Mel Gurtov
Professor Emeritus of Political Science, Portland State University

Israel’s Al-Shifa Operation, A Critical Examination

Israel’s attack on the Al-Shifa Hospital in Gaza City has become both the reality and the symbol of all that is wrong with its war on Hamas. To some in Israel, it has become a “litmus test” of support within the country as well as an important measure of world opinion and international understanding. For many observers focusing on the situation from abroad, Al-Shifa is what the World Health Organization has referred to as a “death zone.” Comments such as these have raised profound questions about the erosion of Israeli moral authority in a part of the world in which public morality is on everybody’s lips but is seen far less often in daily actions.

What started as an understandable military response to the horrific attacks of October 7 has devolved into a continuing, intentionally designed, and deadly strike on civilian hospital facilities, services, and noncombatant patients—both through active military interventions and through control of vital hospital systems and structures. Worse yet, it has evoked the morally and legally untenable claim advanced by Prime Minister Benjamin Netanyahu and his government that the Al-Shifa exercises are justified by continuing threats posed by Hamas. We dispute that claim and offer recommendations to mitigate the disaster in ways that are both humane and in the best interest of all sides to the conflict.

Ongoing Israeli military operations at Al-Shifa have made the hospital unsafe for patients and staff and have precipitated an indescribable humanitarian crisis in Gaza City and throughout the enclave. In addition to armed intervention, the shutdown of basic hospital infrastructure and ordinary medical resources—electricity, fuel, drugs, food, and supplies—have left newborns without functioning incubators, wounded surgical patients without anesthetics, and older residents without the care and security every compassionate individual would hope for. As of November 18, Israel has reportedly advised patients able to leave the hospital to do so, leaving only a small number of the most critically ill and injured patients in place.

The Israeli operations have severely degraded the country’s precious stock of moral authority and claims under international law by equating its military defense with the right to take offensive action against defenseless, hospitalized noncombatants. No matter how the facts of the Al-Shifa tunnel system ultimately shake out—if they do—the moral damage to Israel will have already taken its toll.

So far, Israel’s claim that Hamas has used the tunnel system beneath the hospital for command and control and arms storage has not been adequately demonstrated. (Israel has not asserted that Hamas is actively using the tunnels for military operations.) To be very clear, however, even should it turn out that Hamas made use of the Al-Shifa tunnels for military purposes, such a determination could not and would not justify the targeting of the hospital based on a claim of self-defense. Netanyahu’s assertions on National Public Radio—that there were “a lot of terrorists there, but they fled as our forces approached the hospital,” and that “we found a lot of weapons” and a command and control center—lack evidence. CNN has reported a continuing failure on the part of the IDF to back up its claims. It has also been reported that the network’s own video analysis suggests that images of hidden weaponry may have been altered. Finally, Israel’s former prime minister, Ehud Olmert, asserts that Hamas’ underground command center is actually based in Khan Yunis, a city in the south now coming under Israeli attack.

Mathilde Philip-Gay, an expert in international humanitarian law at Lyon 3 University in France, recently told The Guardian that international humanitarian law, as set forth in the Geneva Conventions, provides that “it is forbidden to turn recognized civilian hospitals into a conflict zone. It is also forbidden to use civilian populations, the sick or the injured as human shields, it is a war crime, as is fighting from inside a hospital.” While clearly demonstrated, ongoing military use of the tunnels by Hamas against Israeli forces might provide justification for a limited Israeli response, Israel has neither made such a claim nor provided the required demonstration.

The best recourse available to Israel at this juncture would be to announce and implement an immediate and complete cessation of military operations against Al-Shifa and all medical facilities in Gaza. Israel should restore full electric service, the supply of fuel, and delivery of drugs and other vital supplies including water, blood, and communications. At the same time, it should request the assistance of the outstanding medical-humanitarian NGOs on the ground, such as Doctors Without Borders, Mercy Corps, and Norway’s Emergency Medical Team. These organizations can make an assessment of needs and medical capacity, provide direct medical assistance at Al-Shifa and other facilities, and coordinate the immediate resupply of medical equipment and supplies from the Rafah border. A vital component of the Israeli commitment would be to provide security for the NGO staff living and working in the hospitals and medical facilities in Gaza.

As US, UN, and many other sources agree, Gaza faces a humanitarian catastrophe—to which Secretary of State Antony Blinken has added that it is a catastrophe for Israel and not just for Gaza’s people. The hospital assault can only increase the casualty count, already over 11,000 dead according to accounts published in the Washington Post and elsewhere, and the flight of refugees. And to that suffering must be added the alienation of a good part of the international community, the widening gap between Israel and the US over war policy, and prolongation of prospects for a cease-fire and the release of hostages.

The above was coauthored by Larry Kirsch.

About the Author
Mel Gurtov is Professor Emeritus of Political Science and Senior Editor of ASIAN PERSPECTIVE. He has published over 30 books and numerous articles on US foreign policy, Chinese politics, and international affairs from a human-interest perspective. He previously served with the RAND Corporation, during which he co-authored the Pentagon Papers. He blogs "In the Human Interest," has a podcast on Substack, and does weekly, five-minute radio commentaries on two stations in Oregon.