shield for Hamas terror infrastructure,” said IDF Spokesperson Rear Adm. Daniel Hagari on October 27.  “Hamas wages war from hospitals. By operating from these hospitals, Hamas not only endangers the lives of Israeli civilians; but also exploits innocent Gazan civilians.”

He added: “Hamas terrorists operate inside hospitals precisely because they know that the IDF distinguishes between terrorists and civilians.”

The IDF released evidence of Hamas weapons found inside Al-Shifa’s MRI center, during its operation targeting Hamas on November 15. It published images and videos showing assault rifles, grenades, and other military equipment. 

🚨 Hamas' headquarter is located directly under the Al-Shifa Hospital, the largest medical complex in Gaza.

Hamas doesn’t care about Palestinian lives.

— American Jewish Committee (@AJCGlobal) October 27, 2023

It published images and videos showing assault rifles, grenades, and other military equipment. 

Further, Israeli soldiers also found Hamas uniforms that were thrown on the hospital floor, presumably so the Hamas operatives could escape in civilian clothes. 

Additionally, the IDF has found evidence that hostages taken by Hamas were kept at Al-Shifa Hospital. The body of Yehudit Weiss, 65, who was taken hostage by Hamas from her home in Kibbutz Be’eri, was found in a building near Al-Shifa Hospital. 

What has been the response by the United States? 

In a press conference on November 16, U.S. President Joe Biden reaffirmed that he supports Israel’s operation against Hamas until it achieves its goal of eliminating the terror group’s ability to harm Israelis.

Further, Biden noted that “one thing has been established: Hamas does have headquarters, weapons, materiel, below this hospital, and — I suspect — others.”

U.S. officials and intelligence agencies have affirmed their own intelligence conclusion that Hamas uses the Al-Shifa hospital as a base for terrorism.

“We have information that Hamas and the Palestinian Islamic Jihad use some hospitals in the Gaza Strip, including Al-Shifa, and tunnels underneath them to conceal and to support their military operations and to hold hostages,” White House National Security Council spokesperson John Kirby said during a press conference on Nov. 14. 

Kirby further confirmed Israel’s assessment that Palestinian terror groups have set up their command and control center under Al-Shifa. 

“Hamas and the Palestinian Islamic Jihad members operate a command and control [center] from Al-Shifa in Gaza City. They have stored weapons there and they’re prepared to respond to an Israeli military operation against that facility,” Kirby said.

Humanitarian aid to Gaza hospitals from Israel

While Hamas commits war crimes by firing rockets from and storing weapons in schools, mosques, and hospitals, the IDF has reportedly provided unprecedented medical and humanitarian aid to Gaza’s Al-Shifa Hospital, including incubators for premature babies, baby food, and medical supplies to meet its obligations under international humanitarian law. 

According to reports from hospital officials, they were caring for 36 premature babies as of November 14. Israeli forces provided incubators to help evacuate the babies from the hospital. 

On November 20, it was reported that 29 premature babies from Al-Shifa Hospital were evacuated and arrived in Egypt. An initial 31 babies were reportedly evacuated from Al-Shifa to another Gaza clinic and it was not immediately clear why only 29 arrived in Egypt. 

Israel also sent a medical team and Arabic-speaking soldiers to ensure that those supplies reach those in need as well as to assist with providing care in serious cases for people who cannot evacuate, according to the IDF. 

Israel also reportedly provided 300 liters of fuel to Al-Shifa for urgent medical purposes. Hamas prevented the hospital from receiving the fuel. 

This is an unprecedented move in a highly complex and sensitive urban war and highlights not only Israel’s commitment to providing aid to Palestinian civilians but also reinforces that this is a war with Hamas, not the Palestinian people. 

Overall, more than 1,100 trucks providing humanitarian aid have entered Gaza through the Rafah border crossing with Egypt since the start of the war, with 115 trucks arriving recently.  Israel has also now allowed fuel into Gaza that will be delivered to UNRWA, the United Nations agency that handles Palestinian relief.

Hamas weapons cache under Gaza’s children’s hospital

Al-Shifa is not the only hospital in Gaza used by Hamas terrorists. Israel’s military invited international media to witness Hamas’ abhorrent use of key civilian infrastructure firsthand at Gaza’s Al-Rantisi children’s hospital, where parts were used as a Hamas command and control center, to hold Israeli hostages, as well as to store weapons.

Among the weapons found in the hospital basement were suicide-bomb vests, grenades, AK-47 assault rifles, explosive devices, RPGs, and other weapons, according to the IDF. 

Amid the fighting with Hamas terrorists, Israel helped to evacuate Rantisi, which specializes in cancer care, and other Gaza hospitals Al-Shifa and Nasr. Israeli military officers spoke directly with hospital officials giving them instructions for safe passage out of the facility and ambulances to evacuate the sick. 

Media bias and Gaza’s hospitals

Since the launch of the Israel-Hamas war, several media outlets have falsely reported on Israel’s actions to defend itself from Hamas terrorists, specifically regarding hospitals. 

On October 23, some media outlets around the world spread a vicious lie by the Hamas-run Palestinian Health Ministry that an Israeli airstrike had killed hundreds of Palestinians at the Al-Ahli Arab Hospital in Gaza City. The explosion at the hospital was later confirmed by Israeli, U.S., and other Western intelligence agencies to be a result of a misfired Palestinian Islamic Jihad rocket. The New York Times published an editor's note acknowledging that its coverage of the incident should have been more rigorous. It said its initial reports “relied too heavily on claims by Hamas, and did not make clear that those claims could not immediately be verified."

On November 14, a BBC anchor, citing a Reuters report, said on air that Israeli forces entering Al-Shifa hospital “were targeting people including medical teams and Arab speakers.” 

However, the Reuters report did not say that. In fact, the Reuters story quoted an IDF statement that said upon entering Gaza’s largest hospital, specially trained forces were accompanied by “medical teams and Arabic-speaking soldiers [who] are on the ground to ensure that [medical] supplies reach those in need.”

The BBC apologized for the on-air error. 

“This was incorrect and misquoted a Reuters report,” an anchor for the UK broadcaster later said. “What we should have said is that IDF forces included medical staff and Arabic speakers for this operation.

“We apologize for this error, which fell below our usual editorial standards. The correct version of events was broadcast minutes later.”