For Palestinians in Gaza, it is the “house of healing.” For Israel, it is the main command center for Hamas.
Al-Shifa, the enclave’s largest hospital, is now at breaking point, struggling to treat thousands of patients as it comes under direct attack from the Israeli army.
Last week, the Israeli army bombed an ambulance outside the hospital, which was part of a convoy supposed to transport 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 Health Ministry, which coordinated the trip with the International Committee of the Red Cross (ICRC) in Gaza.
Human Rights Watch (HRW) said the attack, which killed people in and around the ambulance, should be investigated as a possible war crime.
The deadly Israeli strike on an ambulance near al-Shifa hospital should be investigated as a possible war crime. @hrw verified video showing a woman on a stretcher in an ambulance and found no evidence of its military use. International law protects ambulances in all circumstances 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 supplied electricity to its main services. With almost no fuel left in its tanks to run its single generator, it’s only a matter of time before the hospital is forced to turn off vital equipment like ventilators and dialysis machines, leaving the patients die.
Here’s what you need to know about al-Shifa and why he’s 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 specialized facilities: surgical, internal medicine, obstetrics and gynecology.
Located in the northern district of Remal, near the port, the site originally housed a British army barracks. Becoming a hospital in 1946, it underwent successive expansions under Egyptian domination and during the Israeli occupation in the 1980s.
The hospital has become a lifeline for people requiring urgent medical intervention. Like all hospitals in the besieged strip – except the Jordanian field hospital, which received an airdrop of medical aid at midnight on Sunday – it was denied urgent supplies of medicine and fuel.
It has the capacity to treat 700 patients, but doctors are currently treating about 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 live in the corridors and courtyard of the hospital.
Already overwhelmed, the hospital has been flooded with corpses and injured patients since last week’s bombing of the Abou Assi school, run by the United Nations Relief and Works Agency (UNRWA). Casualties mounted on Sunday, after one of the heaviest nights of bombardment yet, in which the Israeli army hit 450 targets in the north, including the nearby Shati refugee camp. .
Dr. Marwan Abusada, head of the hospital’s surgical department, said al-Shifa can offer 210 beds in normal times. Currently, 800 patients are waiting to be admitted, he said in a statement relayed to Al Jazeera by the NGO Medical Aid for Palestinians (MAP).
The hospital is also understaffed. Israeli airstrikes killed 150 medical personnel in the Gaza Strip.
What are the conditions currently?
“At every level, we are facing a health catastrophe,” said Dr. Abusada.
MSF, which supplied al-Shifa with the medicines and equipment it still has in stock, reported that surgeons at the hospital operate on patients without painkillers. Short of beds, surgeons amputated limbs while patients lay on the floor.
With no place to keep patients in unsanitary conditions, surgical patients are at high risk of infection. “We have a type of worm, called a whitefly, that covers the wounds after surgery. They appear after a day,” said Dr. Abusada.
Running on empty, the hospital is barely able to meet its needs, retaining electricity supply to its emergency department, intensive care unit and operating rooms. “We strive to continue providing services to patients who need kidney dialysis, urgent catheterization and…incubators, but we provide the bare minimum,” the doctor said.
On Monday, an Al Jazeera report described scenes of chaos outside and inside the hospital, with bloodied patients lining the corridors. After observing the death of a man, surgeon Sara Al Saqqa spoke about her life, sleeping and waking at the hospital, where she worked for up to 72 hours straight.
“Every day we say today was the worst ever, and tomorrow will be even worse,” she said, later adding that there weren’t enough freezers to preserve the corpses.
This weekend, the hospital was forced to transfer its maternity ward to the Al Helou International Private Hospital in Gaza City. According to the United Nations Palestine Population Fund, around 50,000 pregnant women are caught up in the conflict. Premature births and miscarriages are on the rise, due to fear and panic caused by the bombings.
In northern Gaza, where the hospital is located, the main water sources – a desalination plant and the pipeline from Israel – have been closed since the start of the war. Currently, the hospital only receives salty groundwater, unsuitable for drinking and hygiene. According to the UN, only 5 percent of Gaza’s water needs are met.
Why is he attacked?
Al-Shifa is a prime target for Israeli forces, who say the hospital is located above the headquarters of Hamas, the armed group that has ruled Gaza since 2007.
Last month, the Israeli military released a video using a combination of satellite imagery and animated graphics to claim it had intelligence-based evidence of Hamas’ alleged use of the underground hospital, with tunnels, installations and meeting rooms. Hamas has rejected these claims, which it says shelter more than 40,000 displaced people.
This is not the first time that links have been established between Hamas and al-Shifa. Following the Israeli ground offensive in Gaza in 2014, Amnesty International accused Hamas of committing “frightening” atrocities against its political rivals in the abandoned hospital areas to extract confessions of collaboration. In a previous report, the human rights group also accused Israel of war crimes during its incursion, which killed more than 2,100 people.
Also at this time the hospital was attacked. Israel and Hamas shared responsibility for the explosion at the hospital, which reportedly killed at least 10 children. Hamas blamed the explosion on an Israeli drone attack, while Israel claimed it was caused by a failed Palestinian rocket. The episode resembled an equally controversial, but far deadlier, explosion at al-Ahli Arab Hospital last month.
In the current conflict, Israel has accused Hamas of stockpiling fuel for its own operations, thereby preventing more supplies from entering the limited number of humanitarian convoys passing through the Gaza Strip. Without electricity, 16 of the 35 hospitals in the Gaza Strip stopped functioning.
What future for al-Shifa?
As Israeli forces close in, the outlook is bleak for al-Shifa. At the time of writing, Israeli troops had separated northern Gaza from the rest of the enclave and were engaged in fighting against Hamas fighters in the heart of Gaza City.
Israel has insisted it wants to rout Hamas, destroy the so-called headquarters beneath the hospital and hunt down the group’s fighters. He also stated that he wanted to take control of the security of the Gaza Strip in the near future.