To people in Gaza, Al Shifa is the biggest and most advanced hospital around — a lifeline, in normal times, and now a place of refuge from relentless Israeli airstrikes.
More than 60,000 people are sheltering there. But to the Israeli military, it is a threat, and, perhaps, a target.
On Friday, hours before the Israeli military stepped up its bombardment of Gaza in retaliation for Hamas’s mass killings of Israelis three weeks ago, it held a news conference in which it said that Al Shifa conceals underground command centers for Hamas — raising fears that the military was laying the groundwork for attacking the hospital.
Hamas “does its command and control in different departments of the hospital,” said Rear Adm. Daniel Hagari, the chief spokesman for the Israeli military, speaking in English and citing intelligence sources that he did not release. He displayed an illustrated map of the hospital marking what he said were several underground Hamas installations in the complex.
“This is where they direct rocket attacks, command Hamas forces,” he said at the news conference held in Tel Aviv.
Israel has long maintained that Al Shifa is used as a Hamas war room and that its leaders hide under the hospital. But this was the first time the military had publicly laid out where it said specific installations were hidden, based on what they said was intelligence.
Admiral Hagari also played a recording of a call, whose origins he did not specify, in which an unidentified man tells a woman that Hamas’s military headquarters are below the hospital.
“God forbid!” the woman, who is also unnamed, replies in the audio recording.
Salama Marouf, the head of the Hamas-run Gaza government media office, denied the accusation in a news conference on Friday night, saying Israel had “failed to provide a single piece of evidence” supporting its claims about Al Shifa. He said the recording Admiral Hagari cited was “fabricated.”
On Saturday, Admiral Hagari said the news conference about the hospital was part of a continuing effort to “expose” Hamas’s “exploitation of the civilian population in the Gaza Strip.”
Also on Saturday, Israel released a pair of videos that it said showed Palestinian prisoners who had been “involved” in Hamas’s Oct. 7 raids on Israel speaking about Hamas’s use of Al Shifa.
“I know, for example, according to what I’ve heard, the Shifa Hospital, they’re using it, they’re hiding there,” says one, who describes himself in the video as a paramedic.
Israel has long viewed civilian infrastructure like malls and places of worship as legitimate targets for its strikes, saying Hamas uses civilians as human shields by running operations in and around such places. And it says that when attacking, it attempts to distinguish between civilians and combatants.
Yet civilians continue to pay the price. Gaza’s health ministry has released the names of at least 1,500 children under the age of 10 who it says were killed in Israeli airstrikes between Oct. 7 and Oct. 26.
Al Shifa’s usual capacity is 700 beds. But it is now housing more than 60,000 people — the wounded, those trying to care for them and tens of thousands more who have taken refuge there, believing that a hospital would offer them some protection.
Among them are a growing number of premature babies and wounded children who are the only remaining survivors in their families. In these days of chaos and fear, they have no one but the staff to look after them.
The laundry of the displaced hangs out the windows and all along the metal fence around the hospital. Their children run down the fluorescent-lit corridors. At night, they huddle together under colorful blankets, while the staff prepare for another day of treating patients without enough fuel, water or critical medications. During periods of heavy bombardment, the building has been shaking every 15 minutes.
Hospital staff say they are short of everything imaginable.
Space: The buildings were so crowded there is barely any place to stand.
Time: Dr. Abu Sittah, a British-Palestinian plastic surgeon who put his London practice on hold to volunteer at Al Shifa’s burn treatment unit, said in an interview with a Lebanese television journalist that he had been performing up to 12 operations a day, barely leaving the operating room in three days.
Medical supplies: Dr. Abu Sittah told CNN the hospital was running out of burn dressings and rods and pins to patch up broken bones, while Dr. Nasser Bulbul, the head of the premature and neonatal care departments, said he was short of lifesaving medications that were normally given to premature babies in the first two hours of their lives.
Most of all, the doctors said, they needed fuel. Like every other hospital in Gaza trying to keep the lights on under Israel’s siege, they said Al Shifa was on the brink of running out of fuel, which powers everything from the incubators to ventilators to the machines that sterilize surgical instruments before an operation.
The hospital had already turned off some elevators, water heaters and air-conditioners to save fuel, Dr. Mohammed Abu Selmiya, Al Shifa’s director, said last week. At least six other hospitals have closed for lack of power.
Israel has banned fuel from entering Gaza on the aid trucks that began trickling into the strip from Egypt a week ago, saying it could be diverted for use by Hamas.
On Friday, Admiral Hagari said that Israeli intelligence showed that hospitals in Gaza had fuel, but that Hamas was stealing it. He played a recording of a second phone call that he said was between an Israeli military official and an energy official in Gaza, in which the Gaza official said fuel was still available.
Mr. Maarouf, the Gaza government spokesman, said this evidence, too, had been fabricated, and pointed to statements by United Nations officials that Gaza was on the brink of running out of fuel.
Among Al Shifa’s current patients are about 130 newborns who were orphaned just as they were born, according to doctors at Al Shifa.
When their pregnant mothers were pulled dead or dying from the rubble of buildings destroyed in Israeli airstrikes, obstetricians went to work, tugging the infants from their mothers’ bodies. Born premature, they were placed in incubators in Al Shifa’s neonatal intensive care unit.
Most of them are the only survivors in their families, according to Bisan Ouda, a Gazan journalist and filmmaker who filmed inside the hospital this past week and interviewed staff there in videos released by the United Nations Population Fund.
“We don’t know the fate of their relatives or have information about their identities,” Dr. Bulbul says in one video.
Dr. Abu Sittah told CNN on Oct. 24 that the hospital had coined a new designation, “wounded child with no surviving family,” to refer to more than 50 children who had by that point been pulled from the rubble and taken to Al Shifa.
“The amount of children I treated — they have not a single relative left,” he said in the interview with the Lebanese television journalist on Friday. “The father was killed, the mother also, and the brothers, aunts, uncles, grandfather and grandmother.”
He added: “It’s hard not to imagine your own children when you see these people’s children, as they suffer like this in this brutal way. Their only sin is being Palestinian.”
Iyad Abuheweila and Isabel Kershner contributed reporting.