AP – The head of surgery at Gaza’s largest and most advanced hospital held up his phone on Saturday to the hammering of gunfire and artillery shelling. “Listen,” said Dr Marwan Abu Sada as fighting raged around Shifa Hospital.
Shells hissed through the hospital courtyard and crashed into wards while Israeli soldiers and Hamas militants locked in close quarters combat. Doctors tried to help patients even as they ran for cover.
Dr Abu Sada described Shifa as a deathtrap for thousands of war-wounded, medical staff and displaced civilians sheltering there. The Israeli military denied it launched direct strikes or placed Shifa under siege.
In the conflict, hospitals in the main combat zone of northern Gaza have increasingly ended up in the crosshairs as Israeli tanks crunch through the hollowed-out heart of Gaza City.
Israel said Hamas fighers are using hospitals as shields for fighters but hasn’t provided evidence of that, while Palestinians and rights groups accuse Israel of recklessly harming civilians seeking shelter.
The battles around Shifa on Saturday raised an urgent question: When do medical facilities lose special protection under international humanitarian law?
WHAT DOES ISRAEL SAY?
Israel claimed that Hamas locates military assets under hospitals and other sensitive sites like schools and mosques.
Israel singled out Shifa, claiming Hamas operates its command headquarters beneath the hospital complex. The Israeli military released an illustrated map of Shifa marked with claimed locations of the underground militant installations, without offering further evidence. Hamas, and Shifa Hospital Director Mohammed Abu Selmia, denied this.
Israel said it will pursue Hamas fighters wherever they are, while trying to spare civilian lives.
Last week, Israel defended its bombing of an ambulance convoy evacuating wounded patients from Shifa, alleging that it was carrying Hamas fighters.
That strike killed at least 12 bystanders, Abu Selmia said.
On Saturday’s events at Shifa, chief Israeli military spokesman Rear Admiral Daniel Hagari said the forces were not besieging Shifa Hospital but allowing a safe exit point on the hospital’s eastern side.
Israeli forces also battled Hamas fighters in the rubble-filled streets outside Gaza’s Rantisi Hospital for Children, humanitarian officials reported.
Rantisi Hospital shut down on Friday after running out of fuel, said the World Health Organization, and it’s unclear how many people evacuated.
WHAT DO PALESTINIANS SAY?
Throughout the war, Palestinian families fleeing bombed-out homes have taken refuge in medical compounds, believing them to be safer than other alternatives.
Kamal Najar, a 35-year-old who sheltered at Shifa with his toddler son and infant daughter this week, said he believed that the hospital would be “off-limits, even for Israel”.
“It was the thing we somehow told ourselves wouldn’t happen,” he said, speaking by phone from the central city of Deir al-Balah, where he arrived by foot on Friday after escaping what he said were strikes on the hospital with tens of thousands of others.
On Saturday, some 1,500 patients, along with 1,500 medical workers and some 15,000 displaced people were still stranded at Shifa, health authorities said. They said a blackout plunged Shifa Hospital into darkness and switched off life-saving equipment, killing several patients – including a newborn in an incubator.
Palestinian medical workers accused Israel of mounting an all-out attack on infrastructure to punish the population and force a surrender. “It’s to say, ‘Not only will we kill and wound you, we will ensure you have nowhere to go to be treated,’” said Dr Ghassan Abu Sitta, a British Palestinian surgeon working for Doctors Without Borders in Gaza City.
Some 190 medical workers were among over 11,000 Palestinians killed since the start of the war, according to the Health Ministry in Gaza. Ongoing Israeli bombardment has wrecked 31 ambulances and knocked 20 hospitals out of operation, the ministry said. The war was triggered by Hamas’ October 7 attack on southern Israel in which some 1,200 people were killed.
“Death always feels close,” said Naseem Hassan, a 48-year-old medic in the southern city of Khan Younis. Too many colleagues, he said, have left the hospital only to return hours later in body bags. He had a close call on Thursday when two missiles landed just metres from his ambulance.
“This is a war of all-out destruction and there is no protection anywhere,” he said. “Israel could be more precise but it’s choosing not to be.”
Israel said it targets Hamas fighters, not civilians. However, it used powerful explosives in strikes on densely populated areas that have killed large numbers of women and children.
WHAT DOES INTERNATIONAL HUMANITARIAN LAW SAY?
The claims and counterclaims over Gaza’s hospitals raised pressing questions about what is allowed under international laws governing war.
International humanitarian law lends hospitals special protections during war. But hospitals can lose their protections if combatants use them to hide fighters or store weapons, the International Committee of the Red Cross (ICRC) said.
Nonetheless, there must be plenty of warning before attacks to allow for the safe evacuation of patients and medical workers, ICRC legal officer Cordula Droege said.
Even if Israel succeeds in proving Shifa conceals a Hamas command centre, the tenets of international law remain in place, said expert in military ethics at Ohio’s Case Western Reserve University Jessica Wolfendale.
“It doesn’t license an instant attack,” she said. “Steps need to be taken to protect the innocent as much as possible.”
If the harm to civilians is disproportionate to the military objective, the attack is illegal under international law.
In an editorial published on Friday in Britain’s The Guardian newspaper, International Criminal Court prosecutor Karim Khan issued a warning to combatants that the burden of proof is on them if they claim hospitals, schools or houses of worship have lost their protected status because they are being used for military purposes. And the bar for evidence is very high.
“If there is a doubt that a civilian object has lost its protective status, the attacker must assume that it is protected,” Khan wrote. “The burden of demonstrating that this protective status is lost rests with those who fire the gun, the missile, or the rocket in question.”
