The largest hospital in Gaza that is still open was invaded by the Israel Defense Forces on Thursday in Khan Younis, a southern city that has been under siege for weeks and once housed over 100,000 displaced Palestinians.
According to "credible intelligence," the IDF told Vox that Hamas was holding prisoners in Nasser Hospital. It appears that terrorists are also operating out of the hospital. Citing their own intelligence and evidence from liberated prisoners, IDF spokesperson Rear Adm. Daniel Hagari stated in a statement that IDF special forces are carrying out a "precise and limited mission" to locate and retrieve the bodies of Israeli hostages who they believe to be in the hospital. Vox is unable to independently verify those accusations, and Hamas has denied them.
Israel has carried out numerous hospital raids in Gaza and the occupied West Bank since the start of the conflict; this is only the most recent. The attacks have been the subject of intense controversy. While opponents of the country's war policy contend that nothing Hamas does can justify the pain Israel exacts on civilians, Israel maintains that Hamas has left it with no alternative but to resort to such methods.
Human rights advocates assert that Israel cannot defend the severe humanitarian effects of the raid in this and other cases, even if the IDF's statements are accurate.Doctors, patients, and displaced Palestinians who were taking refuge there were forced to leave due to the IDF's operation, but many of them are still stuck inside and are unable to escape. That's in spite of the IDF's guarantees that civilians would be allowed safe passage and that the hospital would keep running.
The attack coincides with reports that Israel is planning a land invasion of Rafah, the southernmost city in Gaza, which has a mostly closed border with Egypt. Although the UN claims that any attack in Rafah will result in "carnage," Israel maintains that it is the last known Hamas bastion.This is mostly due to the fact that the population of the city has grown by almost five times since the start of the conflict, primarily as a result of refugees from Khan Younis and other locations farther north.
It’s not clear how the US government will respond to the operation at Nasser Hospital, given increasingly critical rhetoric from top officials and the president himself. Last week, Biden said that Israel had been “over the top” in its approach in Gaza and that civilian suffering and death “had to stop.” However, he has shown no sign of wanting to withdraw any of the US’s ongoing military support to Israel. The White House and the State Department did not immediately respond to requests for comment.
“There is a cost for the United States in not being seen as consistent in how it judges these situations,” Michael Wahid Hanna, US program director for the International Crisis Group, told Vox in an interview. “And for many, there is a sense that such accidents elsewhere would necessarily be seen as unacceptable.” Attacks on hospitals in Syria and Ukraine, for example, have rightly been condemned by the US and the international community.
What we know about the raid
According to the IDF, its attack on Nasser Hospital in Khan Younis was an operation to recover the remains of Israeli hostages thought to be at the facility.
The IDF told Vox, without providing any evidence to support this assertion, that “Hamas terrorists are likely hiding behind injured civilians inside Nasser Hospital right now and appear to have used the hospital to hide our hostages there too.”
IDF spokesperson Hagari stated in a video message that during the raid on Thursday, IDF forces had apprehended suspected militants within Nasser Hospital, including individuals who had taken part in the October 7 attacks. Vox was informed by a hospital emergency department nurse—whose identity Vox is hiding for their safety—that there were no militants present when the raid took place.
According to Hanna, "[The IDF] is not trying anymore, in a sense," to defend its attacks on hospitals. They have practically set the example and followed it. It appears like it's becoming more of a normal operating procedure at this point, with the preparatory procedures just being omitted.
Israeli forces initially ordered the evacuation of Khan Younis in January, but many patients, medical staff, and displaced people remained at the facility. Such an evacuation is difficult — if not impossible — for the seriously sick and injured, especially without transportation like helicopters and a guaranteed safe evacuation route. And for people already displaced in Gaza, there are few other options.
On Tuesday, Israel commanded everyone to evacuate prior to the raid. Vox has reviewed video footage of some medical staff and others evacuating, as well as footage of patients and displaced people crowded into an older building in Nasser Hospital, leaving the surgical and obstetrics and gynecology wards for inspection.
Prior to Thursday’s IDF raid, a drone attack wounded one of the doctors working at the hospital; a separate overnight strike on the hospital wounded six patients and killed one, according to the Associated Press. The Gaza health ministry told the BBC that Israeli sniper fire killed three people and injured two on Tuesday and that a further seven people were shot and killed Monday.
Medecins Sans Frontieres, one of the medical charities operating in Gaza, also said that Israel had shelled the hospital early Thursday morning, even though Israeli forces had told patients and medical staff they could stay there.
“Our medical staff have had to flee the hospital, leaving patients behind,” the group wrote on the platform X on Thursday. “Israeli Forces set up a checkpoint to screen people leaving the compound; one of our colleagues was detained at this checkpoint. We call for his safety and the protection of his dignity.”
There is a narrow exception to medical facilities’ protected status under international humanitarian law (IHL), but it’s not yet clear that what Israel has found at Nasser makes it exceptional. Absent overwhelming evidence that Hamas is using a given hospital to launch military attacks, experts said the facility should not be considered a military apparatus and should maintain its special protected status — and even should an attack be legal, it must be proportional.
In any case, civilians inside the hospital — patients and medical staff — are still protected under IHL.
For months, Israel has been conducting hospital raids.
The IDF has stormed hospitals throughout the Gaza War on the grounds that Hamas fighters may be hiding there. Hospitals are protected by international humanitarian law much more than other civilian facilities.
According to accusations made by Israel and the US, Hamas has been utilizing "human shields," or purposefully positioning itself in places (such as hospitals) where their proximity to civilians and other protected individuals would shield them from assault under the laws of war. It is illegal to utilize human shields in times of conflict.
The claims, which Vox is unable to independently confirm, have been refuted by Hamas. There is evidence, including that analyzed by independent media sites, that Hamas had previously positioned certain activities under hospitals, if not established command and control centers there. Hamas does, in fact, run a vast network of tunnels beneath Gaza.
Even if those accusations were true, that wouldn't give Israel the right to treat hospitals as respectable military targets. According to the law, hospitals can lose their protected status "when acts harmful to the enemy are being committed" at the location, according to Human Rights Watch's Israel and Palestine director Omar Shakir.
Before storming the al-Shifa hospital in November, the IDF made specific claims about how the hospital was being used by Hamas: The militant group’s activities were concentrated in five buildings atop a tunnel network that could be accessed from the hospital, which was used as a command center for rocket launches and militants. They then released photos and video of the operation that they said proved as much. But a detailed Washington Post forensic analysis later found that the “evidence presented by the Israeli government falls short of showing that Hamas has been using the hospital as a command and control center.”
Even if a hospital were being used as a command and control center to commit acts harmful to the enemy, “Israeli authorities cannot treat a hospital as a free fire zone,” Shakir said.
“The protections against indiscriminate and disproportionate attacks not only continue to apply, but actually are heightened at a hospital because even what may seem like a relatively minor attack can have life-altering consequences for patients who are being treated there, as well as for the medical workers that are providing lifesaving care to patients,” he said.
International humanitarian law also requires that Israel provide safe evacuation for civilians in the area. IDF spokesperson Hagari said in a statement that the military had opened a humanitarian corridor at the Nasser Hospital, but reports have indicated that people have been blocked from leaving the premises, with some coming under attack when they tried to flee.
“The Israeli government has consistently failed to provide a safe passage,” Shakir said. “They made these promises, over and over again, with evacuations from Northern Gaza from other hospitals. And consistently there have been well-documented reports of people being killed in airstrikes in purportedly safe zones. So these statements need to be read with a high degree of skepticism.”
The IDF also led raids on the al-Ahli Hospital in Gaza City and the Kamal Adwan hospital in northern Gaza in December, the Ibn Sina Hospital in the West Bank town of Jenin in January, and others. And it has been accused of targeting ambulances and of conducting shelling near hospitals. Human Rights Watch has called for some of these “repeated, apparently unlawful attacks on medical facilities, personnel, and transport” to be investigated as war crimes.
As Israel has made Gaza uninhabitable, hospitals have been the last safe place for civilians to shelter, even while facing a critical shortage of medical supplies. For those still trapped inside Nasser Hospital, that is no longer the case.
