Fact sheet: Gaza’s hospitals and ambulances – and Hamas’ exploitation of them

Nov 14, 2023 | AIJAC

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Pervasive misinformation and distortion alleging Israel is targeting medical facilities and ambulances in an illegal and indiscriminate fashion is being spread by journalists, analysts, activists and even officials. Even Australian Foreign Minister Senator Penny Wong recently said Israel must stop “attacking” hospitals.

US National Security Council spokesperson John Kirby recently told reporters, based on multiple independent US intelligence streams, including intercepted communications:

I can confirm for you that 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, and they’re prepared to respond to an Israeli military operation against that facility.

Dave Harden, a former United States Agency for International Development (USAID) mission director in the West Bank and Gaza, recently tweeted:

It was broadly suspected/understood as far back as 2014 that Hamas used the Al Shifa Hospital complex as a command center and base for operations. I didn’t have direct evidence, but it was recognized by both trusted Palestinians and Israelis in my network. Further, Hamas used ambulances to move its people. This was based on my conversations with the then head of [the International Committee of the Red Cross].

A Gazan patient interviewed anonymously as part of the joint Voices from Gaza project by the Free Press and 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.” Another said that “[Hamas] exploited the fact there were so many people [at Al-Shifa]. To be candid, their ammunition depot was in Shifa Hospital. We noticed it by accident. That’s the reason we decided to leave.”

A British doctor who once worked at Shifa told France24, “When I was first asked to work there, I was told there was a part of the hospital I was not to go near, and if I did, I’d be in danger of being shot…You know, people were genuinely fearful. I cannot emphasize too much the air of collective paranoia that existed there.”

A recent investigation by David Collier reveals that all of those being quoted as sources by media outlets about the situation at Al-Shifa Hospital are outright supporters of terrorism and Hamas and openly celebrated the October 7 massacre, among other terrorist attacks.

Below is a current update on the reality of the situation with respect to the hospitals of Gaza, including the well-documented evidence and history of Hamas’ use of hospitals and ambulances for terrorist purposes. These practices remove their protected status under International Humanitarian Law ( see Article 19 and Article 28 of the Fourth Geneva Convention and Rule 28 of Customary International Law, inter alia), allowing the Israel Defence Forces (IDF) to strike these targets, though of course while continuing to seek to minimise harm to civilians within the laws of “proportionality” and while adhering to other relevant rules.

There have been large battles around many hospitals and facilities in Gaza, including the current battles around Shifa Hospital, Gaza’s largest. It’s unclear who those trying to malign Israel suggest the IDF is battling at these sites if not Hamas.


Hamas ambulances and its headquarters in Al-Shifa Hospital

Israel has long identified bunkers directly under Shifa Hospital as the main headquarters of Hamas’ military wing in the Gaza Strip and has released a diagram of the specific bunkers under the hospital. This has been confirmed by US intelligence and numerous media reports.

IDF animation of Hamas command centre under Shifa hospital (screenshot)

While there has certainly been fighting near Shifa Hospital over recent days, Israel has denied that it has ever struck the hospital itself directly, although a New York Times visual investigation suggests at least some of the munitions that hit the hospital were Israeli. Israel says a failed Palestinian rocket as well as Palestinian rocket-propelled grenades did hit it, causing casualties. Hamas has also reportedly prevented medical workers from evacuating Shifa.

Over recent days, thousands of civilians who had taken shelter around the Shifa Hospital complex have been evacuated with Israeli help and guidance through safe corridors. Of the original 40,000 or so taking shelter there, only a few hundred patients, staff and civilians still remain, according to IDF spokesperson Lieutenant Colonel (Ret.) Peter Lerner. Hamas claims the number is roughly 1,500 patients, staff and displaced people, although the BBC cites Hamas as claiming at least 2,300 people altogether remain at the complex.

Interrogation videos of Hamas operatives involved in the October 7 massacre released by the IDF also reveal that Shifa is considered a safe place for Hamas to command the battle as well as move weapons, food, fuel and medicine to their fighters. Another detainee testified that approximately 100 Hamas operatives were operating in Shifa, some dressed as nursing staff, including in the ICU.

The bodies of two hostages, Cpl. Noa Marciano and Yehudit Weiss, were found next to the hospital, with the former being executed by Hamas inside Shifa itself, according to the IDF. The Jerusalem Post reports that there is “significant evidence” that hostages and bodies were held at Al-Shifa, while also reporting that top Hamas officials may have left the hospital shortly after the ground invasion began.

The IDF recently struck an ambulance near the Shifa hospital which it said was carrying Hamas operatives,  and released audio recordings of conversations showing Hamas operatives boasting they can use “any ambulance” in this fashion. Israel has also released testimony from captured Hamas operatives saying Hamas “has their own ambulances, some of which are located on the military base. The appearance of these ambulances is deliberately made to resemble civilian ambulances” and “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.”

The Fuel Issue

We are constantly hearing reports that Gaza’s hospitals, including Shifa, are running out of fuel to power their generators, necessary to supply essential medical services.

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.”

Israel says it has evidence that Hamas has been hoarding a substantial volume of fuel for its own use, reportedly over 200,000 gallons (more than 750,000 litres) stored directly underneath Shifa, even as Shifa insist it has no fuel to function.

Furthermore, Hamas not only refuses to give this fuel to hospitals, hoarding it for rockets, vehicles and to run ventilation and lights for its tunnel network, but has also allegedly been stealing it directly from the hospital and blocking Israeli deliveries of fuel to it.

The IDF released an audio recording, alongside video showing IDF soldiers attempting to provide Shifa with an emergency ration of 300 litres of fuel, in which hospital officials say the fuel transfer was blocked by the head of Hamas’ Health Ministry.

IDF trying to deliver fuel to Shifa (screenshot)

Hamas Health Ministry Spokesman Dr Ashraf al-Qudra disputed the precise details of the claim but admitted their substance,  saying that Israel had in fact offered 200 litres of emergency fuel, but Shifa rejected it because it wasn’t enough and because “Taking this fuel would give Israel credit for allowing fuel into Gaza”.

Meanwhile, Shifa Director Dr Muhammad Abu Salmiya – whose brother seems to have been a senior Hamas military commander assassinated by Israel in 2004 and who has himself long openly supported terrorismadmits it was in fact 300 litres, but then claimed it was not enough for even 30 minutes, that they couldn’t get to it because of Israeli tanks and said he told the IDF they want the fuel but it needs to be delivered through international institutions, an unacceptable proposition due to the probability of diversion to Hamas. Since then, however, Israel has agreed to allow approximately 140,000 litres of fuel per day into Gaza for humanitarian aid purposes.

The US State Department spokesperson Matthew Miller recently told reporters 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.

Another audio recording released by the IDF shows a Gaza healthcare official appearing to confirm Hamas is stealing fuel from Shifa Hospital and storing it underneath in its tunnels. The lack of fuel at hospitals, as attested to by the US, is primarily the responsibility of Hamas, which has vast stores – although Israel has offered to supply Gaza’s hospitals with fuel, as it tried to do with Shifa.

Israeli releases video showing weapons, terror tunnel and possibly hostage-holding at al-Rantisi Hospital

Al-Rantisi is a paediatric hospital in Gaza City. The hospital now appears to have been evacuated and came under the direct control of Israel forces on Nov. 13. About a thousand people sheltering in and near the hospital were able to leave after the IDF killed a Hamas commander, Ahmed Siam, and other terrorists with him, who were allegedly preventing them from evacuating.

The IDF has released a video showing a cache of weapons, including suicide-bomb vests, grenades, AK-47 assault rifles, explosive devices and RPGs, found in the hospital basement, as well as additional evidence the basement was used as a Hamas command and control centre. The video also provides evidence that hostages seized on Oct. 7, including infants or babies, may have been held in the hospital basement – notably, the Palestinian Authority accused Hamas of using hospitals to torture and interrogate Palestinians in 2009 – and shows a Hamas tunnel from a nearby house owned by a Hamas commander that, it is claimed, leads into the hospital.

A Palestinian detainee testified that approximately 100 Hamas operatives completely took over Rantisi, camping around it in groups of 4-5 and carrying out attacks.

Hamas weapons in the basement of Rantisi hospital

Prior to its evacuation, the IDF was in contact with hospital officials at Rantisi to discuss arrangements for ambulances for evacuation. A phone call heard by the BBC has an IDF officer explaining in detail evacuation instructions and routes for the civilians, and the head of the hospital told the New York Times that the IDF had delivered maps of evacuation routes to them last week.

Other hospital bases aside from Shifa and Rantisi

The IDF military operation to destroy Hamas following the mass kidnapping and pogrom on October 7 has come with substantial IDF documentation of Hamas’ use of hospitals, including al-Shifa, the Indonesian Hospital and the Sheikh Hamad Hospital.

The IDF has released footage of a tunnel entrance going directly underneath Sheikh Hamad Hospital as well as Hamas terrorists shooting at IDF soldiers from inside the hospital.

The Indonesian Hospital was allegedly constructed right on top of and adjacent to a large Hamas base, as demonstrated through satellite imagery by the IDF. That location was chosen specifically to cover the military infrastructure that existed there before the hospital was built. Launch pits for rockets also dot the area.

The IDF says around 100 Hamas fighters made a last stand inside the Indonesian Hospital and have released phone intercept recordings of Hamas officials discussing an order that was given to steal diesel fuel from it. IDF spokesman Lieutenant Colonel Jonathan Conricus recently asserted that Hamas was firing on the IDF from the Indonesian Hospital as it had from the Sheikh Hamad Hospital.

The IDF also released geolocated footage of Hamas fighters firing from right next to Al-Quds hospital.

One Palestinian detainee detailed the use of the Red Crescent building, where Hamas on a daily basis hid rockets and guns inside mattresses, while another spoke about witnessing Hamas’ use of a hospital he called the “Swedish Hospital”, which he said was run by UNRWA. He asserted that Hamas used the hospital as a “base of operations, they prepared themselves from within the hospital, launched units for their missions outside.”

Hamas terrorist fighting right outside Al-Quds hospital (screenshot)

IDF efforts  to safeguard civilians in and around hospitals

The IDF has repeatedly called for the evacuation of civilians from the battle zone for the past month, including through tens of thousands of individual phone calls and millions of leaflets, pre-recorded calls and SMS messages. Humanitarian corridors and pauses for the delivery of aid are widely publicised and protected by the IDF, which includes ways to contact them if Hamas is blocking civilians from evacuating, something it openly does both rhetorically and practically.

Specifically regarding hospitals, the IDF is ensuring evacuation of the Shifa, Rantisi and Nasser hospitals. Contrary to pervasive misinformation, the Shifa hospital is not under siege, and the IDF say it has designated a safe evacuation zone on its east side and is in constant contact with the staff, which requested IDF help evacuating babies from the paediatric unit to a safer hospital out of the combat zone, and Israel has agreed to provide that help. Israel is also delivering incubators to Shifa and helping the UN evacuate newborns in them, as well as facilitating the delivery of supplies by Jordan for its field hospital in the South of Gaza, and is coordinating with the UAE to establish another field hospital in the Strip.

IDF transporting incubators to Shifa

Perhaps the greatest indication that both sides know Israel does not in fact target hospitals is the large number of casualties from the widely misreported explosion in the Al-Ahli Arab Hospital car park on October 17. The overwhelming evidence from every possible source points to a misfired Palestinian rocket falling on the car park. Whether casualties were in the hundreds or dozens, the reason so many were killed is because Palestinians take shelter near hospitals knowing Israel won’t strike them. This is also demonstrated by the tens of thousands who sought refuge at the Shifa Hospital complex and Al-Quds Hospital.

Documentation from previous wars of Hamas using hospitals and ambulances

2007 Palestinian Civil War

Human Rights Watch documented that Shifa was a Hamas base of operations, reporting:

After Hamas fighters killed Fatah intelligence officer Yasir Bakar, Fatah gunmen began firing mortars and rocket-propelled grenades at Shifa Hospital in Gaza City, drawing Hamas fire from inside the building, killing one Hamas and one Fatah fighter.

2009: Operation Cast Lead

The Sydney Morning Herald reported 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.

Mohammed Shriteh, 30, an ambulance driver registered with and trained by the Palestinian Red Crescent Society, 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. This practice has continued in every subsequent war, including the current one.

Hamas also purges staff at Al-Shifa hospital to ensure loyalists and operatives have free rein. Eyad al-Bayary, a senior nurse at Al-Shifa, told the Herald that he was fired and barred from the hospital during the war because he was a Fatah loyalist.

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 Al-Shifa and Nasser, among others.

The New York Times reported in Dec. 2008 that armed Hamas operatives in civilian clothes were walking around Al-Shifa Hospital and executing those accused of collaborating with Israel.

Israel claimed in 2009 that Hamas was hiding under Al-Shifa Hospital, something an anonymous doctor in Gaza interviewed by PBS also suspected. The doctor “added that he believes Hamas is aware that they are putting civilians in harm’s way.”

2014: Operation Protective Edge

The Washington Post’s William Booth reported in 2014 regarding the Shifa hospital:

At the Shifa Hospital in Gaza City, crowds gathered to throw shoes and eggs at the Palestinian Authority’s health minister, who represents the crumbling “unity government” in the West Bank city of Ramallah. The minister was turned away before he reached the hospital, which has become a de facto headquarters for Hamas leaders, who can be seen in the hallways and offices.

A television reporter from Finland’s Helsingin Sanomat also reported that Hamas had fired rockets from the Shifa hospital parking lot.

Another hospital, the Al-Wafa Hospital, was similarly used in such a fashion. According to the IDF:

Hamas transformed Wafa Hospital, a civilian building in the Shuja’iya neighborhood of Gaza City, into a command center, rocket-launching site, observation point, sniper’s post, weapons storage facility, cover for tunnel infrastructure, and a general base for attacks against Israel and IDF forces. Hamas repeatedly opened fire from hospital windows and used anti-tank missiles from the premises. Hamas deliberately and cynically turned the hospital into a legitimate military target.

The IDF released footage of terrorists firing from inside the hospital, as well as recorded phone conversations with personnel at the hospital to double check it had been evacuated before striking it. Secondary explosions, likely from stored munitions and rockets, can be seen.

The IDF further alleged that rockets were launched from the Indonesian Hospital.

Even senior Hamas official Ghazi Hamad, who like the rest of Hamas just lies and continues to lie about well-documented facts – and even stormed out of a recent BBC interview after denying that Hamas intended to kill civilians on October 7 despite overwhelming evidence, much of it produced by Hamas fighters themselves – did not even fully deny the Israeli allegations in 2014, telling the Associated Press, “The Israelis kept saying rockets were fired from schools or hospitals when in fact they were fired 200 or 300 metres away. Still, there were some mistakes made and they were quickly dealt with.”

Amnesty International, in a 2015 report on Hamas torturing and murdering Palestinians during the 2014 war, claimed that “[Palestinians] were interrogated and tortured or otherwise ill-treated [by Hamas] in a disused outpatient’s clinic within the grounds of Gaza City’s main al-Shifa hospital.”

1982-1983: PLO use of hospitals in Lebanon

Hamas’ use of hospitals is not an innovation, but a tactic it borrowed from the PLO in Lebanon. Jack Anderson, a famous US journalist, reported on Aug. 15, 1982:

Yasser Arafat took me on a personal tour of a West Beirut hospital to see the damage done by Israeli shelling. My Lebanese driver heard the doctor there complain to Arafat in Arabic that the PLO gun placements in front of the hospital had invited the Israeli attack…These exclusive Israeli surveillance photos, never before released, show that the PLO placed their field guns and anti-tank missiles literally a few yards away from homes, schools, hospitals…

In 1983, Kenneth R. Timmerman reported on the failure of the media to highlight the PLO’s use of hospitals and other civilian infrastructure:

Most of the sins committed by Western newsmen under PLO constraints were sins of omission: showing bombed buildings but not the arms stockpiled in their basements; describing bombed hospitals but not the PLO fighters whose bases of operations were inside…

Since November

Update: Since Israel took the Al-Shifa Hospital, it has begun releasing evidence that it was used by Hamas, including:

  • Video of a substantial tunnel 10 metres underground with a blast door at the end that was eventually breached by the IDF. New footage of the tunnel, which is hundreds of metres long, shows large rooms, including bathrooms and a small kitchen, running under the Qatari building of Shifa, siphoning off electricity and water for ventilation and other needs from the hospital. That tunnel came out in a civilian home under the floor of a classroom for children and branched off into a new direction from there.  The IDF claims yet another tunnel found on the hospital grounds had an elevator going down and also leads back to Shifa, the central hub connecting the tunnels.
  • Security camera footage from Shifa showing armed Hamas operatives in civilian clothing bringing two hostages into the hospital – notably, as pointed out by Hen Mazzig, Hamas drove them to Shifa rather than multiple other hospitals en route, indicating it is their headquarters – and milling around inside, as well as footage of captured IDF vehicles being driven to the hospital
  • Footage and photos of weapons caches and other material found in the MRI room as well as in a booby-trapped Hamas pickup truck. More recent footage shows a substantial amount of firearms, ammo and even drones uncovered by the IDF at the hospital.

Update: A large-scale operation over several days at the Kamal Adwan Hospital in Jabaliya, claimed to be a Hamas command and control centre, resulted in the filmed surrender of over 70 suspected Hamas operatives, some with weapons in hand, and the uncovering of weapons caches, including guns, anti-tank missiles, explosive devices, other equipment and Hamas intelligence documents. Interrogations of hospital staff revealed further weapons, classified documents and communications equipment were stored in NICU incubators.

  • The director of Kamal Adwan Hospital, Ahmed Kahlot, himself a lieutenant colonel in Hamas since 2010, revealed during interrogations that the hospital hosted Hamas offices and was used as a base of operations and that at least 16 of the staff, including doctors, nurses and paramedics, were Hamas military operatives.

Update: US intelligence agencies are confident that Al-Shifa Hospital was being used as a command and control centre by Hamas and PIJ and that the tunnel network under the hospital was used to store weapons and hold some of the hostages, but that the terrorists had evacuated days before Israel went in and destroyed papers and electronics on their way out. A senior US intelligence official said, “The US Intelligence Community is confident in its judgment on this topic and has independently corroborated information on Hamas and [Palestinian Islamic Jihad]’s use of the hospital complex for a variety of purposes related to its campaign against Israel.”

Update: The IDF tracked the trajectory of a rocket fired at troops in Gaza and found it was fired from Nasser Hospital in Khan Younis. Special forces discovered Hamas vehicles that partook in the October 7 attacks as well as Israeli vehicles stolen during the attack at the hospital; detained hundreds of terrorists, including many that took part in the attack, and other suspects inside and around the hospital; and found weapons and explosives. The IDF also found medication intended for Israeli hostages that was never delivered to them. Intelligence suggested hostages and the bodies of some hostages might be held at the hospital.

Update: The New York Times reported, based on classified Israeli intelligence documents and images, that the tunnel under Al-Shifa was at least 213 metres long and more extensive than revealed by the IDF, and that soldiers had “found underground bunkers, living quarters and a room that appeared to be wired for computers and communications equipment along a part of the tunnel beyond the hospital.” The evidence “suggests Hamas used the hospital for cover, stored weapons inside it and maintained a hardened tunnel beneath the complex that was supplied with water, power and air-conditioning.”

Update: A large-scale raid of the Al-Shifa Hospital complex that began on March 18 following intelligence about the re-infiltration of Hamas and PIJ fighters and officials has so far resulted in the death of at least 200 terrorists and capture of about 800 suspects, among them at least 500 confirmed PIJ and Hamas terrorists, including senior commanders from both groups. During the operation, the head of the Operations Directorate of Hamas’ Internal Security, Faiq Mabhouh, was killed. Millions of dollars as well as weapons and intelligence documents were also recovered. The operation is ongoing as of March 26.

A Hamas official in Lebanon told the Hezbollah-aligned Al-Akhbar, “Nobody should underestimate the size of the infiltration carried out by the enemy army at Al-Shifa Hospital, nor underestimate the importance of the figures who were arrested or executed.”

Update: Former Israeli hostage Hagar Brodutch claims she and her 3 children were transported by Hamas in an ambulance.


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