Al Shifa Hospital is a challenging situation for the IDF

Analysis: Military operation in Al Shifa working to dismantle Hamas' infrastructure needs to be slow and methodical to preserve legitimacy, but this could come at a cost

Ron Ben-Yishai|
The basement of Al Shifa Hospital in Gaza has been serving as a shelter for terrorists for over 20 years. Even during the days of Yasser Arafat, terrorists and leaders of Palestinian organizations, including Fatah, Hamas and others, used it to hide when the IDF conducted operations following major terror attacks. Hamas only expanded this method.
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A few years after taking control of the Gaza Strip and ousting the Palestinian Authority's rule, Hamas realized the potential of hiding beneath the hospital and expanded it into the vast tunnel system Israel is combating today.
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תיעודים מכניסת כוחות צה"ל בהובלת אוגדה 36 לבית החולים שיפא והסיוע ההומניטרי בבית החולים
תיעודים מכניסת כוחות צה"ל בהובלת אוגדה 36 לבית החולים שיפא והסיוע ההומניטרי בבית החולים
IDF forces near Shifa Hospital
(Photo: IDF Spokesperson's Unit)
Therefore, the hospital can be seen as the place where the two central components of Hamas' fighting tactics solidified. The first involves warfare conducted from within and protected by a civilian population, which serves as a human shield for terrorists. The second is the subterranean tunnel system that originated in Al Shifa’s basement and gradually evolved into a network spanning over 500 km.
Therefore, the takeover of the Al Shifa Hospital complex by the IDF overnight Wednesday is both a symbolic and practical necessity. Al Shifa symbolizes Hamas' ability to survive underground, and seizing control of it constitutes a significant blow to morale, aimed at undermining the organization's perception that hiding behind and beneath civilians, especially under a hospital, makes it immune.
The operational need for this action is to uproot the subterranean military complex that Hamas established. As long as the hospital’s basement serves as a central military command and control point that can serve terrorists, the IDF won’t be able to undermine the organization's control in the northern part of the Gaza Strip, particularly within Gaza City. The fact that forces encountered active terrorist resistance defending the facility underscores how crucial this military stronghold is for Hamas, both in terms of their morale and capabilities.
The central problem Israel faces is getting international legitimacy for its actions, primarily from the United States, which is crucial for the IDF to continue achieving its objectives in the war. In the two weeks since the ground offensive began, the army refrained from operating in the hospital partly because it wasn't physically close enough, but mainly due to Hamas using it to monitor its worldwide propaganda efforts via medical staff.
Al Shifa's management and personnel constantly claimed the hospital lacked fuel and alleged that the fighting was causing infant deaths. However, they refused any assistance offered by the IDF, including receiving incubators and fuel. This was likely orchestrated by Hamas, aiming to exacerbate the crisis in hospital departments and other vital areas in the hospital, hoping to influence international public opinion and force Israel to cease its attacks.
Only after the IDF recently took control of the Al Shati refugee camp, thus creating optimal conditions for an expanded operation, did it turn toward Al Shifa Hospital. Throughout the night, the military surrounded the hospital and engaged in clashes with the terrorists inside, but refrained from entering.
So how did it eventually enter the complex? The U.S. announced, based on intelligence information it independently obtained, that Al Shifa's basement indeed serves as a military center for Hamas, and possibly a shelter for Israeli captives. This announcement, made twice by U.S. Security Council spokesman John Kirby - once three days ago and again on Tuesday - gave the IDF the green light to cautiously neutralize Hamas’ stronghold beneath the hospital.
Al Shifa Hospital is a massive complex comprising more than 10 large buildings and several smaller ones. It’s surrounded by a wall, and in its courtyard are currently thousands of displaced refugees from the initial 100,000 Gazans who sought refuge there at the start of the conflict and have yet to move toward the Strip’s south.
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בית חולים שיפא ב עזה
בית חולים שיפא ב עזה
Al Shifa Hospital in Gaza
(Photo: Khader Al Zanoun / AFP)
The hospital still accommodates numerous wounded and sick individuals; therefore, caution must be exercised to avoid engaging in combat within medical departments and vital healthcare facilities. At this time, details about how IDF forces entered Al Shifa are unavailable. What’s important for the Israeli public and the world to know is that forces got inside in a way that didn’t interrupt the hospital’s activities.
Additionally, to overcome international legitimacy concerns, the IDF brought incubators, oxygen tanks and fuel into the hospital compound's yard, which were previously refused by the hospital’s management. Currently, Hamas can’t prevent the hospital from accepting them.
It can be assumed that the IDF will operate slowly and cautiously in the hospital until the large compound's courtyard and other areas are evacuated of civilians, patients and the wounded, allowing the troops to eliminate Hamas forces in the hospital.
Al Shifa and its basement were planned by Israeli engineers who supervised its construction, so the IDF is familiar with the area. It can operate with the necessary caution to avoid a humanitarian incident that could lead to international and American pressure to halt the operation.
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ארכיון בית חולים שיפא עזה
ארכיון בית חולים שיפא עזה
Refugees shelter outside Al Shifa hospital
(Photo: REUTERS/Doaa Rouqa/File Photo)
Exercising the necessary caution may also come at a cost: Hamas terrorists could escape and disappear into the tunnels connecting Al Shifa’s basement to the extensive tunnel system beneath the city.
This, however, is a compromise that must be made for the sake of the larger goal, which is maintaining Israel’s legitimacy. Swift and aggressive action might lead Hamas to deliberately detonate a part of the hospital, resulting in blame being put on Israel.
If the IDF can successfully clear both the hospital and the subterranean basement while preventing a humanitarian disaster, it will mark a significant and meaningful milestone in undermining Hamas’ control in the northern Gaza Strip.
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