Clashes in Gaza’s hospitals raise the stakes for Israel

Israel is pushing for the eradication of Hamas from Gaza City hospitals despite calls to avoid clashes in health facilities to prevent a worsening humanitarian crisis.

Israel says Hamas uses medical facilities as command bases, making them a legitimate military target, and the U.S. on Tuesday shared declassified intelligence to support those claims.

But fighting over hospitals puts patients, including young children, at risk and raises concerns that Palestinian civilians caught in the crossfire will soon lack comprehensive treatment facilities in Gaza City.

As the world watches, Israel tries to convey the message that it must destroy Hamas wherever the group operates and mitigate the harm to civilians in hospitals.

Hamas likely wanted to force Israel to conduct a delicate operation around medical facilities, said Joel Zivot, associate professor of anesthesiology and surgery at Emory School of Medicine.

I suspect that from Hamas’s perspective this was a strategic decision. The decision to put these sites inside hospitals was precisely because of this problem of trying to enter and attack a military site, he said.

I have a lot of compassion for patients and injured and innocent people, continued Life. But the tragedy is that Hamas built itself into these buildings, so they became military targets.

International humanitarian law under the 1949 Geneva Convention prohibits attacks on hospitals and other medical sites unless they are used for military operations, at which point they become a legitimate target.

This is true if even one fighter launches a single missile from a hospital, which transforms it from a hospital into a military base. But attacks are still considered illegal if they are indiscriminate or disproportionate, such as launching an explosive device in a densely populated area.

Since the start of the war on October 7, there have been 137 attacks on medical sites, according to the World Health Organization (WHO), and more than 500 people have died in those attacks, including 16 medical workers.

The WHO has called for an immediate halt to military operations in hospitals, while human rights groups warn of potential war violations.

Paul O’Brien, executive director of Amnesty International USA, said in a statement to The Hill that his human rights organization has documented illegal and indiscriminate attacks, including hospital bombings, that should be investigated as war crimes.

In an investigative report on Tuesday, Human Rights Watch (HRV) accused Israeli forces of killing and injuring people at al-Shifa, an Indonesian hospital and other health facilities.

Repeated Israeli attacks damaging hospitals and harming health workers, already hard hit by the illegal blockade, have devastated Gaza’s health infrastructure, said A. Kaium Ahmed, special advisor for the right to health in the Croatian Republic, in a statement.

Israel is now fighting over several hospitals in Gaza City, including al-Shifa, which it claims is the site of Hamas’ main command base.

The Israeli Defense Forces (IDF) signaled even before entering Gaza City that they needed to eliminate Hamas operations in Al-Shifa, also the city’s largest hospital.

But even if al-Shifa is the main base of operations, Hamas is a decentralized network that does not have a single central command node, said Michael Nagata, senior national security fellow at the Middle East Institute (MEI) and retired US military. lieutenant general.

The idea that they will completely destroy Hamas, from my point of view, is unattainable, he told reporters during a press conference. Some elements of Hamas will survive, live to fight another day.

Nagata added that Israel relies on outside support from allies and could face a reckoning over how it has waged its war against Hamas if the attacks continue to kill and injure large numbers of civilians.

If they lose enough international support, all this becomes impossible, he said.

The fighting has forced hospitals to the brink as they struggle to access electricity, water and food and to treat wounded patients. In al-Shifa, hospital officials reportedly claimed to be digging mass graves.

Israeli soldiers have tried to take steps to minimize casualties in health facilities as it wages its revenge war against Hamas for killing 1,200 people in a deadly surprise attack on October 7.

Before moving in, Israel ordered the evacuation of 22 hospitals in Gaza City and opened evacuation corridors, although it may be extremely difficult for some patients and staff to leave quickly.

Other Israeli soldiers provide incubators to the pediatric ward in al-Shifa. Israel tried to deliver 300 liters of fuel to the hospital, but later said Hamas intercepted the shipment.

Mick Mulroy, a former US deputy assistant secretary of defense for the Middle East who is now at MEI, said daily tactical breaks should also be used to evacuate patients from hospitals by ambulance.

Mulroy also said that Israel is caught in a complex battle.

“You have newborns in intensive care and you’re trying to defeat the enemy, you’re trying not to get killed and you’re trying to minimize casualties,” he said in a press release. At the end of the day, Hamas caused it, but it is IDF that must do everything it can to avoid these civilian casualties.

As the questions mount, IS is trying to produce evidence of its claims of command posts in hospitals, which Hamas and Palestinian health officials deny.

One video allegedly shows Hamas tunnels near Rantisi Hospital. Others showed apparent Hamas military planning documents, weapons and rooms under hospitals for holding hostages and recording videos.

At Al Quds Hospital, Israel released video this week of what appeared to be a militant with a rocket launcher near the building. Israeli forces claimed to have killed 21 militants at the hospital who fired from the entrance.

This is Hamas, said IDF spokesman Rear Adm. Daniel Hagary in a video showing alleged gun evidence in a hospital basement. The world must understand who Israel is fighting against.

Along with Hamas, Palestinian health officials at Hamas-run hospitals dispute claims that militants are operating from health facilities.

The US has backed Israel’s claims, although it has not described how it gathered its intelligence on the matter.

Pentagon Deputy Press Secretary Sabrina Singh said Tuesday that Hamas is using hospital sites to cover and support military operations and to hold hostages. But Singh said hospitals should continue to treat civilians and they should be protected.

We do not want to see a firefight in a hospital where there are innocent civilians, she told reporters at the briefing.

President Biden called for greater protection for hospitals at the White House on Monday.

I hope and expect that there will be less intrusive actions in relation to hospitals and that we remain in contact with the Israelis, he said.

Russell Berman, a senior fellow at the Hoover Institution who studies the Middle East, said Hamas was known to use hospitals as well as schools to shield its activities from Israeli soldiers.

Israel is not fighting in the hospitals because Hamas is not there, he said. But in the end, this is a fact that will have to be proven.

Fighting over hospitals is expected to threaten what little medical access remains for the beleaguered Palestinians.

The humanitarian group Médecins Sans Frontières shared witness accounts in al-Shifa, where basic supplies are lacking, ambulances have reportedly fallen under crossfire and people have died after losing access to ventilators.

Some hospitals have already closed in Gaza after running out of fuel, and there are growing fears that they will disappear due to Israel’s blockade of the coastal enclave. The Palestinian Red Crescent Society, a humanitarian group, said on Tuesday it had managed to evacuate all patients and staff from Al Quds Hospital.

Zivat, from Emory School of Medicine and also an intensive care physician, suggested evacuating patients to nearby hospitals in Israel, Jordan or Egypt, although he acknowledged those operations were difficult to perform quickly.

If the hospital is not functioning or does not have the capacity to provide service, then evacuate that person, he said. It becomes the responsibility of the international community to help Qatar, UAE, Saudi Arabia [should] come and help these people evacuate and place them in your hospitals.