Explained | How Gaza's Al-Shifa hospital got enmeshed in the Israel-Hamas war

Al-Shifa Hospital, targeted by Israel on Wednesday (Nov 15),stands as the largest medical facility in the Gaza Strip. Both Israel and the United States allege that Hamas militants exploit Gaza's hospitals, including Al-Shifa, to hidecommand posts and hostages using a network of underground tunnels.

Controlling the coastal enclave since 2007, Hamas has reportedly constructed an extensive tunnel city beneath Gaza, spanning hundreds of kilometresand reaching depths of up to 80 metresin some areas.

Despite these claims, Hamas, health authorities, and Al-Shifa directors deny the stashing of military infrastructure within or beneath the hospital complex. They express a willingness to undergo international inspection to verify these assertions.

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Where is the hospitallocated?

Situated a few hundred metresfrom Gaza City's small fishing port, Al-Shifa is a sprawling complex bordered by the Beach refugee camp and the Rimal neighbourhood.

The name "Shifa" is derived from the Arabic word for "healing," a common term for hospitals in the Middle East.

As of Tuesday (Nov 14), the hospital was caring for 36 babies, with medical staff noting a lack of a clear mechanism for their relocation despite Israeli efforts to provide incubators for evacuation.

Three premature babies have already succumbed to the challenges arising from the hospital's fuel shortage, which occurred over the weekend and affected the generators powering their incubators.

Historical background

Constructed in 1946 during British rule, two years before Britain withdrew from Palestine, Al-Shifa survived the Egyptian invasion in 1948 and subsequent decades of Egyptian military rule.

Following Israel's capture and occupation of the Gaza Strip in 1967, Shifa remained a focal point for Palestinians during clashes with Israeli troops.

Throughout its history, Shifa witnessed incidents, including a reported gun battle in 1971 between a Palestinian militant and an Israeli army patrol within the hospital premises.

In 1987, during the First Intifada against Israeli occupation, confrontations occurred outside Shifa between Palestinians and Israeli soldiers.

During the 1980s, the hospital complex underwent a redesign by Israeli architects, reportedly with American support. Claims by Zvi Elhyani, founder of the Israel Architecture Archive, suggest that an underground area created during the revamping was later appropriated by Hamas. However, evidence supporting this assertion is not provided.

In 1994, control of Shifa shifted from the Fatah-dominated Palestinian Authority to Hamas following the latter's surprise election victory in 2006 and subsequent military takeover of Gaza in 2007.

During the power struggle between Fatah and Hamas leading up to the takeover, fighters from both sides received treatment at Shifa under a truce agreement that neither side would harm the other's wounded.

Previous allegations and verification challenges

Israel had previously claimed that Hamas used underground areas in Shifa to hide during the 2008-2009 war, where over 1,400 Palestinians and 13 Israelis lost their lives. However, verifying such claims has proven challenging.

The recent events surrounding Shifa Hospital showthe complexities and longstanding historical context surrounding this vital medical facility in the Gaza Strip.

White House says Hamas using Al-Shifa for military operations

The White House announced on Tuesday (Nov 14) that it hasintelligence indicating that Hamas is usingAl-Shifa for military operations, potentially storing weapons, and characterised these actions as war crimes.

National security spokesperson John Kirby stated that the information confirms Hamas is using the hospital for command and control purposes, emphasising that such actions violate international law.

According to Kirby, the United States obtained this information through various intelligence methods. He said that the Biden administration downgraded the classification level of some data on Tuesday to share its conclusions with reporters.

Kirby specified that Hamas and the Palestinian Islamic Jihad were allegedly using several hospitals in Gaza, including Al-Shifa, to hideor support their military operations and to hold hostages. He noted that these groups were prepared to respond to Israeli military operations against these facilities.

Kirby stressed that while Hamas' actions complicate Israel's efforts to root out the group, it does not diminish Israel's responsibility to protect civilians. He made it clear that the USgovernment does not endorse airstrikes on hospitals and stressed the need to avoid endangering innocent and vulnerable people seeking medical care.

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In the latest, Israeli forces have surrounded Al-Shifa hospital, claiming it serves as an underground headquarters for Hamas militants.

In response, Hamas, the ruling group in Gaza, denies the presence of fighters in the hospital, alleging that hundreds of patients and thousands of civilians are trapped on the premises, facing sniper fire and drone attacks.

The situation at Al-Shifa, particularly the reported siege, has raised international concern, including from the United States, Israel's closest ally. Israel denies the hospital is under siege, asserting that exit routes are provided for those inside. However, conflicting accounts make it challenging to independently verify the situation.

(With inputs from agencies)