(CNN) — Gaza’s largest hospital, Al-Shifa, has become a flashpoint in Israel’s war against Hamas, which began when gunmen from the militant group crossed the border into Israel on October 7, killing around 1,200 people.
Palestinians and humanitarian agencies say the current fighting in and around Al-Shifa is proof of Israel’s wanton disregard for civilian life in Gaza, while Israel accuses Hamas of using the medical center as a shield for its operations. On top of providing medical care, the Al-Shifa Hospital had recently become a key shelter for thousands of Palestinian civilians fleeing Israeli bombardment.
Since launching its operation at the hospital on November 15, the Israel Defense Forces (IDF) have shown images of a tunnel shaft and military equipment, but have yet to show conclusive proof of the large-scale command and control center it alleges is there.
Hamas, the Gaza Health Ministry and hospital officials have denied Israel’s claims, saying that hospitals in the Strip have only been used to treat patients. Doctors in Al-Shifa have also sounded the alarm about deteriorating conditions inside the medical facility, which is struggling to meet patients’ needs amid supply shortages and the presence of Israeli troops.
The IDF is now under pressure to prove Israel’s long-standing assertion with its promise of “concrete evidence.” Its ability to continue its operation in Gaza, and the credibility of Israel, could be at stake as the number killed in Gaza surpasses 12,000, according to authorities in the Hamas-controlled Strip.
Here’s what we know so far.
What does Israel say?
For weeks, the IDF said Hamas has been using Gaza’s largest hospital as cover for what it calls terror infrastructure below ground. IDF spokesperson Rear Admiral Daniel Hagari said Hamas had a command and control center or headquarters underneath the hospital complex grounds, which other senior Israeli officials have also insisted on.
In a presentation to the media last month, Hagari claimed that Hamas was directing rocket attacks and commanding operations from bunkers underneath the hospital building, which he said were linked to a network of tunnels that Hamas had dug underneath Gaza City.
The IDF also published an “intelligence-based” illustrated video of what it claims the Hamas headquarters under Al-Shifa looks like. The video shows a 3D diagram of the hospital, which moves to show an animated network of purported tunnels and operation rooms.
CNN cannot independently verify Israel’s claims that Hamas is operating a “command and control center” from the hospital.
The White House has backed Israel’s claims, saying that Hamas was storing weapons and operating a command node from Al-Shifa, citing US intelligence. But senior US officials have declined multiple times to expand on how they can corroborate Israel’s claims, as the US does not have a presence on the ground in Gaza.
What evidence has Israel provided?
Over the weekend, the IDF took CNN and other news organizations to a newly exposed tunnel shaft on the grounds of the Al-Shifa hospital complex that it says was used by Hamas.
The structure appeared to be substantial, with the remains of a ladder hanging over the opening and a pole that looked like a hub for a spiral staircase running through the middle of the shaft.
The IDF also released video – filmed on Friday – from inside the shaft, showing a staircase leading down into a concrete tunnel that the military said was 55 meters long and located 10 meters underground. At the end of the tunnel is a metal door with a small window, according to the video, which the IDF said it had not yet opened to the possibility that Hamas had booby-trapped it.
The video is arguably the most compelling evidence thus far that the IDF has offered that there may be a network of tunnels below the hospital. It does not, however, establish without a doubt that there is a command center under Al-Shifa.
The Israeli military on Sunday also presented several videos that it said illustrated Hamas’ presence at Al-Shifa hospital, including CCTV footage that appeared to show hostages being brought through the hospital itself and separate footage from inside a tunnel shaft on the medical compound’s grounds. CNN cannot independently verify the content of the videos.
The CCTV footage showed Hamas fighters moving a Nepalese hostage and a Thai hostage through the hospital on October 7, IDF spokesperson Hagari said. One appears to be frog-marched through the building, while another appears to be bleeding and is pushed on a gurney.
Hagari did not spell out how the IDF had acquired the videos, though he did say that Israeli intelligence officers were part of the operation inside the hospital to try to locate the hostages.
Hagari also dismissed suggestions that the hostages had been brought to the hospital because they were wounded, claiming that one of the two hostages in the videos was not injured and did not need medical treatment. They had been brought to the hospital first before being moved to hiding spots like nearby apartments, he said.
The shared CCTV footage comes after Israel’s military said it found the bodies of two Israeli hostages – a 65-year-old woman and an Israeli soldier – in the same neighborhood as Al-Shifa hospital.
The IDF had previously touted other alleged discoveries on the hospital grounds, saying soldiers located a room in Al-Shifa where they found “technological assets, along with military and combat equipment used by Hamas” for “terrorist purposes.”
Hamas has rejected those claims as “baseless lies.”
CNN analysis of separate footage published online by the IDF prior to visits from international media outlets suggests weaponry at Al-Shifa may have been rearranged.
An IDF video on November 15 showed a military spokesperson touring the facility, during which an AK-47 gun is seen behind an MRI machine. Fox News and the BBC were subsequently granted access to the hospital. In their reports filmed after the IDF clip, two AK-47 guns are visible in the same location. It is unclear where the second assault rifle came from.
The IDF told CNN the discrepancy between the military’s own video and the BBC footage was “due to the fact that more weaponry and terrorist assets were discovered throughout the day.”
“Suggestions that the IDF is manipulating the media are incorrect,” it said.
The United Nations has called for access to the site for an independent investigation into the competing allegations and warned that hospitals should not be used as battlegrounds for any side.
How has Hamas responded?
Israel’s allegations have been vehemently denied by Hamas, the Gaza Health Ministry, and hospital officials.
The director general of the Hamas-controlled health ministry, Dr. Medhat Abbas, told CNN that hospitals in the enclave “are used to treat patients only” and are not being used “to hide anyone.”
The health ministry responded to the images of hostages inside Al-Shifa released Sunday by the IDF by questioning their authenticity – but went on to say that if true, the pictures showed that hospitals in Gaza provided medical care to anyone who needed it.
In a statement issued Saturday before the release of the CCTV videos, Hamas said it had brought several hostages to hospitals for medical treatment after they were injured in Israeli air strikes.
After Israel launched its operation, Hamas accused the US of giving Israel “a green light … to commit more massacres against civilians” by amplifying what it called a “false narrative” that a militant command center lies somewhere inside Al-Shifa.
Why Al-Shifa matters and what’s happening to its patients
More than five days since the IDF raided Al-Shifa hospital, Israeli troops are still on hospital grounds, and the facility is still filled with patients and medical staff operating in dire humanitarian circumstances.
Doctors who are still at the hospital cannot treat patients due to heavy shelling in the past week. Fuel shortages and a lack of electricity prevent them running incubators for the babies. ICU patients and several neonatal babies in Al-Shifa have died in recent days.
A doctor inside Al-Shifa hospital told CNN Monday that staff movements around the complex were being restricted, and Israeli forces are questioning staff about Hamas and tunnels.
Dr. Ahmed El Mokhallalati, head of the burns unit, said the hospital is also running out of urgent requirements, including anesthetics, oxygen tanks, medicine and blood banks.
Israel’s Defense Ministry says it delivered more than 6,000 liters of water and 2,300 kg of food — including fish, canned food, bread, spreads and dates — over the weekend.
El Mokhallalati also told CNN that Israeli forces had removed about 200 bodies from the hospital’s mortuary as well as from mass graves recently dug on the site. “They brought two trucks and they have taken all the dead bodies out of the hospital,” he said.
Several days ago, Israel’s army spokesman Hagari dodged a question about whether Israel had taken bodies out of the hospital complex as part of its efforts to determine the fate of hostages kidnapped from communities in southern Israel on October 7.
A group of UN humanitarian workers visited Al-Shifa on Saturday, describing the hospital as a “death zone” where “signs of shelling and gunfire” were evident.
An Egyptian government official told CNN Monday that 28 of 31 premature babies that were evacuated from Al-Shifa to southern Gaza have arrived in Egypt through the Rafah crossing. The three remaining babies remained in Gaza but are still alive, the official added.
The sprawling medical facility of Al-Shifa, which sits in the western part of Gaza City, was built in 1946 when Gaza was still under British rule.
It has long been seen as the backbone of medical services across the besieged Gaza Strip, and Israel’s operations there have compounded a grim humanitarian crisis, Palestinian health officials have said.
This story has been updated with additional developments.
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CNN’s Eyad Kourdi, Kareem Khadder, Nadeen Ebrahim, Jessie Yeung, Christian Edwards, Andrew Carey, David Shortell, Katie Polglase, Gianluca Mezzofiore, Lauren Said-Moorhouse, Martin Goillandeau, Eleni Giokos and Jo Shelley contributed reporting.