Australia / Israel Review

As of November 20, the IDF has released substantial proof that Al-Shifa Hospital, Gaza’s largest, was a Hamas headquarters. This includes weapons caches; security camera footage of hostages being brought in, Hamas fighters milling around, and captured IDF vehicles being driven to the complex; a booby-tracked pickup truck filled with weapons and explosives; and at least one very substantial tunnel with a blast door at the end to block IDF entry into underground bunkers. More footage of weapons, tunnels and other evidence is likely to emerge.

That such a Hamas command and control centre likely exists on the hospital grounds had been confirmed by US officials, including National Security Council spokesperson John Kirby, who recently told reporters: 

“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. Hamas and… Palestinian Islamic Jihad – PIJ – members operate a command-and-control node from Al-Shifa in Gaza City. They have stored weapons there.”

The US reportedly based this information on intercepted communications from Hamas terrorists inside Shifa as well as other hospitals, something also revealed through Israeli interrogations of captured Hamas operatives.

Israel has uncovered or revealed evidence of the military use of multiple hospitals by Hamas, including tunnels, rockets, weapons caches, underground areas that may have been used to hold hostages and footage of armed fighters firing from hospitals. 

International Law and Medical Facilities

It has long been known that Hamas uses hospitals and ambulances for military purposes, thus negating their protected status under International Humanitarian Law (IHL). 

Article 19 of the Fourth Geneva Conventions, for instance, clearly states that “The protection to which civilian hospitals are entitled shall not cease unless they are used to commit, outside their humanitarian duties, acts harmful to the enemy.” This protection stops “after due warning has been given, naming, in all appropriate cases, a reasonable time limit, and after such warning has remained unheeded.” 

Customary International Law also states that “Medical transports lose their protection if they are being used, outside their humanitarian function, to commit acts harmful to the enemy.”

Yet there has been pervasive misinformation about the nature and legality of Israel’s conduct, including from Australian Foreign Minister Penny Wong, with claims that essentially amount to saying international law gives immunity from retaliatory Israeli military action when Hamas deliberately and illegally uses hospitals and ambulances for military purposes. 

Below is an overview of the long and well-documented history of Hamas’ exploitation of ambulances and hospitals in Gaza as well as the steps Israel has taken to ensure the safety of civilians. 

Hospitals

The first reports of Hamas using Shifa for military purposes are from Operation Cast Lead in 2008, with a New York Times report describing armed Hamas agents in civilian clothing roving the hospital to kill suspected collaborators. In 2009, the Palestinian Authority asserted that “Hamas unfortunately used several facilities, mainly a large number of hospitals, as stations for summons, interrogation, torture and detention,” specifying Shifa and Nasser, among others. Amnesty International released a report in 2015 accusing Hamas of torturing and otherwise mistreating detainees in the Shifa complex. The IDF claims one of the October 7 hostages, Cpl. Noa Marciano, was executed on Shifa’s grounds.

A Gazan civilian who was a patient at Shifa recently interviewed anonymously as part of a joint project between the Free Press and the Center for Peace Communications said, “When I went to Shifa Hospital, I found Qassam fighters all around us. Every Palestinian knows Shifa is full of them, but nobody can talk.”

A British doctor who once worked at Shifa testified that there were areas of the hospital he was warned not to go to or he would be shot and that there was a general air of terror over Hamas’ presence in the hospital.

In 2014, during Operation Protective Edge, the Washington Post’s William Booth reported that Shifa had “become a de facto headquarters for Hamas leaders, who can be seen in the hallways and offices.” The hospital’s parking lot was also reportedly used to fire rockets at Israel, as attested to by a Finnish reporter. 

It’s not just Shifa that Hamas exploits. In 2014, the IDF released footage of Hamas operatives firing on it from the Al-Wafa Hospital, which was subsequently destroyed in a strike, followed by what seemed to be secondary explosions from munitions in or near the hospital. 

This year’s ground operation inside Gaza has uncovered more evidence at more hospitals. For instance, the IDF released footage of a weapons cache in the basement of the Al-Rantisi paediatric hospital. There was also an area of the basement separate from the rest of the hospital, which contained evidence that hostages may have been held there. A tunnel exposed by the IDF in the nearby house of a Hamas commander allegedly led into the hospital. 

Meanwhile, the IDF also alleged, during a briefing based on satellite imagery, that Gaza’s Indonesian Hospital was built right on top of and adjacent to a Hamas tunnel complex, and showed how rocket launching pits dotted the area of the hospital. According to the Israeli army, approximately 100 Hamas operatives also made a last stand there. 

The IDF also showed a tunnel entrance directly connected to the Sheikh Hamad Hospital and Hamas operatives shooting at them from that hospital. Similarly, geolocated footage shows a Hamas operative with a rocket-propelled grenade launcher right next to Al-Quds Hospital. 

Ambulances

Hamas not only routinely misuses civilian ambulances, but according to Israeli interrogations of captured operatives, actually has its own fleet of ambulances, designed to look like civilian ambulances, to use for military purposes. One Hamas detainee says in footage Israel released: 

Ambulances play a critical role [for Hamas] during combat, not only evacuating fighters but also transporting supplies, food, cargo, and weapons. They are deemed the safest way to transport these items.”

In 2009, during Operation Cast Lead, the Sydney Morning Herald reported on Mohammed Shriteh, an ambulance driver registered with the Palestinian Red Crescent Society, who said that Hamas was threatening Palestinian medical personnel and using ambulances to transport fighters, including several attempts to hijack the entire ambulance fleet of Al-Quds Hospital. 

Shriteh also told the Herald, “We would co-ordinate with the Israelis before we pick up patients, because they have all our names, and our IDs, so they would not shoot at us.” Hamas terrorists, however, threatened him at gunpoint to endanger everyone by transporting them in ambulances during battles.

Dave Harden, a former United States Agency for International Development (USAID) mission director in the West Bank and Gaza, recently tweeted that during his tenure, Hamas was using ambulances to move its fighters, information he gleaned from conversations with the then head of the International Committee of the Red Cross. 

Meanwhile, an intercepted communication released by the IDF features a Hamas operative boasting he can use “any ambulance” in Gaza to move around. 

Fuel

Despite widespread allegations to the contrary, Israel is not responsible for Gaza’s hospitals running out of fuel. 

US Secretary of State Antony Blinken testified before Congress in October that Hamas was refusing to share its fuel with hospitals, saying, “Hamas has its own supply stockpile of fuel. If it cared a whit about the people of Gaza, it would make sure itself that it used that fuel to have the hospitals be able to operate the incubators, stay turned on, etc. But, of course, it doesn’t.”

Not only has Hamas been hoarding fuel for rockets and vehicles and to run ventilation and lights for its tunnel network, it has also allegedly directly stolen fuel from hospitals, as detailed in two IDF audio intercepts. Worse, Hamas also allegedly blocked Shifa from receiving an emergency ration of 300 litres of fuel hand-delivered by IDF soldiers on Nov. 12, with a spokesperson saying this “would give Israel credit for allowing fuel into Gaza.” 

The US State Department spokesperson lamented on Nov. 13: 

We would love to see Hamas take some of the fuel reserves it’s sitting on and use that to supply hospitals in northern Gaza. We would love to see Hamas have taken the fuel that Israel offered it yesterday – that they declined – for use at al‑Shifa Hospital. 

IDF efforts to protect and evacuate civilians

The pernicious myth that Israel indiscriminately targets medical facilities is belied by the fact that tens of thousands of Palestinian civilians have taken shelter near various hospitals because they know they will not be targeted by Israeli airstrikes. This is the reason dozens to hundreds of civilians were killed in the widely misreported Al-Ahli Arab Hospital car park explosion on Oct. 17, caused by a misfired Palestinian rocket. 

Israel is targeting Hamas military assets in and around hospitals, but doing so in ways designed to minimise harm to doctors, patients, and refugees sheltering there.

The IDF has helped evacuate all the northern Gaza hospitals mentioned above, repeatedly communicating and coordinating with hospital staff either before strikes or when there was fighting in the area – on top of weeks of general evacuation warnings. The same was true in 2014 with the Al-Wafa Hospital, when the IDF released recorded phone calls with staff repeatedly checking no patients or staff were inside, before striking it, as discussed above.

At Shifa, the IDF designated a safe evacuation route and has been in constant contact with the staff. The IDF offered to help evacuate babies from the paediatric unit to a safer hospital out of the combat zone.

After the IDF entered some of the complex, it began delivering incubators for the NICU as well as baby food and medical supplies. When announcing the start of the operation at Shifa, the IDF explained that its “forces include medical teams and Arabic speakers, who have undergone specified training to prepare for this complex and sensitive environment, with the intent that no harm is caused to the civilians being used by Hamas as human shields.”

Meanwhile, at Al-Rantisi Hospital, the BBC verified a phone call involving an IDF officer explaining to hospital administrators detailed evacuation instructions and routes for civilians, while the head of the hospital told the New York Times that the IDF had delivered maps of evacuation routes to them.