A complex, surgical IDF operation in Hamas’ military-civilian dual use nerve center

Last updated: December 8, 2023

The Al Shifa compound serves as Hamas’ nerve center, therefore qualified as a high-quality military target. It is deliberately located in a sensitive civilian location with the anticipation of the international pressure that will follow upon Israel exercising its right to operate there. Left: Military equipment used in the October 7 massacre and found in Al Shifa; Right: hostages led in the hospital corridors (IDF Spokesperson)


The core mission of the IDF ground operations in Gaza is the complete destruction of Hamas, including both its military wing and political bureau. After the IDF revealed intelligence which confirmed independent US intelligence assessments regarding the role of Al Shifa hospital as the nerve center of Hamas, the IDF began its operation around the compound[1]. The operation at Al Shifa is therefore key to the IDF’s success in completing the Israeli cabinet’s war objectives.

The IDF also provided evidence for the way in which Hamas and Palestinian Islamic Jihad have built their military command center underneath the hospital, with the intent to use the civilians in the hospital as human shields. Hamas captured terrorists revealed in a published video by the Shin Bet how their thinking was that the “Jews” do not attack hospitals and ambulances, which is the reason for which they built their operation center underneath the Al Shifa hospital[2].

Hamas’ strategy as an actor with inferior military capabilities was therefore to trigger a global delegitimization campaign against Israel, knowing full well the shockwaves a “hospital raid” will cause in the international community and in turn will be translated into political pressure on Israel. This pressure would have been designed to present Israel with a dilemma: forcing it to choose to pay an international PR price in order to fight it or leave the Hamas infrastructure in place.

The raid on the hospital by the IDF is being carried out in a cautious manner and involves minor incursions into sections and terror tunnels around the compound. The IDF has found a weapons depot which includes mortars, RPGs, and AK 47s in the hospital wards, adjacent to MRI machines[3] and next to patients. In every hospital facility, IDF troops found Hamas intelligence or weapons, or both. There were over 70 vehicles used by Hamas on October 7 that were in the hospital complex. Additionally, multiple evidence that are beginning to emerge show how hospital structures themselves, not just the underground tunnel network, were used for the purpose of holding hostages, and even executing them.

As of November 27th, the IDF is continuing to send special forces to search the Al Shifa compound in limited raids, going floor by floor in a measured way. These cautions prudent operational actions are made in order to avoid shootouts inside the hospital and minimizing civilian casualties. The IDF has agreed to allow doctors and patients who cannot move to remain in the hospital.

The pinnacle achievement of this operation can potentially be going after the Hamas headquarters themselves, in the underground tunnel network of Hamas where its senior most officials are hiding. Techniques for fighting inside tunnels are extremely complicated, and once these shafts and entries to these entrances are found, they will have to initiate an intricate military operation, to strike enemy targets while avoiding the loss of IDF soldiers’ lives while refraining from expanding the fight into the hospital structures. These techniques include inter alia robots, dogs, and other means that precede the soldiers before entering the tunnels, as they have already done elsewhere in Gaza, to engage in face-to-face combat.

The bodies of 65-year-old Yehudit Weiss and 19-year-old Corporal Noa Marciano, both hostages who were abducted by Hamas on October 7, were located and recovered from structures surrounding the hospital’s complex.

In the structure in which Yehudit Weiss was located, IDF troops also found military equipment including AK-47s and RPGs.

IDF’s Brigade 7 commanded an array of elite units, including Shldag, Oketz, Yahalom and other forces, and uncovered a vast underground tunnel network, underneath Al Shifa. They found ceramic construction for the rooms, modern air conditioning, bathrooms, and other elements that exceeded other tunnel areas by several levels. According to the IDF, this array of tunnels connected with other hospitals and compounds, such as the Qatari hospital, and was battle-ready to enable the fighting of entire brigades. This is another indication of the seniority of the Hamas commanders who operated under the hospital[4].

IDF units uncovering the underground tunnel network, Al Shifa Hospital (IDF Spokesperson)

International Law

International law statutes regarding warfare consider facilities used for military purposes as legitimate military targets, under the principle of proportionality. Once a civilian compound is used as a military base of operations the international protections of the compound under the law are removed (Article 19 of the Geneva Convention)[5]. Specifically, when a high-quality target such as this, the Hamas nerve center, which was used for the command and control of the entire war against Israel, exit points for militants who embarked on the October 7 massacre, and even for holding and executing hostages, this qualified as an entirely legitimate military target.

To enable the safe evacuation of civilians from what has become a battle zone, the IDF allowed and even facilitated the movement of civilians while Hamas was shooting at the Israeli troops[6]. It has also refrained from ordering civilians to leave, but rather enables them to leave – as reiterated by the IDF Spokesperson and illustrated in a phone call between an IDF officer and the hospital director. The IDF is also providing extensive evidence of the use of the Hospital as a terrorist hotspot- exposing terror tunnels[7], taking kidnapped Israeli civilians through the hospital[8] etc.

Operational tunnel shaft in Al Shifa (IDF Spokesperson)

IDF Operational Tactics

Generally speaking, the IDF has been extremely cautious in its operative tactics, employing world-class, surgical precision accuracy, in targeting terrorists while doing everything it can to avoid civilian casualties and harm. This includes “Roof knocking,” distributing warning pamphlets for civilians and making phone calls and text messages urging civilians to evacuate. IDF tactics have been adopted by other Western militaries[9] and have been praised for their care for enemy civilian lives. After Israel’s 2014 “Protective Edge” war with Hamas, US officials sent military missions to Israel in order to study war tactics that were used to minimize civilian casualties.

In the case of the hospital raids, those began after the IDF had spoken to the hospital staff and offered those who wish to evacuate to do so and made sure to protect those patients who were too sick to leave.

Aiding the Hospital

While combatting and engaging in firefights with the local governing entity, Hamas, that uses their own population in the hospital facility as a military base blended with civilian activity, the IDF even provided the civilians with necessary humanitarian aid. That included 50 gallons of diesel for the hospital to operate after Al Shifa claimed that its power was about to end. Hamas forbade hospital staff to take the diesel, as proven by a phone call between the IDF and the hospital director. The IDF included in its deliveries baby incubators, over 6,000 liters of water and over 2,300 kilograms of food to the medical facility[10].

This is unprecedented on a global scale: a country that provides supplies to the civilians of an enemy entity.

IDF transfer of food and water to Al Shifa (IDF Spokesperson)

Humanitarian Aid

Hamas has been documented stealing supplies[11] provided by international aid to civilian uses including the stealing of diesel and other supplies from UNRWA and hospitals for its own use. Israel has allowed trucks of diesel to enter Gaza, knowing full well that Hamas would prioritize using the fuel for its own needs rather than civilian infrastructure- hospitals, water pumps, sewage pumps as exposed by a Gaza Healthcare official in a conversation with the IDF[12]. Energy has been traditionally the main driver of enemy surrender; with no energy the enemy cannot operate its war machine.

Israel has practically been asked to facilitate the receipt of fuel for its war machine knowing that it would jeopardize its war effort and prolong the war.

The IDF directly aids the hospital by maintaining contact with the Al Shifa staff. The IDF transferred aid including medical supplies, food and water, incubators, baby food, 4000+ liters of water 1,500+ ready-made meals. It sent Arabic speaking soldiers and medical teams for assistance. The scale of the IDF’s assistance to an enemy population during war is unprecedented by any measure compared to other conflicts around the world.

Hamas has been documented on several instances shooting Palestinian people who leave the Al Shifa hospital and other civilians making their way to the south.

Tackling the claim: “Israel has not provided extensive proof of Terrorist Infrastructure in the Al Shifa Hospital”

Hamas has been using the Al Shifa hospital as a terror base since 2007 after it took over the Gaza strip. This widely-known fact has been proven multiple times, both by Israeli military information, Western and other foreign militaries, and intelligence agencies, including the United States military, and multiple other independent sources have confirmed that as well.

  • Hamas had taken over the hospital first after the 2007 coup in which it fired all doctors with associations to Fatah and threatened to murder doctors who would return[13]. During the 2007 fighting between Hamas and Fatah, Hamas fighters were seen in the hospital killing their opponents[14].
  • Amnesty International, an NGO that is known for its harsh criticism of Israel, reported that Hamas used the hospital during the 2014 Israel-Hamas conflict as a center for torturing, interrogation, and executions of political opponents[15].
  • In 2006, PBS aired a documentary under the name “Gaza E.R.” as part of the “Wide Angle” program. Hamas fighters can be seen in parts of the program roaming around the hospital and controlling it[16]. As part of the program, an anonymous doctor said that Hamas operatives are hiding in the Hospital basement.[17]
  • During interrogations of multiple captured terrorists of the October 7 massacre, they described how Hamas has turned the hospital into its base of operation with the knowledge that the Israelis would not bomb it. Their testimonies included:

Medical team was frustrated because Hamas operatives and operatives of other terrorist organizations were inside the hospital. I saw a lot of them… it reached 100 people. They (Hamas) dressed as nursing staff.”

“While the Hamas operatives stayed at the complex, they continued to operate. For example, what I saw, was how they wrapped rockets with mattresses.[18]

Hamas terrorist confesses the organization uses Al Shifa as a military facility
  • There are other accounts of the use of the hospital as a terrorist base like the account by a UK doctor who recounted that there were areas in the hospital, he was banned from entering with the threat of being shot by Hamas.[19]
  • Hamas’ enemy Fatah that initially controlled the Health Ministry after Hamas took over the strip, blamed Hamas for turning Al Shifa and other hospitals into a de facto prison.[20]
  • The Washington Post reported during the 2014 war that Al Shifa became “de facto headquarters for Hamas leaders, who can be seen in the hallways and offices”[21]. Also, The Guardian reported on a similar story as their journalists encountered Hamas men[22]. A Finnish reporter during the same war reported that rockets were fired from the hospital compound[23].
  • The main claims that there are no Hamas men in the hospital come from 2 Norwegian doctors who served in the hospital, Erik Fosse and Mads Gilbert. Both doctors are members of the Red Norwegian party, a Maoist Communist radical left party.

To conclude, even if one does not believe Israel regarding the use of Al Shifa hospital as a terror base, it is impossible to ignore the countless accounts from multiple sources including Palestinian ones about the Hamas grip over the hospital. IDF has released multiple videos from the recent localized raid of the hospital showing a terror tunnel with a depth of up to 10 meters underground with a large metal door. Moreover, in this raid the IDF found stacks of weapons and ammunitions in the hospital right next to MRI machines and inside hospital wards.

Claims that Israel has not provided enough evidence on the Hamas HQ under Al Shifa are therefore designed to pressure Israel to release its intelligence assets, as well as continue the trend of doubting claims on Israel’s right for self-defense, much like the doubts on the murder of 40 Israeli babies or the very massacre of October 7.

Claims by former Israeli PM Ehud Barak

Former Israeli Prime Minister Ehud Barak claimed in an interview to CNN’s Christiane Amanpour that Israel built the bunkers under Shifa referring to larger spaces that Israel built. This quote was taken out of context by Arab media to create the impression that Israel built the spaces used by Hamas rather than creating more space for patients. This also white washes the Hamas terror tunnels that were built under the hospital.

In fact, Barak was clear – Israel expanded the Al Shifa structure during the 1980s, “over 4 decades ago”, according to the same architectural models of many other hospitals in Israel, such as Beilinson, Soroka and Sorasky. National Roads Company of Israel (MAATZ), with rich experience in constructing state hospitals in Israel hired Israeli architects Gershon Tsfor and Benjamin Edelssohn to design the model, that served for the expansion of the British Mandate-era compound after the Six Day War. Israel’s construction project included expanding the 320-bed hospital into 900 beds and to serve the entire Gaza Strip, rather than merely Gaza City, and inaugurated the central 6-floor building that included an emergency room, respiratory critical care, seven X-ray rooms, five surgery rooms, and a bomb shelter in the underground floor.[24]

This does not infer that the bomb shelter, typical for any Israeli state building and many of Israel’s residential buildings, has been used solely by Hamas, therefore making Israel the architect of its enemies’ hiding place. Hamas significantly expanded the compound, building an underground tunnel network across the Gaza Strip, deepening the underground compound into weapon silos, entire halls, tunnels wide enough to allow ammunition trucks to go through, and an operational headquarters. A standard basement floor, therefore, is not comparable to a vast terrorist network of underground tunnels.

The Al Shifa model as per Israeli architects, including structures that have not been constructed, and an archive picture of the hospital during the Israeli military administration (Ran Arda, Gershon Tsfor collection, Israel Architecture Archive)

Similar Case studies – The US’ fight against ISIS

The United States was facing a similar situation to Israel’s war against Hamas in 2016 in the battle for the liberation of Mosul from ISIS. ISIS used hospitals as command centers in Mosul and Fallujah in Iraq. The US used airstrikes against the al-Salam Hospital Mosul when it contained “only” 10 ISIS fighters[25]. ISIS has used the tactic of occupying medical centers throughout the war against the US. The US launched airstrikes against targets in Fallujah General Hospital and occupied clinic in the town of Hammam al-Alil without prior warning[26].


[1] “White House says it has evidence Hamas using Al Shifa hospital to run military actions”, Reuters, https://www.reuters.com/world/middle-east/white-house-says-it-has-evidence-hamas-using-al-shifa-hospital-run-military-2023-11-14/

[2] Times of Israel, “In interrogation video, Hamas terrorists confirm group’s hideout under Gaza hospital”, October 29th, https://www.timesofisrael.com/in-interrogation-video-hamas-terrorists-confirm-groups-hideout-under-gaza-hospital/

[3]IDF, “EXPOSED: Weapons in Gaza’s Shifa Hospital’s MRI Building”, YouTube, Retrieved November 16th, https://www.youtube.com/watch?v=hEhsIJUw1DQ

[4] https://www.jpost.com/middle-east/article-775348


[5] The protection of hospitals during armed conflicts: What the law says, ICRC,


[6] Video of Hamas shooting at Gazans evacuating in the Humanitarian Corridor https://twitter.com/amjadt25/status/1726140208301642065

[7]IDF, “Terrorist Tunnel Exposed Underneath the Shifa Hospital”, YouTube, Retrieved November 19th, https://www.youtube.com/watch?v=rRra0hvjAL0

[8] Video Showing Hamas terrorists with Kidnapped civilians dragged through Al Shifa Hospital X (Twitter), https://twitter.com/YaariCohen/status/1726484815363428463

[9] “U.S. Adopts Israeli Tactic Employed in Gaza War in Fight Against ISIS” Haaretz, https://www.telegraph.co.uk/bnews/2016/04/27/us-adopts-controversial-israeli-air-strike-tactic-known-as-roof/

[10] “IDF Transfer of Medical Supplies to Shifa Hospital in Gaza”, IDF, YouTube Retrieved November 16th,

[11] Video by Kan 11 showing Hamas beating Gazans and stealing Humanitarian aid, https://twitter.com/kann_news/status/1723779530924470311

[12] IDF, “Healthcare official in Gaza says Hamas uses the Shifa hospital’s fuel for terrorist purposes”, YouTube, Retrieved November 3rd, https://www.youtube.com/watch?v=Kvc2T5d40ag

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048866/

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1906608/

[15] https://www.amnesty.org/en/latest/news/2015/05/gaza-palestinians-tortured-summarily-killed-by-hamas-forces-during-2014-conflict/

[16] https://www.pbs.org/wnet/wideangle/uncategorized/preview-gaza-er-2/4082/

[17] https://www.pbs.org/wnet/wideangle/wa-blog/gaza-er-hamas-hiding-in-shifa-hospital/4086/

[18] https://www.youtube.com/watch?v=MBhT1AA-nMo

[19] https://www.dailymail.co.uk/news/article-12770641/gaza-al-shifa-hospital-british-doctor-claim-hamas-warning.html

[20] https://www.ynetnews.com/articles/0,7340,L-3668018,00.html

[21] https://www.washingtonpost.com/world/middle_east/while-israel-held-its-fire-the-militant-group-hamas-did-not/2014/07/15/116fd3d7-3c0f-4413-94a9-2ab16af1445d_story.html

[22] https://www.theguardian.com/world/2023/oct/30/human-shield-israel-claim-hamas-command-centre-under-hospital-palestinian-civilian-gaza-city

[23] https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiVtavd_dWCAxUdv4kEHUIJABAQFnoECBQQAQ&url=https%3A%2F%2Fwww.ynetnews.com%2Farticles%2F0%2C7340%2CL-4553643%2C00.html&usg=AOvVaw0goCYiZqDMJOGJNJnRGK57&opi=89978449

[24] https://www.ynet.co.il/architecture/article/syyihpw76

[25] “US launches airstrike on Mosul hospital used by Isis, military says”, The Guardian


[26] Iraq: In Mosul Battle, ISIS Used Hospital Base, HRW, https://www.hrw.org/news/2017/02/08/iraq-mosul-battle-isis-used-hospital-base