Gaza's Shifa Hospital has become the focus of a dayslong stalemate in Israel's war against the Hamas militant group.
Shifa is Gaza's largest and best-equipped hospital. Israel, without providing visual evidence, claims the facility also is used by Hamas for military purposes. It says Hamas has built a vast underground command complex centre below the hospital, connected by tunnels, something Gaza health officials and Hamas deny.
Since Israel declared war against Hamas in response to a deadly cross-border attack by Hamas on October 7, its forces have moved in on Shifa. While Israel says it is willing to allow staff and patients to evacuate, Palestinians say Israeli forces have fired at evacuees and that it is too dangerous to move the most vulnerable patients.
Meanwhile, doctors say the facility has run out of fuel and that patients are beginning to die.
Here is a closer look at the Shifa standoff.
A HOSPITAL AND A SHELTER Shifa is the leading hospital in a healthcare system that has largely collapsed after years of conflict, chronic underfunding and an Israeli-Egyptian blockade aimed at weakening Hamas.
Shifa has over 500 beds and services like MRI scans, dialysis and an intensive care unit. It conducts roughly half of all the medical operations that take place in Gaza, according to the Health Ministry in the Hamas-run territory.
After the war erupted, tens of thousands crammed into the hospital grounds to seek shelter. As the war has moved closer to the hospital, most of those huddling there have fled south — joining some two-thirds of the territory's 2.3 million residents who have left their homes.
But hundreds of people, including medical workers, premature babies and other vulnerable patients, remain, staffers say.
On Saturday, the hospital announced that its last generator had run out of fuel. Health officials say at least 32 patients, including three babies, have died. They say 36 other babies are at risk of dying because life-saving equipment can't function.
The Health Ministry released a photo Monday showing about a dozen premature babies wrapped in blankets on a bed to keep them warm. “I hope that they will remain alive despite the disaster in which this hospital is passing through,” said ministry spokesman Medhat Abbas.
International law gives hospitals special protections during the war. Hospitals can lose those protections if combatants use them to hide fighters or store weapons, according to the International Committee of the Red Cross.
Still, there must be plenty of warning to allow the evacuation of staff and patients. If harm to civilians from an attack is disproportionate to the military objective, it is illegal under international law.
ISRAEL'S CASE AGAINST HAMAS Israel has long accused Hamas of using civilians as human shields. The group often fires rockets toward Israel from crowded residential areas, and its fighters have battled Israeli troops inside densely populated neighbourhoods.
Throughout the war, Israel has released photos and video footage showing what it says are weapons and other military installations inside or next to mosques, schools and hospitals.
Late Monday, Israel's chief military spokesman, Rear Adm. Daniel Hagari, showed footage of what he said was a Hamas weapons cache found in the basement of Gaza's Rantisi Hospital for Children.
Hagari said he entered the hospital with Israeli troops on Monday, a day after the facility's last patients were evacuated. The hospital ran out of fuel last week, and Israel had ordered people to leave as it conducts its ground offensive.
Hagari entered a room decorated with a colourful children's drawing of a tree, with weapons lying across the floor. He said they included explosive vests, automatic rifles, bombs and rocket-propelled grenades.
“Hamas uses hospitals as an instrument of war,” he said.
He showed another area that he said appears to have been used to hold hostages.
It included what appeared to be a hastily installed toilet and air vent, a baby bottle and a motorcycle — scarred by a bullet hole and apparently used to carry hostages. One windowless room had curtains on the wall that he said could be used as a backdrop in a video. Hagari said forensic experts were examining the scenes.
“This is not the last hospital like this in Gaza, and the world should know that,” Hagari said.
The army has claimed that Hamas is operating inside Shifa and underneath it in bunkers, some of which it says are accessible from the hospital itself. It also claims hundreds of Hamas fighters sought shelter at Shifa after the October 7 massacre, in which at least 1,200 people in Israel were killed.
Israel says these claims are based on intelligence. However, it has released no visual evidence to support the claims. Hagari last month unveiled maps showing where Israel believes Hamas' underground command centres are located, including one next to hospital's reception area and another next to the dialysis department.
He also showed off simulated illustrations of what these centres allegedly look like, but acknowledged: “This is only an illustration." Israel also released a video of what it said was a captured militant answering questions during an interrogation. The militant, speaking quietly but clearly under duress, says that most tunnels are “hidden in hospitals”.
“At Shifa, for example, there are underground levels,” the militant says. “Shifa is not small. It's a big place that can hide things.” The army also released a voice recording of what it says are two anonymous Palestinians in Gaza discussing the presence of a tunnel under Shifa. The recording could not be verified.
Ghazi Hamad, a senior Hamas official, rejected the Israeli claims about Shifa as “false and misleading propaganda”.
“The occupying forces have no evidence to prove it,” Hamad said. “We have never used civilians as human shields because it goes against our religion, morality and principles.” HOW WILL THE STANDOFF END? Israel on Sunday said it had tried to deliver some 300 litres (about 80 gallons) of fuel to the hospital in plastic containers several hundred metres (yards) from the facility. But as of Monday, the fuel had apparently not been taken.
Israel accused Hamas of preventing medical workers from retrieving the containers. Hospital officials said the fuel should be delivered by the Palestinian Red Crescent and that the quantity of fuel was insufficient in any case.
Israel offered safe passage for people to leave. But those who tried to go described a terrifying experience.
Goudhat Samy al-Madhoun, a healthcare worker, said some 50 people left the facility on Monday, including a woman who had been receiving kidney dialysis. He said Israeli forces fired on the group several times, wounding one man who had to be left behind.
US President Joe Biden on Monday said the hospital “must be protected” and called for “less intrusive action” by Israeli forces.
“It is my hope and expectation that there will be less intrusive action,” Biden said in the Oval Office.
The Israeli army has said it is aware of the complexities but says Hamas should not expect immunity.
“We're not looking to take control of hospitals. We're looking to dismantle their infrastructure,” said Lt. Col. Richard Hecht, another Israeli army spokesman.
“We'll go in, we'll do what we have to do and leave,” he said. “What it's going to look like, it's hard to say.”
