Israeli military forces caused deaths and unnecessary suffering of Palestinian patients while occupying hospitals in the Gaza Strip during the current hostilities, amounting to war crimes, Human Rights Watch said today.
Witnesses at three hospitals told Human Rights Watch that Israeli forces denied electricity, water, food, and medicines to patients; shot civilians; mistreated health workers; and deliberately destroyed medical facilities and equipment. Unlawful forced evacuations put patients at grave risk and left desperately needed hospitals nonfunctional.
"Israeli forces repeatedly demonstrated deadly cruelty against Palestinian patients in hospitals that they seized," said Bill Van Esveld, associate children's rights director at Human Rights Watch. "The Israeli military's denial of water and electricity left sick and wounded people to die, while soldiers mistreated and forcibly displaced patients and health workers, and damaged and destroyed hospitals."
Israeli authorities have not announced any investigations into alleged serious violations of international humanitarian law, including apparent war crimes, by Israeli ground forces while in control of these or other hospitals. Unlawful forced evacuations of hospitals knowingly carried out as part of the Israeli government's policy of forced displacement of Palestinians in Gaza would amount to crimes against humanity.
Human Rights Watch interviewed nine patients and two healthcare workers present when Israeli forces raided and occupied al-Shifa medical complex in Gaza City in November 2023 and again in March 2024; Kamal Adwan hospital in Beit Lahia in January 2024; and Nasser medical complex in Khan Younis in February 2024. The Gaza Health Ministry reported that 84 patients, and possibly many more, died from lack of care in the three hospitals at these times, excluding people killed by shelling or gunfire.
Israeli forces occupying hospitals severely interfered with the treatment of wounded and sick patients. Medical workers said Israeli forces denied doctors' pleas to bring medicine and supplies to patients and blocked access to hospitals and ambulances, leading to the deaths of wounded and chronically ill patients, including children on dialysis.
Ansam al-Sharif, who had been hospitalized after losing her leg in an Israeli airstrike and needed crutches to walk, said Israeli soldiers told patients at Nasser hospital to sleep upstairs but to go downstairs from 7 a.m. to 9 p.m. "We stayed there for four days with no food, water, or medicines," she said. Al-Sharif witnessed the deaths of four older patients during this time.
Israeli forces forcibly evacuated hospitals and put patients, healthcare workers, and displaced people at grave risk. They ordered patients to leave hospitals without assistance, including those on stretchers and in wheelchairs. They only rarely facilitated transfers to other health facilities, which sometimes could not provide care. After Israeli forces evacuated some hospital buildings, they unlawfully burned or destroyed them.
Israeli soldiers committed abuses against patients, healthcare workers, and displaced people at the hospitals. They shot and killed civilians, fired on healthcare workers, and mistreated people in their custody.
Human Rights Watch previously reported on unlawful Israeli attacks on hospitals and ambulances, as well as the arbitrary detention and torture of healthcare workers. By September 2024, only 4 of Gaza's 36 hospitals had not been damaged or destroyed by Israeli forces, the World Health Organization (WHO) reported, posing a critical threat to the short- and long-term health of the population.
Since the Hamas-led October 7, 2023 attacks on Israel, Israeli authorities have deliberately inflicted damaging and fatal conditions on the Palestinian population in Gaza, including deliberately depriving them of food, water, and other objects necessary for their survival like medicine, amounting to the crime against humanity of extermination and acts of genocide.
Since March 2, 2025, the Israeli government has again blocked all aid entering Gaza, including fuel, in flagrant violation of international humanitarian law.
"The Israeli military's occupation of Gaza's hospitals has transformed sites for healing and recovery into centers of death and mistreatment," Van Esveld said. "Those responsible for these horrific abuses, including senior officials, should be held to account."
Legal Standards and Israeli Forces' Occupation of Hospitals
International humanitarian law provides that hospitals and their staff may not be deliberately attacked. Parties to the conflict must at all times respect and protect hospitals and take all feasible precautions to minimize harm to patients, staff, and facilities during the hostilities.
Hospitals remain protected from attack unless they are used to commit acts harmful to the enemy and only after due warning that has gone unheeded. Acts harmful to the enemy would include housing able-bodied combatants, arms and ammunition stores, or a military command post. However, the presence of wounded or sick combatants and their small arms does not make hospitals subject to attack.
A military force may temporarily enter a hospital for reasons of military necessity, including interrogating and detaining wounded or sick combatants, or verifying that a facility is not being used for military purposes. Such an inspection may not interfere with patients' medical treatment and needs to take into account the potential humanitarian impact. Military personnel must not remain in the facility longer than necessary.
A force that has seized a hospital must actively facilitate the delivery of medical supplies and equipment and not deprive the hospital of other vital resources such as electricity or water.
Occupying a hospital may impede the functioning of the facility and care for the wounded and sick, as well as make the hospital a military objective, endangering patients and staff. Parties are prohibited from interfering in the hospital's work. Ordering patients and staff to evacuate a hospital may only be done as a last resort. Intentionally destroying facilities or medical equipment is prohibited and, if unlawful or wanton, is a war crime.
While Israeli forces exercised effective control over hospitals, they were also obligated under international human rights law to respect, protect, and fulfill the right to the highest attainable standard of health. The United Nations Office of the High Commissioner for Human Rights (OHCHR) has stated that violating the right to health during armed conflict can include: decimating the healthcare system; directly attacking patients, medical personnel, facilities, and transports; obstructing access to health care; limiting access to health services as a punitive measure; and threatening or restricting access to the underlying determinants of health.
Al-Shifa Medical Complex
November 2023
Israel's general evacuation order for northern Gaza, issued on October 13, 2023, included the al-Shifa medical complex. But as of early November 2023, about 50,000 displaced people were sheltering at al-Shifa, according to the UN human rights office. Photographs and videos from inside the compound, verified by Human Rights Watch, showed scores of tents and hundreds of people in the courtyard, including families, medics tending patients, and emergency workers. Civilians and emergency workers brought hundreds of injured and dead to the hospital day and night.
As a result of Israel cutting all electricity and blocking fuel to Gaza after the October 7 attacks, al-Shifa had run out of fuel for its main generators on October 21. A small generator for the intensive care unit (ICU) ran out of fuel on November 11 and could not be replenished. Dr. Khalid Abu Samra, 30, told Human Rights Watch he was presentwhen staff had to remove a patient from a ventilator because of a lack of electricity. "There was no water or food," he said.
Israel's general evacuation order for northern Gaza, issued on October 13, 2023, included the al-Shifa medical complex. But as of early November 2023, about 50,000 displaced people were sheltering at al-Shifa, according to the UN human rights office. Photographs and videos from inside the compound, verified by Human Rights Watch, showed scores of tents and hundreds of people in the courtyard, including families, medics tending patients, and emergency workers. Civilians and emergency workers brought hundreds of injured and dead to the hospital day and night. The Israeli military issued a statement on November 8 that "time is running out" for civilians to evacuate Gaza's north via one route along Salah al-Din Road. The military said it kept the road "open" for a few hours at a time but there was no reliably safe route to flee the hospital. Five days earlier, an Israeli airstrike had hit an ambulance a few meters from the hospital's busy entrance, leaving at least 21 people dead or wounded, including 5 children. It was one of several attacks striking ambulances with patients evacuating from al-Shifa.
Data from NASA's Fire Information for Resource Management System (FIRMS) from between November 6 and 9, based on satellite observation, showed several fires along Omar al-Mukhtar Road, the connecting road from al-Shifa to the Salah al-Din Road main evacuation route. Satellite imagery from November 7 showed Israeli armored vehicles on the connecting road.
Ridana Zukhra, 25, said she left al-Shifa with her children, brother, and cousin when Israeli forces ordered people to evacuate. Despite holding white flags, a tank fired at the group, badly wounding her daughter, Ghazal, 5, whose leg had to be amputated.
By November 12, Israeli forces had surrounded and cut off access to al-Shifa medical complex. About 600 patients were at the hospital at that time, including premature babies and dialysis patients. Hospital administrators said that from November 11 to 17, 40 patients at al-Shifa died, largely due to power cuts, withfurtherdeaths reported from November 17 to 24.
Israeli forces raided and occupied the hospital on November 15. Shahad al-Qutaiti, 23, had been transferred to al-Shifa after a munition hit her apartment building in Gaza City on October 11, killing her husband, mother-in-law, and another relative. Al-Qutaiti was severely wounded and her left leg had to be amputated. She was seven months pregnant and delivered a stillborn baby girl on November 13.
On November 15, al-Qutaiti was recovering from her injuries on the fourth floor of the maternity building, which was "full of patients." She said Israeli soldiers launched "a sound [flash-bang] grenade and a smoke grenade through the windows to force people to go downstairs." Her father and brothers carried her in her wheelchair.
The Israeli militaryinterrogated patients and staff and ordered them to leave al-Shifa on November 17. About 150 patients who could not move remained, including comatose patients, double amputees, and premature babies, along with 10 nurses and 7 doctors, said Dr. Abu Samra.
On November 18, Israeli forces ordered the 2,500 displaced people still sheltering at the medical complex to leave, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA). The forces facilitated a one-hour UN assessment mission, which reported that hallways were "filled with medical and solid waste." A military commander gave hospital staff permission to bury patients who had died since November 11, Dr. Abu Samra said. After staff buried about 50 bodies, Israeli forces took another 70 bodies away.
The media and UN agencies reported that from November 11 to 19, five premature babies died at the hospital and 31 were evacuated, all seriously ill. Israeli forces allowed more patients and staff to evacuate on November 22, but 250 remained. The staff asked for 50 ambulances to evacuate, but on November 23, Israeli forces allowed 14 ambulances and 2 minibuses, Dr. Abu Samra said. At least 10 patients on dialysis machines "refused to leave," he said. "I have no idea what happened to them." A doctor told the media that a maternity patient died after being evacuated to another hospital that lacked ICU care.
March 2024
Al-Shifa hospital resumed limited services in January 2024. By mid-March, an estimated 7,000 patients, caregivers, staff, and displaced people were at the medical complex when Israeli forces began shelling intensively nearby. Theyraided the compound "by surprise" on March 18, an Israeli military spokesman said, because "senior Hamas terrorists" were "using the hospital to command attacks."
While Israeli forces said on March 17 that "there is no obligation for the patients and medical staff to evacuate," on March 18 they ordered "all those … in al-Shifa hospital" to "immediately evacuate." CNN reported that witnesses and Palestinian officials had said that when Israeli forces withdrew on April 1, buildings were destroyed and bodies were strewn on hospital grounds. WHO said that at least 21 patients had died and the hospital was largely destroyed.
Dr. Badr B., 28, who asked not to use his real name for his protection, said that electricity at the hospital was cut off at about 2 a.m. on March 18. Israeli forces broadcast a message that no one could leave, he said, and they shot and wounded four healthcare workers near the entrance. A doctor told the BBC that two patients on life support died because of the electricity cut.
Israeli forces seized the complex with "military vehicles, snipers, quadcopters [drones], soldiers, everything," Dr. B. said. Israeli forces ordered the 72 healthcare workers left at the hospital to transfer about 180 patients from the third and fourth floors of the ICU in the specialized surgeries building to the ground floor and warned they would "start shooting at these floors" within two hours. Dr. B. said that they began "shooting as we were evacuating the last group, three [patients] on crutches and the rest in wheelchairs." Staff then transferred patients to the hospital's reception building.
One patient, Abdullah al-Hajj, 33, an employee with the UN Relief and Works Agency for Palestine Refugees (UNRWA) whose legs had been traumatically amputated in an Israeli airstrike, said that after nurses carried him from the ICU to the reception building, Israeli forces including tanks fired at the ICU "nonstop."
Patients were held without food, water, and medicine, with critically wounded patients lying on the floor, WHO reported on March 22. Dr. B said nine patients died in the reception building within a few days, predominantly older people and one patient with Alzheimer's who had been shot in the head. Another doctor told the media that about 16 patients had died in the reception building.
Al-Hajj said that in the reception building, an Israeli soldier forced a man with a post-operative fractured leg to stand up and strip, despite his pain, and threatened to shoot him. He said that after a soldier ordered another man to go outside, "we heard shots fired, and they brought him back as a dead body." Soldiers refused requests to bury them, al-Hajj said. Dr. Khaleel Skaik posted on social media that when he returned from being interrogated with his hands tied and arms raised, a soldier shot him, severing his right thumb.
Dr. B. said Israeli soldiers "screened" him, made him kneel in the cold for hours, made him put on white PPE coveralls, and cuffed, blindfolded, and interrogated him. Two soldiers repeatedly told him, "You're gay," and he heard a man nearby "screaming in pain as a soldier was kicking him." Dr. B. said that when he was called for questioning, an officer pulled down his blindfold and "the first thing he did, he slapped me in the face."
An Israeli commander told news media the army had established a "very systematic control over the separation between the hospital and the terrorists" at al-Shifa, with "announcements, cordons," and other measures. Israeli forces required staff and patients to wear color-coded bracelets.
Both Dr. Abu Samra and Dr. B. said Israeli forces used them as "human shields," to open or break open doors and enter and check whether rooms were empty.
Around March 24, Israeli forces ordered healthcare workers to transfer patients to the Amir Nayef oncology building, al-Hajj said. About 20 patients were able to walk, but about 150 could not, he said, yet Israeli forces fired tear gas and smoke grenades into the building. He said that when the reception building was emptied, Israeli tanks shelled it. Smoke is visible billowing from the hospital compound in satellite imagery taken on March 25.
"Three or four patients would die every day" in the Nayef building, al-Hajj said. These included an older married couple. Dr. B. said that 11 patients died during the first two days there, including a woman who went into shock, heart disease patients, older people, and a 14-year-old girl with diabetes, who was alone.
Israeli soldiers "didn't allow any food, water, [or] aid," al-Hajj said. His own wounds were infested with worms. Dr. B. said Israeli forces prevented him from bringing supplies to patients from elsewhere in the hospital, and denied permission to WHO missions to visit the hospital.
Dr. B. said that around March 26, Israeli forces set up a "clinic" in the human resources building with water and food, and electricity two days later, but "no painkillers, no antibiotics, no [IV] fluids," or even diapers. Six healthcare workers and 25 patients were sent initially. By March 31, there were over 100 patients facing "extremely unsanitary conditions, and a lack of water" and food, according to WHO's director-general. Israeli forces then set the Nayef building on fire, al-Hajj and Dr. B said.
The media reported that Palestinians later exhumedmass graves on hospital grounds, some dug in 2023, that included patients with catheters.
Israeli Allegations of Military Use by Palestinian Armed Groups
The Israeli military in November 2023 said that Palestinian armed groups had used al-Shifa facilities as a headquarters, publishingphotos of weapons, security camera footage of armed men and two Israeli hostages entering the hospital on October 7, and video of a tunnelcomplex below the hospital. The military later said it believed fighters had not used the tunnels, but used the hospital buildings.
In March 2024, the Israeli military released images it said were of hidden weapons, as well as footage of Palestinian fighters inside the hospital that Sky News reported was from fighting outside the compound. The armed wings of Hamas and Islamic Jihad deniedfightinginside the hospital, but stated that they attacked withdrawing Israeli forces outside the hospital on March 31.
Israeli military officials variously stated they killed from "about 40" or "a few dozen" Palestinian fighters, up to "170 ... in or around" the hospital, and detained 600 "terrorists," including alleged senior Hamas and Islamic Jihad officials. Media reported a witness saying Hamas and Islamic Jihad maintained two offices for their civilian agencies in the hospital, and that scores of non-military employees including police and civil defense workers were present to collect paychecks when the raid began.
None of the patients or medical staff who spoke to Human Rights Watch said that they saw Palestinian fighters inside the hospital compound during Israeli military operations. This is consistent with similar interviews published by the international media.
Kamal Adwan Hospital
December 2023
Israeli forces surrounded Kamal Adwan hospital on December 11 and raided it on December 12, leaving 65 patients, including 18 children, and 3,000 displaced people "trapped … with extreme shortages of water, food and power," OCHA reported. By December 17, at least eight patients had died, including a 9-year-old child, according to WHO's director-general. The military ordered the last patients to leave the hospital on December 27.
Ansam al-Sharif, 20, was sheltering at her home in Jabalia refugee camp in northern Gaza on November 19, 2023, when multiple munitions hit her building. Al-Sharif said the attack injured and burned her, causing the amputation of her leg, wounded 10 relatives sheltering with her, and killed 4 people in her building and 39 others in three neighboring buildings. She went to al-Awda hospital, but after a strike there on November 21 killed three doctors and wounded several patients, she was transferred to Kamal Adwan hospital.
CNN and OCHA reported that on December 11, tank fire hit Kamal Adwan's maternity department, killing two women and injuring others. During Israeli forces' occupation of the hospital, they screened all males ages 16 and older, arrested scores of healthcare workers, and ordered patients and staff to move to another building, CNN reported.
Gaza's Health Ministry reported on December 14 that Israeli forces had evacuated 2,500 displaced people and that two emergency room patients had died.
CNN quoted the hospital's head of pediatric services, who said that on December 15, Israeli military bulldozers dug up and crushed bodies buried on hospital grounds. Satellite imagery from December 15 shows the hospital grounds razed and bulldozer marks visible, destruction and marks not visible in an image from December 14. CNN also reported that two doctors and a doctor's son were shot and wounded, and that another doctor said soldiers fired at him as he tried to reach a wounded man, who later died.
The Israeli military said it ended operations in the area on December 16. On December 27, Israeli forces again raided Kamal Adwan hospital and burned and severely damaged the laboratory, surgical unit, and various departments, WHO reported. Israeli forces ordered staff to transfer all remaining patients, sending some to the Indonesian Hospital, which was not functional at the time.
The Israeli military said the Kamal Adwan hospital was being used for military purposes, including detaining an Israeli soldier, and that it had found weapons, "technological equipment, and Hamas intelligence documents." The UN human rights office reported that the military detained hundreds of people while raiding the hospital. The Israeli military released photographs of men without shirts, in a line, carrying guns over their heads, whom it alleged were "terror operatives." Hospital staff said the weapons had belonged to hospital security guards-permissible under international humanitarian law-and were being handed over to Israeli forces under orders. "There were no armed men at all in the hospital," al-Sharif said, and while she was in the hospital no fighting occurred inside.
Nasser Medical Complex
February 2024
Israeli forces surrounded Nasser hospital in Khan Younis on January 21, 2024, when 850 patients and up to 10,000 displaced people were sheltering there, and raided it on February 15. By the time they withdrew on February 22, the hospital was severely damaged, and medical teams buried 13 patients who had died, some due to lack of electricity and oxygen, the Gaza Health Ministry said.
Medecins Sans Frontieres (Doctors Without Borders or MSF) reported that on January 21, Israeli forces ordered people to leave the hospital, but many soon returned, saying people were being wounded and killed on the street. On January 23, the Israeli military issued displacement orders for areas that included Nasser and two other hospitals, but they denied ambulances access and people could not leave "without risking their lives," MSF said. On January 26, the Israeli military said that "there is no obligation to evacuate" the hospital but that people could do so.
MSF and BBC reported that there was shooting at the hospital, killing a nurse inside the operating room on February 8 and killing and wounding others. BBC verified videos of shooting and of three bodies in the hospital courtyard.
The Israeli military rejected a request from WHO to visit the hospital on February 10. Duaa D., who asked that her real name not be used for her protection, said her son Mohammed, 20, was a kidney patient in Nasser hospital at the time, where there was no fresh food, clean water, or medicine for Mohammed's hypertension. Her two younger children, sheltering in a tent in the hospital courtyard, went sleepless with fear. Mohammed said he could barely walk and had lost almost half his body weight due to vomiting and diarrhea, that the water was contaminated, and that he could not digest the canned food due to his chronic illnesses.
On February 13, Duaa saw Jamal Abu al-Ola, 25, who had been sheltering in the hospital, in a white hazmat suit with his hands bound. NBC and other media reported that Israeli forces had detained and beaten him and ordered him to warn the hospital to evacuate, threatening to kill him and others if he did not return. Duaa said al-Ola shared the warning and left the hospital, but soon after was carried back in and "shot, with a fountain of blood pouring." Witnesses told news media that Israeli forces shot and killed him near the hospital entrance.
Early on February 15, Israeli forces raided the hospital, ordering everyone to leave because they "will demolish the whole building," Duaa said. Israeli forces used a bulldozer to demolish part of the complex and an artillery shell hit the hospital, Mohammed said. MSF reported that the attack killed one person and wounded eight in the orthopedic ward. The military acknowledged that a "stray shell" had hit the hospital.
Satellite imagery from February 16 shows parts of the hospital complex had been razed, with bulldozer tracks visible.
Duaa said she saw a large number of bodies on the ground behind the renal unit and recalled an "unbearable" smell. "We saw cats and dogs eating bodies," she said. "Once a dog brought a human hand and gave it to its puppies."
By February 18, Nasser hospital had ceased to function. On February 19 and 20, ambulances evacuated 53 patients, but 100 patients and 15 doctors remained, along with "the decomposing bodies of eight ICU patients who died for lack of oxygen," OCHA reported.
The Israeli evacuation orders separated Mohammed from his family. Israeli forces screened him and ordered him to leave the hospital on foot.
SevenIsraelihostages whom Palestinian armed groups released during the November 2023 ceasefire said they had been held in Nasser hospital, in most cases for several days. The Israeli military said before the raid that bodies of Israeli hostages might be in Nasser hospital, though none were recovered. It later said forces searching for hostages' bodies had exhumed mass graves dug by Palestinians in the hospital. The UN human rights office reported in April 2024 that Palestinians had recovered 283 bodies "buried ... and covered with waste" at Nasser hospital, apparently by Israeli forces, allegedly including bodies with "their hands ... tied and stripped of their clothes."
International and local healthcare workers who had been in the hospital said they were unaware of any fighters there. Duaa's husband, Zaid, said that Palestinian armed groups were fighting in Khan Younis at the time "but not in Nasser [hospital]. … [W]e didn't see resistance [fighters]."
On February 22, the Israeli army withdrew, leaving Nasser hospital severely damaged and non-functioning until limited activities resumed in May 2024.
