A man rushes a child into the al-Shifa Hospital

A man rushes a child into the al-Shifa Hospital after Israeli forces bombed a home in Gaza City on November 4, 2023.

(Photo: Bashar Taleb/AFP via Getty Images)

Human Rights Watch Sounds Alarm as Israeli Forces Close In On Gaza's Largest Hospital

"Hospitals must always be protected. No area is a free-fire zone," said one HRW director. "World leaders should urgently act to prevent further mass atrocities."

As Israeli forces moved toward the largest hospital in the Gaza Strip on Thursday, a leading human rights group expressed concern about the patients, medical staff, and sheltering civilians there, along with Israel's recent calls to evacuate the facility.

The Israeli bombardment of Gaza, launched in response to a Hamas-led attack on southern Israel on October 7, has killed more than 10,800 Palestinians, including over 4,400 children, and displaced an estimated 70% of the strip's 2.3 million residents.

Israel—which is now also conducting ground operations—has bombed homes, schools, religious buildings, medical facilities, and even an ambulance convoy outside Gaza City's al-Shifa Hospital, where an estimated 50,000 to 60,000 people are sheltering.

As Israeli troops neared the hospital on Thursday, Human Rights Watch (HRW) said on social media that "with ongoing strikes and fighting nearby, we are gravely concerned about the well-being of thousands of civilians there, many children among them, seeking medical care and shelter, including people on life support, those who lost limbs in air strikes, and burn victims."

"Videos from inside al-Shifa's compound, verified by HRW, show hundreds of people in a courtyard next to the [emergency room], including sheltering civilians, medics tending to patients, emergency workers collecting dead bodies, and journalists. Satellite imagery shows many tents there," the group said. "Videos and photos taken in recent days show civilians and emergency workers bringing hundreds of injured and dead people to the hospital day and night, by ambulance, by car, on foot, and by donkey cart. People regularly walk in and out of the hospital's main entrance."

The Israel Defense Forces (IDF) has alleged that Hamas' main base of operations is under hospital. Taking credit for the ambulance attack on November 3, the military said that "a Hamas terrorist cell was identified using an ambulance. In response, an IDF aircraft struck and neutralized the Hamas terrorists, who were operating within the ambulance. We emphasize that this area in Gaza is a war zone. Civilians are repeatedly called upon to evacuate southward for their own safety."

HRW highlighted Thursday that Israel has not made public any proof to support it claims about the ambulance attack—which critics have pointed to as yet another war crime in what experts around the world have called a "genocidal" assault of Gaza.

"Al-Shifa and the surrounding area continue to come under fire," HRW noted. "Hospitals have special protection under the laws of war, which they only lose if they are being used to commit 'acts harmful to the enemy' and after due warning. Evacuation of hospital patients and staff should only be a last resort."

"Israel's military has called for the evacuation of al-Shifa Hospital, and said on November 8 that 'time is running out' for civilians to evacuate Gaza's north via Salah al-Din Road, which Israel's military says it keeps 'open' for a few hours at a time," the group continued, sharing a map of the region that shows fires along the evacuation route.

HRW declared that "Israel's evacuation orders raise grave concerns. Warring parties should issue effective warnings when conditions permit. But calls suggesting all civilian structures are targets or alerting civilians to flee without a safe passage or safe place to go does not suffice."

"Civilians who remain in place after an evacuation warning—including those who can't leave, fear moving, or don't want to be displaced—don't lose their protections as civilians under the laws of war. No area is a free-fire zone," HRW stressed, using a term popularized by the "shoot anything that moves" approach of U.S. soldiers during the Vietnam War. "All parties to the conflict have an obligation to take constant care to protect civilians in their military operations, and take all feasible precautions to protect them from the effects of attack."

"World leaders should call on Israel to protect civilians and civilian infrastructure and to not carry out unlawful attacks," the organization concluded. "They should urgently act to prevent further mass atrocities."

Al Jazeera reported Thursday evening that a Palestinian Health Ministry spokesperson "says an Israeli attack hit a car in the yard of al-Shifa Hospital" and "exact casualties are not yet known."

While some political leaders around the world have joined growing global demands for a cease-fire, U.S. President Joe Biden—who recently asked Congress for $14.3 billion to support Israel's war effort, on top of the $3.8 billion in military aid the nation already gets annually—told reporters on Thursday that there is "no possibility" of a cease-fire.

That came after the White House said earlier Thursday that Israel has agreed to daily four-hour pauses for civilians to flee northern Gaza—though, as Reuters later reported, "there was no sign of a let-up in the fighting that has killed thousands and laid waste to the seaside enclave."

While staff at al-Shifa Hospital continues to treat patients despite dwindling supplies, some Gaza facilities have had to scale back services or fully shut down over the past month—leading to warnings that the strip's healthcare system is on the brink of collapse.

The Palestine Red Crescent Society announced on social media Thursday that "a PRCS paramedic volunteer was injured and two ambulances went out of service during the occupation forces' targeting of the area of the al-Awda Hospital in northern Gaza."

The PRCS also runs al-Quds Hospital in Gaza City, which has had to cease most operations this week "to ration fuel use and ensure a minimum level of services in the coming days," according to Al Jazeera.

"We're talking about shelling about 15 metesr [16 yards] from the hospital building," PRCS spokesperson Nebal Farsakh told the outlet Wednesday. "Most of the buildings around [the] hospital have been almost completely destroyed. The bombings are getting closer and closer to the hospital, and we fear a direct hit to the hospital."

"We have about 500 patients inside the hospital. We have 15 patients in the [intensive care unit]," she added. "They are wounded and on respirators. We have newborns in incubators. We have 14,000 displaced people, the majority of whom are women and children."

Mohammed Abu Msbeh of PRCS warned Thursday that al-Quds Hospital only has around 24 hours of fuel for its generator, and if it is not replenished, there will be "a total shutdown of all hospital services."

The World Health Organization said Thursday that lack of fuel in Gaza has also "led to the shutting down of desalination plants, significantly increasing the risk of bacterial infections like diarrhea," and "disrupted all solid waste collection, creating an environment conducive to the rapid and widespread proliferation of insects [and] rodents that can carry and transit diseases."

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