The largest hospital in the Gaza Strip, al-Shifa hospital in Northern Gaza, became  nothing short of a death trap in March. 

Israel attacked al-Shifa for the first time in November and again on March 18th, claiming that the extremist group Hamas had returned to what was once considered the  best-equipped hospital of the Gaza Strip.

During the two-week siege in March Israel claims to have killed 200 Hamas terrorists in or near the hospital area. It is unclear how Israel ensured that the killed individuals were indeed Hamas militants.

There is very little reliable information about the fate of patients, medical staff, and civilians in the hospital. International organizations have left the hospital, and there are frequent communications blackouts.

Linda Konate, the head of the Finnish branch of Doctors Without Borders/Médecins Sans Frontières (MSF), says that their staff in the area have reported bodies lying in the streets and have heard rumors of staff being arrested.

”Getting an overall picture is very difficult. There is no constant nor thorough access.”

MSF evacuated its staff from the hospital in November before Israel attacked al-Shifa for the first time. However, a few staff members have returned to the hospital voluntarily.

Following the latest attack, Israel withdrew from the hospital on April 1st. New York Times published satellite images after Israel’s withdrawal showing the hospital in ruins.

Dire shortage of everything

Voima interviewed surgeon Ahmed Almaqadma over the phone in the beginning of March, just two weeks before Israel’s attack on the hospital. According to him, the situation in the hospital was desperate. 

Al-Shifa had already suffered significant damage in Israel’s November attack. In March the hospital suffered from power outages, and there was a desperate shortage of clean water.

”The hospital is hardly functioning,” Almaqadma described, and said that the situation was worsening continuously. Israel has restricted the entry of aid convoys into Gaza, and humanitarian aid has not been able to be delivered adequately even to hospitals. Medications were also mostly exhausted.

Konate says MSF has delivered individual aid shipments to al-Shifa in collaboration with other humanitarian organizations. The last shipment arrived in early March.

”It is clear that there have been shortages of absolutely everything, but the hospital has tried to function nonetheless,” Konate says.

Most of the hospital staff had fled the war to southern Gaza. However, Almaqadma decided to stay.

”Helping patients is my and my team’s duty,” he said.

According to several media sources, Almaqadma was found killed on April 1st near al-Shifa after the Israeli forces withdrew from the hospital. His mother, who was a general practitioner in al-Shifa, and his cousin were also found dead.

Broken rules of war

There were still many patients and civilians seeking refuge in al-Shifa Hospital in early March. ”The most common reasons to seek treatment are injuries caused by the war and communicable diseases due to the lack of hygiene”, Almaqadma said.

There was an endless list of patients and he had to prioritize the worst cases. ”I haven’t been able to sew up all the wounds quickly enough. There are so many patients and too few surgeons.”

Almaqadma said he has operated on four or five patients every day and at times without proper anesthesia. Despite the desperate situation, the doctors and nurses who remained in the hospital were doing their best to help the patients.

Almaqadma said there was such a severe shortage of food in Gaza that people were picking leaves from the ground to eat. Patients were very weak due to food and water shortages and were more susceptible to infections. ”Patients may not necessarily die from injuries but infection or malnutrition.”

Almaqadma said he himself suffered from hunger and thirst. ”We are trying hard with my family to find food, but most of the time there isn’t any.”

Israel claims that terrorist organization Hamas is responsible for Israel’s attacks. According to Israel Hamas has infiltrated the hospitals using civilians as human shields.

Hospitals and medical personnel enjoy special protection under international humanitarian law. However, if a hospital is used for military purposes, it may lose its status.

Jani Leino, a legal adviser to the Finnish Red Cross, says that ”there should be an advance warning before an attack so that the enemy can either cease its activities or so that those in need of protection can be evacuated. Additionally, there should be no harm inflicted on units and persons, which would be disproportionate to the sought military advantage.”

According to Leino, the attacking party should have reliable information that the target is indeed being used for military purposes.

According to Israel, there was a Hamas command center in a tunnel beneath al-Shifa Hospital, where Hamas also kept Israeli hostages. However, Israel has not publicly presented evidence to support its claims.

Almaqadma said he was at al-Shifa when Israeli forces entered the hospital for the first time in November. ”They [Israeli forces] tried hard to find something, but they didn’t find anything. They dug deep under the hospital and found a small tunnel next to the building. I don’t know the purpose of the tunnel, but there are tunnels everywhere in Gaza City.”

Gaza has a vast network of tunnels originally used to smuggle food and fuel past Israel’s blockades.

Attack on healthcare

The peer-reviewed medical journal BMJ reported in January that according to international organizations, over 300 healthcare workers and 167 aid workers have died in Gaza during the war. BMJ notes that these figures are higher than in any other conflict in this century. Estimates of the death tolls vary depending on the source.

The Palestine Red Crescent Society PRCS reported at the end of March that a total of 26 of its staff members had died in the Gaza war. According to the organization, fifteen of the staff members died while on humanitarian duties in PRCS uniforms.

MSF witnessed the trying circumstances while evacuating its staff from the Nasser Hospital in mid-February. ”We had agreed upon the evacuation of our staff in advance, but despite this, one staff member was arrested and has been detained for over a month now.”

Despite inquiries MSF has not been given any reason for the arrest. Konate states that healthcare has been the subject of widespread harassment in Gaza. 

”In addition to attacks on hospitals, arrests of staff and overly strict evacuation orders, ambulance transports have also been blocked. This phenomenon is so extensive and systematic that it can be said that hospitals are also targeted, even though they should not be.”

Almaqadma emphasized in his interview that Israel has killed and detained healthcare workers during its occupation. He believes that Israel is deliberately attempting to destroy Gaza’s healthcare system in order to make life in Gaza unbearable.

”Israel has targeted every single hospital and every health center in Gaza,” Almaqadma said.

Ahmed Almaqadma’s death has been confirmed to Voima by his cousin living in Finland.