The Real Gaza Hospital Crisis

The media firestorm over whether Israel attacked the al-Ahli hospital in Gaza is over. It was an errant rocket shot by the Iran-backed Islamic Jihad group that exploded near the compound. But another media firestorm is brewing, and it will focus squarely on the Al-Shifa hospital in Gaza City. Al-Shifa is the largest hospital in Gaza. It is also, according to numerous and credible reports, a Hamas base of military operations.

The specifics have been revealed in a steady drip of open-source information dating back to 2006, when a PBS documentary showed Hamas fighters roaming Shifa’s halls, intimidating staff, and denying access to parts of the hospital. The following year, according to Human Rights Watch, Hamas fired at its rival group Fatah from within the Shifa hospital compound during a Palestinian civil war. As one doctor said, “the medical staff are suffering from fear and terror, particularly of the Hamas fighters, who are in every corner of the hospital.”

In 2008, the year that marked the first rocket war between Hamas and Israel, the New York Times noted that Hamas was operating openly within the hospital, and that members of the group murdered a patient there. One Times report stated that the Hamas leadership was located in a bunker under the hospital’s burn ward, while the group fired rockets from areas near the hospital, in an effort to deter an Israeli response. The following year, the Times cited Yuval Diskin, the former head of Israel’s internal security services (Shin Bet), who said Hamas leadership was holed up in a bunker below building number 2 of Shifa Hospital.

Avi Dichter, another former head of the Shin Bet, stated in 2009 that Hamas’s operations in Shifa was an open secret. It was such an open secret that Hamas operative Rami Misbah Abed-Rabbo admitted himself that Hamas took over a large bunker under Shifa during the war with Israel in 2008.

During the 2014 war between Hamas and Israel, multiple credible media outlets reported on the Hamas operations in the Gaza hospital. The Washington Post reported that Shifa was a “de facto headquarters” for Hamas. Wall Street Journal reporter Nick Casey tweeted an image of a Hamas spokesman giving an interview at a Gaza hospital, saying, “You have to wonder … how patients at Shifa hospital feel as Hamas uses it as a safe place to see media.” The tweet was later deleted. Similarly, Palestinian journalist Radjaa Abou Dagga wrote about how Hamas used Shifa for military purposes, but then sought to remove the article, fearing for his family’s safety.

An open source intelligence report also published in Israel that year cited Palestinian sources who noted that Hamas used Shifa’s x-ray department as a jail and interrogation facility. An Amnesty International report the following year cited evidence of Hamas torturing and killing prisoners in Shifa.

In the course of my own research on Hamas over the last 10 years, multiple Israeli officials across multiple government agencies have confirmed the existence of a Hamas command center below the Shifa hospital. The group is believed to have constructed significant infrastructure well beneath the ground. This includes an operations room that effectively serves as the eyes and ears of Hamas across the Gaza Strip, with direct and secure lines to the Iranian regime, Hezbollah, other state patrons, and nonstate partners.

Since the Hamas attack of October 7, Israel has warned that it plans to destroy all Hamas infrastructure in the Gaza Strip. In private conversations with former Israeli officials, I have heard Shifa mentioned multiple times. Nobody has stated that Israel is preparing to destroy the command center. But the implication is not hard to miss.

A ground invasion might lead to Israeli forces working to clear the compound, floor by floor, room by room. However, such a battle would put Israeli forces at a disadvantage. If given a choice, Israel would almost certainly elect to destroy the command center by air. This would, of course, mean additional misery for the beleaguered people of Gaza.

There is a legal term for what Hamas is doing. It is using the medical staff and patients as “human shields” to protect Hamas terrorists from lawful attack. Doing so is a war crime, prohibited by the international law of armed conflict.

The United Nations and governments worldwide have condemned the use of human shields. However, none of these actors have come forth yet to condemn Hamas for using al-Shifa as a military headquarters.

The coming battle over Shifa promises to be intense. The Israeli, American, and other governments should reveal what is known about the Hamas presence there right now. Hamas must be pressured to vacate if tragedy is to be averted.

Of course, this is easier said than done. Hamas is defiant as Israel prepares for a ground invasion now.  Still, the coming standoff need not lead to the destruction of the Shifa hospital. Rather, Israel should continue to clear the northern Gaza Strip and even bombard the entire area surrounding Shifa once civilians have been evacuated. When it is safe for Israeli forces to enter, they should surround the hospital and demand that unconditional surrender of the Hamas leadership still holed up inside.

This is a drama that should play out in front of the entire world. Should Hamas refuse to surrender after a period of days or even weeks, Israel should carefully enter the compound. The first goal must be to defend the lives of all patients and doctors inside. But, when all is said and done, Israel must emerge from this compound with photos, videos, captured weapons, and other evidence of Hamas military activities that took place under the hospital.

Many critics of Israel have questioned whether a ground invasion could end Hamas. It’s a fair question. There may not be a military solution on its own. But military operations supplemented with damning evidence that Hamas has held the Gaza Strip hostage could prove to be a dramatic moment that swings world opinion against the Iran-backed terrorist organization, once and for all.

Jonathan Schanzer is senior vice president for research at Foundation for Defense of Democracies, a nonpartisan think tank in Washington, D.C. Follow him on X @JSchanzer.