Built during the British Mandate, it treated Egyptian soldiers in the 1967 War, and was thereafter taken over by the Israeli Military Administration which continually enlarged and developed its sophisticated medical infrastructure. In the 1980s in particular Israeli architects and public contractors and expanded its buildings and developed its underground basement.

Since the 2005 Israeli evacuation of the Gaza Strip, Hamas has transformed the hospital underground floor into one of its key military headquarters. IDF intelligence confirmed that the basements and underground areas include shelters of senior Hamas leaders, pier openings to the highly sophisticated offensive tunnels network, coordination headquarters for the launching of rockets on Israel, and other terrorist infrastructures. The Israel Security Agency (Shabak) and Washington Post similarly warned of these developments in 2009 and 2014 respectively.

Reuters reported last week that thousands of Palestinian evacuees have been filling the hospital’s corridors, waiting rooms and parking lot, and have turned it into one of the largest refugee camps in the Gaza strip.

Israeli sources have expressed fears that Hamas may be holding hostages under the hospital

On 6.11 the IDF denied claims by the Gazan Ministry of Health (controlled by Hamas) that it had bombed Shifa hospital. In the following days, the IDF completed the encirclement of Gaza City (using phosphorescent lighting flares in the vicinity of the hospital) and has been preparing to enter the hospital. American officials on CBS News have expressed worry about battles in the hospital premises

More than 240 Israeli civilian hostages are still held captive in the Gaza Strip. Since the beginning of the war 333 Israeli soldiers have been killed (correct as of noon on 2nd November), 23 in northern Gaza alone.

On 11.11 the Gaza Ministry of Health claimed that the hospital is no longer functioning and has run out of electricity and water.

Recognising the humanitarian predicament in Shifa, Israel has taken steps to protect the hospital’s patients and medical staff.

• according to Reuters and Ynet, Israel requested the creation of alternative hospitals in Gaza (ships from Italy, France and Greece as floating hospitals along the coast, field hospitals to be set up by Egypt, European countries and the UN);

• UNRWA-WHO emergency medical supplies continue to reach the hospital;

• On 12.11.23 IDF announced the opening of humanitarian corridors to allow patients to be transferred from Shifa, Rantisi and Nasser hospitals;

• IDF provided Shifa with fuel for urgent medical purposes. Hamas has reportedly prevented the hospital from receiving this fuel.

American officials have expressed their worry over possible battles within the hospital premises, which would endanger patients and lead to further regional escalation.