Al-Shifa Hospital

For other hospitals, see Shifa Hospital (disambiguation).

Al-Shifa Hospital
Geography
Location	Gaza, Gaza Governorate, Palestinian territories
Coordinates	31°31′27″N 34°26′39″E
Organisation
Care system	Internal medicine, surgery, pediatrics, ophthalmology, obstetrics, gynecology
Type	Treatment
History
Opened	1920s

Al-Shifa Hospital (Arabic: مستشفى الشفاء Mustašfā š-Šifāʾ [musˈtaʃ.fa‿ʃ.ʃiˈfaːʔ]) is the largest medical complex and central hospital in the Gaza Strip, located in the neighbourhood of northern Rimal in Gaza City.

Originally a British Army barracks, the site was transformed into a healthcare facility, the Dar al-Shifa or "house of healing", by the government of Mandatory Palestine in 1946. The hospital was expanded during the Egyptian and later Israeli occupations during the 1980s. In the 21st-century, the hospital has been prominent during the Gaza–Israel conflict. During the Gaza War (2008–2009), much of the media coverage came from correspondents reporting from the hospital.

In 2014, Amnesty International accused Hamas of using the hospital for torturing and murdering alleged Palestinian collaborators. A former Israeli official also said Hamas leaders were hiding in the hospital. Norwegian doctors Erik Fosse and Mads Gilbert, who were working at the hospital, stated that they did not see any evidence of military activity at the hospital during the war.

During the 2023 Israel-Hamas war, Israel and the United States, claimed that the hospital is being used as a military base, which Hamas and hospital administrators denied. The hospital was subsequently raided by Israeli forces on 14 November 2023, which reported to having found weapons in the building. The raid was widely criticized by governments, United Nations agencies and aid organisations. Later a shaft was discovered on the perimeter of the hospital, described by the IDF as a "tunnel entrance", CNN confirmed the existence of the tunnel, but the New York Times noted that this did not settle the issue of whether the hospital had served as a command center. During the 1980's, Israel expanded the hospital with functional basements for maintenance and administration purposes; according to Israel, Hamas eventually appropriated these spaces, then expanded them with its own system of tunnels and bunkers. Multiple experts on France24 confirmed that the tunnel found was a Hamas tunnel, with its construction matching tunnels found in previous conflicts.

Israel has been criticized for the raid on the hospital, with the head of the World Health Organization calling it "totally unacceptable".

1948–1967

Dar al-Shifa, which means "house of healing" in Arabic, was originally a British Army barracks, but was transformed into a center to provide treatment for quarantine and febrile diseases by the government of the British Mandate of Palestine in 1946. Prior to the 1948 Arab-Israeli War, al-Shifa was one of two hospitals in Gaza, the other being al-Ahli Arab Hospital. When the Egyptians administered the Gaza Strip after the war, the quarantine and febrile diseases department was relocated to another area in the city, and al-Shifa developed into the central hospital of Gaza. Initially, a department for internal medicine was established, followed by a new wing for surgery, and subsequently new buildings for pediatrics and ophthalmology were added to the hospital. In 2013, a special surgical building was opened.

After a brief occupation by Israel during the 1956 Suez Crisis, the returning Egyptian administration, under directives by president Gamal Abdel Nasser, paid more attention to the health and social situation of Gaza, and al-Shifa was expanded to include departments for obstetrics and gynecology. They established a new health administration for the Gaza region, later building several clinics throughout the city that were attended by doctors from the hospital. The largest department in al-Shifa was internal medicine (100 beds), then pediatrics (70 beds), surgery (50 beds), ophthalmology (20 beds) and gynecology (10 beds).

1967–2005: Israeli occupation–Israeli disengagement from Gaza

When Israel occupied Gaza in the 1967 Six-Day War, the entire Egyptian administration and staff in the hospital were taken prisoner. By 1969, the department of internal medicine grew to contain several sub-departments.

Architecture and expansion

The hospital underwent a major Israeli renovation and expansion. The project was designed by Israeli architects Gershon Tzapor and Benjamin Edelson in their Tel-Aviv office, both well experienced in the construction of high standard hospitals. The project was done in the 1980s as part of a project to improve the living conditions of Gaza residents.

This project came as part of the Israeli idea of mutual existence between Jews and Arabs. The project intended to house 900 beds in the entire campus, a 50 dunam area. The Israeli additions were considered to be in the same standard as those hospital wings in Israeli hospitals such as Tel HaShomer. The architecture of the hospital came to reflect the modernist and post modernist trends in Israeli architecture. In particular was the similarity of the project to existing Israeli hospitals such as the facades of the Bezalel building in Jerusalem. Similarly to other Israeli projects, the building was built with sharpened diagonal staircases, akin to projects by Israeli architects Dan Eitan, Shlomit Nadler and others at the time.

During a renovation in the 1990s a large basement was added, which the IDF later said was appropriated by Hamas and used to store weapons. According to Newsweek the bunker "constructed decades ago, includes a secure underground operating room and tunnel network." According to former Israeli PM Ehud Barak in an interview with CNN, the tunnels were built in the 1980s by Israel as part of the hospital's construction. In particular, in 1983, the Israelis built "a secure underground operating room and tunnel network" beneath Building 2 of the hospital. According to Israeli officials, Hamas subsequently dug out the original basement, later adding new floors and connecting it as a hub within their existing tunnel system.

2005–present: Palestinian control

In 2005, Israel withdrew from Gaza and handed over control to the Palestinian Authority.

2007 Fatah–Hamas conflict

During the Fatah–Hamas conflict in June 2007, Fatah and Hamas clashed at the hospital, killing one member of each organization. Some injured people brought to the hospital were killed by Hamas militants once inside. A doctor in the hospital reported, "The medical staff are suffering from fear and terror, particularly of the Hamas fighters, who are in every corner of the hospital." Hamas fired about 600 doctors affiliated with Fatah, threatening to shoot them if they returned to the hospital.

The two Norwegian medical doctors, Erik Fosse and Mads Gilbert, have done humanitarian work at the hospital.

2008–2009 war

During the Gaza War (2008–2009), Al-Shifa hospital overflowed with Palestinians injured by Israeli airstrikes. Already before the war, the blockade of Gaza had caused a shortage of ventilation systems, patient-handling systems such as operating tables, beds, trolleys, and various types of medical equipment. These shortages affected clinical work.

In the first 13 days of the war, about 360 surgical operations were performed. Among the people brought to the hospital, about 340 were pronounced dead on arrival. The number of injuries treated during this period was 1039, but this is regarded as an underestimate, since it doesn't include many patients with minor injuries.

Much of the media coverage of the 2008–2009 Israel–Gaza conflict was broadcast or written by correspondents reporting from the hospital.

During the 2008–2009 Gaza War, The New York Times reported that "armed Hamas militants in civilian clothes roved the halls" killing alleged collaborators. Several reports by Israeli Shin Bet officials alleged that Hamas used Al-Shifa hospital as a bunker and refuge, knowing it would be spared by air strikes. The Israeli allegations were difficult to confirm because Israel had banned reporters from Gaza at the time. PBS' Wide Angle programme, which interviewed a doctor from Gaza who preferred to remain anonymous, said that he believed that Hamas officials were present under the hospital. In 2009, the Palestinian Health Ministry, run by the Palestinian Authority in the West Bank, accused Hamas members of taking control of wards in Shifa Hospital, using them for interrogation and imprisonment, while withholding medical care. The ministry also called on Hamas to stop stealing and redirecting the medical resources to the organization's warehouses and centers (outside of the hospital).

2014 war

During 2014 Gaza War, Israeli operations, initiated following Hamas kidnappings and attacks on Israeli civilians centers, killed more than 2,100 Palestinians and injured over 11,000. During the war, a total of 8,592 patients visited Al-Shifa hospital, and most were civilians. Of these, 490 (5.7%) were dead on arrival. After a detailed triage, 1808 patients were admitted, of whom 78 (4.3%) died in the hospital. 842 major life-saving surgeries were performed, including 90 laparotomies, 146 orthopaedic fixations, 106 craniotomies, 69 thoracotomies/airway interventions, 38 vascular procedures, 49 amputations, 68 debridements, and 176 other procedures.

Compared to the 2012 war, Intensive Care Unit (ICU) admission rates doubled and ICU mortality rates tripled. The authors speculate that might be due to the "extreme character" of the attacks in 2014.

American journalist Max Blumenthal was in Gaza during the 2014 war. Blumenthal wrote that doctors were burnt out after weeks of amputations and shrapnel extractions, with some "on the brink of insanity". One of the hospital directors screamed "Can't the world see that we're human?". Blumenthal reported that many refugees had setup tents beside the hospital during the war.

Former Israeli Navy commander Eli Marom said Hamas leaders were hiding in basement of Al-Shifa hospital. Washington Post London bureau chief William Booth wrote for The Washington Post that the hospital had become a "de facto headquarters for Hamas leaders, who can be seen in the hallways and offices." Orde Kittrie described Shifa hospital as Hamas' headquarters. Hamas officials were also described as disguising themselves in medical attire within the hospital. Amnesty International documented how the Hamas forces used the abandoned areas of the hospital to abduct, torture, and kill Palestinians accused of collaborating with Israel. Wall Street Journal correspondent Nick Casey tweeted a photo of Hamas MP and media spokesperson Mushir Al Masri conducting media interviews right outside of the Shifa hospital, but later deleted it. The Guardian journalists saw Hamas officials at the hospital. Reporting from the Gaza hospital to the Finnish newspaper Helsingin Sanomat, Aishi Zidan reported that a rocket was fired from the area of the hospital. This was seized upon by the Israeli press, prompting the journalist to take to Facebook to note that her words had been taken out of context and used as propaganda, and that the rocket had actually been fired from "somewhere behind the hospital".

Norman Finkelstein states that the official Israeli report of the war did not accuse Hamas of doing anything at the hospital more serious than "security service interrogations" and criticized the Amnesty report, claiming it omitted evidence to the contrary. Professor Sara Roy concluded that "it was highly improbable that Hamas made military use of the hospital building". Dr. Erik Fosse, who worked at the hospital at the time, found no evidence that it was a Hamas base. Norwegian doctor Mads Gilbert, who also worked at the hospital during the war, rejected that the hospital was used a base by Hamas officials or militants.

2023 war

Main articles: Al-Shifa ambulance airstrike, Al-Shifa Hospital siege, and Alleged military use of al-Shifa hospital

Wounded Palestinians wait for treatment at the overcrowded emergency ward of Al-Shifa hospital in Gaza City following an Israeli airstrike on 11 October 2023

During the 2023 Israel–Hamas war, hospital administrators at al-Shifa said the hospital was overwhelmed with wounded and dying people, operating well over its 700-bed capacity, and was running short on fuel, beds, and medical supplies. The hospital is also housing thousands of displaced Palestinians seeking shelter from airstrikes during the war.

On 3 November, amid the 2023 Israeli invasion of the Gaza Strip, an Israeli airstrike hit an ambulance convoy, resulting in dozens of wounded and several deaths. According to Israel, the ambulances were being used to transport Hamas fighters and weapons, a charge Hamas denied, and Reuters . According to Gaza officials, the ambulances were transporting critical injured patients from the hospital to the Rafah crossing with Egypt. The Palestinian Red Crescent Society said the strike killed 15 people. UN Secretary-General Antonio Guterres said he was "horrified by the reported attack in Gaza on an ambulance convoy outside Al-Shifa hospital" while World Health Organization chief Tedros Adhanom Ghebreyesus said he was "utterly shocked". On 7 November, the Human Rights Watch determined that the strike was "apparently unlawful and should be investigated as a possible war crime", noting that ambulances and other medical transportation must be allowed to function and be protected in all circumstances". It added that the use of ambulances for military purposes would also be against the rules of war, but it had found no evidence of this. The Washington Post stated no weapons or individuals wearing military garb could be seen in videos it reviewed, and Human Rights Watch said it "did not find evidence that the ambulance was being used for military purposes".

On 6 November, Israeli forces struck and destroyed the solar panels atop of Al-Shifa Hospital, leaving the facility totally reliant on back-up generators powered by rapidly dwindling fuel supplies. Israel has offered to supply fuel and evacuate children from the hospital. On 11 November, the IDF announced that it would help transporting babies from the hospital to a safer one on 12 November.

In the lead up to the 14 November 2023 raid of the hospital, the Israeli government called for the evacuation of the building. This evacuation, considered a "death sentence" by the World Health Organization, was rejected by medical staff who were unwilling to leave patients behind. On the day of the raid, the hospital housed 22 intensive care patients, 36 premature babies and more than 2,000 displaced people according to the medical staff. The IDF says that weapons, ammunition and an operational command centre were uncovered in the building, including several assault rifles and grenades found in the hospital's MRI room, a claim that Hamas dismissed. The IDF also said that they delivered incubators, baby food and medical supplies to the hospital. The United Nations and the Red Cross expressed concern over the incursion into hospital, which was condemned by World Health Organization director-general, Tedros Adhanom Ghebreyesus, who advocated for the safety of hospital patients and staff, even if the hospital was being used militarily. Many political commentators such as Jeremy Bowen of BBC News and Mouin Rabbani, were not convinced that the Israeli evidence proved this was the headquarters of the Hamas operation. BBC News and CNN conducted video analyses concluding the Israeli army apparently rearranged, or added, weapons for the media tour. The BBC News also reported it found an Israeli video with the alleged discoveries had been edited despite the IDF Spokesperson's claims footage was unedited and filmed in one take. After touring the tunnels under the Hospital alongside the Israeli military, Haaretz stated "There is no way the hospital administrators didn’t know what was happening.. there is no doubt they were used by Hamas company, battalion and brigade , and that fighting was directed from there in recent rounds, if not in the current war as well."

A team with representatives from the UN and the WHO visited the hospital on November 18. They discovered a mass grave, which they were told contained more than eighty bodies. Numerous patients have died because the hospital lacks essential supplies, including oxygen, fuel, and antibiotics. On 19 November, the 31 living premature babies receiving care at al-Shifa were evacuated to Emirati Hospital in Rafah. 28 babies were then evacuated to Egypt on 20 November.

The director of the hospital Mohammad Abu Salmiya was detained on 23 November by Shin Bet for questioning when traveling on a World Health Organisation convoy with other staff. The detention was condemned by Hamas.

Israeli media campaign

Further information: Hasbara

Before and after the siege, the Israeli government engaged in a public relations campaign aimed at justifying its siege and takeover of the hospital. On 11 November, the Israeli Ministry of Foreign Affairs tweeted a video purportedly of a nurse at al-Shifa in which she backs up Israeli claims of Hamas usage of the hospital. The Nation described the campaign as propaganda, and stated that the video was widely mocked, with many Arabs questioning its authenticity, and the ministry deleting the tweet in a day. The Daily Beast, remarking on the video, said "Everything about it smacked of high school theater—from the botched accent that sounded like it was straight out of an Israeli soap opera to the perfectly scripted IDF talking points rolling off her tongue." France 24 found the video to likely be staged. Subsequently, France 24, citing three experts, Michael Milshtein of Tel-Aviv University, Scott Savitz, an Engineer, and Daphne Richmond-Barak of Reichman University in Israel, found the Israeli-released footage of tunnels beneath Shifa hospital "do indicate that these tunnels have all the characteristics of tunnels that belong to the Hamas terrorist group."

Some experts have said that questionable evidence such as claiming an Arabic calendar was a Hamas shift schedule, and displaying curtains as evidence that hostage videos were filmedl has weakened Israel's credibility, with H. A. Hellyer stating “The irony is they might find something and nobody is going to believe them, at this point their credibility is shot." Adding "We don’t take seriously what a terror group says, but we do take seriously what an army says, especially one that’s an ally of ours,” he said. “So we naturally hold it to a higher standard.” Muhammad Shehada, Euro-Mediterranean Human Rights Monitor Chief of Programmes and Communications, said of the requirements that Israel imposed on media outlets on their supervised tours of al-Shifa that the outlets have essentially agreed to broadcast propaganda, saying of the outlets "You are not allowed to speak to any Palestinian or Gazan to challenge what the IDF is spoon-feeding you. You are not allowed to go beyond the tour that the IDF has staged, so you stick to what the IDF wants to show you and where they take you. And you have to review the material with them before you publish, so that the result of that is not journalism. It’s propaganda."

Jeremy Scahill, in an article published on 21 November 2023 by The Intercept, also referred to Israel's attempts to justify its siege of the hospital as propaganda. Noting that, before the siege, Israel had published animations purportedly depicting a sophisticated underground Hamas command and control center, Scahill opined that the evidence offered by the IDF after taking control of the hospital was unimpressive. Scahill observed that it was not a secret that there existed tunnels and underground rooms at the Al-Shifa Hospital complex–indeed, Israel assisted in their construction and hired Hamas militants as guards to protect the contractors who worked on the underground facilities in the 1980s. Scahill said that remarkable evidence should be required of Israel and its supporters to demonstrate their remarkable claims and, failing that, they should be held accountable for the attacks on the hospital, which disproportionately affected wounded and sick civilians. On the other hand, Scahill wrote that Hamas should also be held accountable if it is shown that they did in fact use the hospital as a command and control center.

Haaretz presented a visual analysis of tunnel footage released by the Israeli army spokesperson and journalists who entered the tunnels. It mapped out how the tunnels passed through the "heart of the compound", and concluded that this represented "unequivocal proof" that Hamas used the hospital for military purposes. Conversely, a visual analysis by The Telegraph concluded that "While the footage does prove the existence of tunnels underneath the complex, it remains unclear whether they formed part of a Hamas command centre, as Israel claims."

See also

• List of hospitals in the State of Palestine

Bibliography

• Husseini, Rafiq; Barnea, Tamara (2002). Separate and Cooperate, Cooperate and Separate: The Disengagement of the Palestine Health Care System from Israel and Its Emergence as an Independent System. Greenwood Publishing Group. ISBN 0-275-97583-5.