Why is Israel attacking hospitals in Gaza?

Israel placed Gaza City's Al-Ahli Arab Baptist Hospital under siege on Thursday after launching a raid on the enclave's biggest hospital, Al-Shifa, the day before.

Despite Israel's claims that a Hamas headquarters is located below Al-Shifa hospital, its forces have so far failed to produce any evidence to substantiate this, raising questions as to why Israeli forces continue to target hospitals in Gaza.

Information war

Israel has long claimed Hamas operates in Al-Shifa – and the allegation has been a key part of its information war.

Launching what it called a "precise and targeted operation" on the hospital was a chance to present evidence that backed Israel's charges about Hamas operating at the facility and add legitimacy to the Israeli assault on the Gaza Strip.

While unable to provide proof demonstrating a headquarters is hiding under the facility, Israel has presented alleged evidence of an armed presence at the site, which has been widely ridiculed.

The Israeli army has published footage to social media claiming to show rifles, explosives, and Hamas uniforms at Al-Shifa, but there was no way to prove who brought these items to the hospital.

It has also released a video showing what it says is a "terrorist tunnel" at the site. The footage captures a hole from above but without showing the inside.

"I was expecting a bit more than a hole in the ground based on what Israel was claiming," said Eliot Higgins, founder of investigative news outlet Bellingcat.

The military has also published a video in which spokesperson Daniel Hagari alleged that a piece of paper hung on a wall in the forcibly evacuated Rantisi paediatric hospital showed the "names" of Hamas fighters who were guarding Israeli hostages.

On closer inspection, a translation of the document showed that it contained no names but was instead a calendar of the days of the week.

Impact on Palestinian data collection

Whatever the motivations for Israel's attacks on hospitals, they are certainly hampering Palestinians' ability to document casualty figures.

Palestinian doctors and officials had been updating death and injury tolls throughout Israel's war on the besieged enclave.

The chaos at hospitals will not make their job easier, particularly as Palestinian health authorities said on Wednesday it was becoming increasingly difficult to obtain accurate casualty figures from Gaza due to the collapse of the hospital and health system in parts of the strip.

But as Israeli forces push deeper into the Gaza Strip and the communications infrastructure degrades, contact with hospitals has buckled and systematic data collection has become more problematic, the Palestinian health ministry said.

"For the fourth consecutive day, the ministry faces challenges in updating the number of casualties because of services and communications collapsing in hospitals in the north," the ministry said in a statement.

Last week, Barbara Leaf, assistant US secretary of state for Near Eastern affairs, said that the number of those killed in Gaza – home to 2.3 million people – is likely "higher than is being cited".

The UN relief agency confirmed in its latest update on Saturday that a communications breakdown has prevented new figures from coming in.

Pushing displaced people south

Palestinians have sought refuge in medical facilities and schools amid Israel's war on Gaza, believing these sites would be less open to attack than their homes.

The targeting of hospitals, including Al-Shifa, which at one point housed 60,000 displaced people, has enabled Israel to push the population south.

There are fears Palestinians will continue to be pushed further and further south until they are forced into neighbouring Egypt, in a repeat of the ethnic cleansing visited upon their people during the Nakba.

The Nakba ("catastrophe" in Arabic) was the ethnic cleansing of some 750,000 Palestinians alongside the 1948 creation of the Israeli state. It is viewed as an ongoing process that has continued over the decades.

There are estimated to be more than 1.5 million internally displaced people in Gaza.

Some 807,000 Palestinians were living in the strip's north as of 11 November, around two-thirds the figure from before the war, the Palestinian Central Bureau of Statistics has estimated.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) said on Friday that reports by humanitarian partners indicate a large proportion and potentially most remaining in the north have been displaced.

"Many of them have lost their homes and are moving within the area, seeking food, water, accommodation and relative safety," OCHA added.

Why are hospitals attacked during war?

Attacks on healthcare facilities, sometimes considered 'soft targets', are not a new phenomenon and have occurred in conflicts before the Gaza war.

Russia and its ally the Syrian regime have carried out many strikes on hospitals in opposition areas of Syria. Hospitals in Yemen have also been repeatedly attacked since war broke out there in 2015.

Medical facilities may be attacked to gain a strategic advantage by disrupting the ability to provide medical care to civilians, instilling fear and terror in the population, and undermining their confidence in the ability to receive care if wounded.

Hospitals may also be attacked to eliminate resources, such as medical supplies, equipment, and facilities that could support the opposing force, causing them to give in.

Can hospitals be military targets?

The Geneva Convention, adopted in the aftermath of the Second World War, form the core of international humanitarian law and "are particularly protective of civilian hospitals", according to Mathilde Philip-Gay, an expert in international humanitarian law at Lyon 3 University in south-east France.

"It is forbidden to turn recognised 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," she said.

Article 8 of the Rome Statute, which established the International Criminal Court (ICC) in The Hague, defines a long list of war crimes including "intentionally directing attacks against buildings dedicated to religion, education, art, science or charitable purposes, historic monuments, hospitals and places where the sick and wounded are collected".

'Hospitals are not battlegrounds'

World leaders and international aid organisations have strongly criticised Israel's assault on Gaza hospitals.

"Hospitals are not battlegrounds," the UN's undersecretary-general for humanitarian affairs and emergency relief coordinator, Martin Griffiths, posted on X on Wednesday.

"The protection of newborns, patients, medical staff and all civilians must override all other concerns," he said.

Tedros Adhanom Ghebreyesus, head of the World Health Organization, agreed that the attacks were "deeply concerning".

"We've lost touch again with health personnel at [al-Shifa] hospital," Tedros said on X, adding: "We're extremely worried for their and their patients' safety."

The International Committee of the Red Cross said in a statement that it was "extremely concerned about the impact on sick and wounded people, medical staff, and civilians".

"All measures to avoid any consequences on them must be taken," it said.

Reuters contributed to this story.