Six days after the Hamas-led massacre in southern Israel on Oct. 7, 2023, Israel ordered the evacuation of 22 hospitals in northern Gaza. In fact, 1.1 million people were ordered to evacuate the entire north of the enclave within 24 hours. But the evacuation of critically ill patients from nearly two dozen hospitals — a total of around 2,000 people, including newborn babies in incubators, patients on hemodialysis and life support — was not possible, certainly not quickly. The World Health Organization (WHO) condemned the order, calling it a “death sentence” for the sick and injured. Health care workers made the difficult choice to stay with their patients, even as their families were forcibly displaced to the south.

On October 17th, 2023, there was a massive explosion in the parking area outside one of these hospitals — Al-Ahli Arab Hospital (also known as the Baptist Hospital, although it’s now run by the Anglican Diocese of Jerusalem). Having been displaced from their homes as Israel launched its offensive, thousands of residents were sheltering in and around the hospital, in addition to patients, families and staff.

According to the Gaza Ministry of Health, 471 people were killed directly in the explosion and many others wounded, some critically. Speaking as a representative of the ministry, Dr. Ashraf Al-Qadra condemned the incident as an expansion of Israeli attacks on Gaza to target the hospital system, though hospitals had already been hit by Israeli strikes. However, Israel denied responsibility.

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A month of analysis and debate followed, with governments including the United States; publications such as the Wall Street Journal and Agence France-Presse; and non-governmental organizations like Human Rights Watch launching their own investigations. “A year ago, after massive blast at #AlAhli Hospital, just questioning if Israeli forces might be responsible was to invite vilification. Today? So many hospitals, clinics, health professionals and patients have been targeted/killed in Gaza and Lebanon, it is impossible to keep track,” Alex Neve, international human rights lawyer and former Amnesty International Canada Secretary General, wrote last week during the sieges of the last three functioning hospitals in Gaza’s north. Yet the widely reported conclusion accepted by most media that fall was that misfired rockets set off by a Palestinian armed group were to blame. Israel didn’t do it. The world moved on.

That was many cynical months ago, and many hospitals ago. Now, a report released this month by an independent commission of the United Nations describes Israel’s repeated and deliberate assault on health care infrastructure in Gaza. It specifically finds that:

Israel has implemented a concerted policy to destroy the health-care system of Gaza. Israeli security forces have deliberately killed, wounded, arrested, detained, mistreated and tortured medical personnel and targeted medical vehicles, constituting the war crimes of wilful killing and mistreatment and the crime against humanity of extermination.

The report will be presented to the U.N. General Assembly today. It’s more timely than ever. Just over a year after the Baptist Hospital explosion, multiple hospitals have come under direct attack by Israeli forces in recent weeks. Israeli forces withdrew on Monday from the last functioning hospital in north Gaza, Kamal Adwan Hospital, after days of direct strikes on the facility with shells and machine gun fire, hitting every hospital department and killing young patients after striking oxygen stations and the hospital generator.

Shortly after that, IDF soldiers stormed the hospital and arrested 44 male medical staff and some male patients. The hospital director's son was killed during the initial invasion of the facility two weeks before, when staff refused to leave their patients upon orders to evacuate. The director himself was arrested and later released.

The week before, the Indonesian hospital was similarly surrounded, shelled and directly attacked with artillery. Al-Awda, the third remaining hospital in this part of Gaza (there were previously 10), was also subject to strikes. Health care facilities in the center and south of Gaza continue to face similar attacks, which over the past year have involved strikes, sieges, forcible evacuations, and storming of hospitals across the Gaza Strip.

"It’s crazy to me that we’ve gotten so almost desensitized to it, or that no one’s really calling it out anymore."

“I get updates from our teams or from people who are scouring the news just to figure out, ‘which hospital is on the list today?’” Dr. Amber Alayyan, an American pediatrician and the deputy cell manager for the Middle East Region at Doctors Without Borders, told Salon in a video call from Paris. She described a message from someone she works with: “it was like, all three of the hospitals in the north like ‘boom, boom, boom,’ one after another are under attack.”

It can no longer be denied, Alayyan said, that Israel is deliberately targeting hospitals, although Israeli authorities deny this. “Now it’s just sort of like ... it’s just getting done, and it’s crazy to me that we’ve gotten so almost desensitized to it, or that no one’s really calling it out anymore,” she said.

Journalists in the north of Gaza reported last week that men detained both within hospitals and in the surrounding neighborhood were separated from women and made to march south. Drone footage from the weekend showed long lines of men and boys standing or walking in single file. As of this writing, their fate is unknown — however, by the following day the Israeli army itself released similar footage of the same scenes.

“It’s hard to describe, like a little part of my soul dies every time there’s a hospital that’s hit," Alayyan told Salon. “I cannot imagine this place, that is one of the safest places where you should be able to go, being a place that’s targeted.”

Alayyan said that despite repeated attacks targeting hospitals and hospital compounds, Palestinians in Gaza continue to flock to hospitals and the areas around them. Many thousands of people live in and around the grounds of the dwindling number of still-functioning hospitals across the territory, whether because they have family members who are patients or because they have themselves just been released from hospital and have nowhere else to go.

People inspect the damage caused by an artillery shell that hit the maternity hospital inside the Nasser Medical Complex, on December 17, 2023 in Khan Yunis, Gaza. (Ahmad Hasaballah/Getty Images)“In Gaza, I think people are sort of holding on for dear life to these hospitals,” Alayyan said, speculating that they persist in the idea that a hospital should be a safe place despite everything. “The people still go there, and the staff still rebuild them.”

Chris Sidoti is one of the three members of the COI, established by a resolution of the U.N.’s Human Rights Council in 2021 in response to “grave” concerns about human rights in the occupied territory. A lawyer, consultant and expert in human rights law, institutions and mechanisms, Sidoti previously served as a Member of the U.N. Independent International Fact Finding Mission on Myanmar.

“We do not find any fact without corroboration,” Sidoti told Salon, speaking from Australia in a video interview. “We interview victims and witnesses. We have done that both in person for medical evacuees from Gaza and members of their family who are accompanying them. We’ve been able to interview them in person, face-to-face. We also conduct interviews online, through telephone and internet, just like this, on Zoom.”

Sidoti confirmed that, based on the commission’s review of available evidence, the cause of that explosion in the courtyard of Al-Ahli Arab hospital almost exactly a year ago remains unclear. In other words, the commonly accepted conclusion that Hamas or other Palestinian forces were responsible cannot be taken as established fact — but neither can later analyses, also reviewed by the commission, such as this one concluding that only........

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