With Israel consolidating its hold on northern Gaza, its forces are closing in on a sprawling medical center that for Israelis and Palestinians alike has emerged as a symbol of the other side’s inhumanity.
By Israel’s account, Al Shifa — the name of the hospital — has become shorthand for Hamas’ willingness to turn its own people into human shields and sacrifice them as cannon fodder in the fight for global sympathy.
The militants, Israeli security officials say, have spent the better part of 16 years building a vast command complex under the hospital, and setting up similar bases underneath other medical facilities in the enclave. American officials agree, citing their own intelligence.
Hamas denies doing anything of the sort, and hospital officials say the facility houses nothing but the sick and injured and the medical professionals dedicated to helping them. In the estimation of most Palestinians, the obsession with Al Shifa is evidence of Israel’s willingness to target even the most helpless civilians without justification.
The hospital’s director, Dr. Mohammed Abu Salmiya, flatly described the Israeli allegations as “untrue” in an interview on Friday.
While it is impossible to independently verify many of the assertions of either side, the competing claims are likely to be tested soon. The hospital, Israeli officials said, was spared in past Israeli operations out of concern for civilian life, but at the cost of leaving whatever may be underneath it intact.
It is a mistake that Israel will not repeat this time, the officials said. They say that the complex under Al Shifa is one of the principal Israeli targets of the war and will not be left untouched, despite the growing international outcry to spare Al Shifa and other hospitals.
“The hospitals will be surrounded, pressure will be put on people to leave,” said Chuck Freilich, a former Israeli deputy national security adviser. “I don’t see Israel going headlong against the civilians, but the hospital — or at least what’s underneath it — has got to be cleared out.”
Only that way, Mr. Freilich said, can Hamas’s rule in Gaza be ended, though “it’s not going to look good.”
Conditions at Al Shifa, Gaza’s main hospital, are dire. Hundreds of seriously ill and wounded patients and displaced people have been trapped inside as Israeli tanks and troops close in on the compound, and close-quarters combat is taking place nearby.
The Health Ministry in Gaza, which is run by Hamas, said that at least five wounded patients had died on Saturday at the hospital, including a premature baby in an incubator, as a result of a power outage. Without fuel to run generators, the hospital has been plunged into darkness, the ministry and the hospital’s administrator said.
In recent days, Israeli soldiers have surrounded at least one other hospital in northern Gaza, stepping up their push to empty the facilities, according to Israeli military officials, as fighting around them intensifies.
At Al Rantisi Specialized Hospital for Children, the only medical center with a pediatric cancer ward in the strip, Dr. Bakr Gaoud, the head of the hospital, said Israeli forces moved in late last week, damaging the ground floor and destroying several vehicles before providing maps that showed a safe route out.
“We dragged our patients on their beds on the street to the south,” he said. “I was the very last one to leave the hospital.” He said the worst-off patients went to Al Shifa, while everyone else made their way south, away from the main area of fighting.
A second hospital, Al Nasr, was similarly emptied out by Israel on Friday, and the Health Ministry reported strikes against other hospitals over the weekend.
Al Shifa can no longer take in new patients, and staff members at the hospital say it is running out of food and water. There are about 1,500 patients, staff and displaced people there now taking shelter, according to Dr. Mohammed Zaqout, the Gazan Health Ministry’s general manager for hospitals.
Israel’s military said in a statement on Sunday that it was securing a route for civilians and patients to leave Al Shifa, suggesting that fighting was likely to intensify around the hospital.
American officials have warned Israel not to move against hospitals that are still treating patients, Jake Sullivan, the national security adviser, said on Sunday in an interview with “Face the Nation” on CBS.
“The United States does not want to see firefights in hospitals, where innocent people, patients receiving medical care, are caught in the crossfire,” he said. “And we’ve had active consultations with the Israeli Defense Forces on this.”
Still, he agreed that Hamas is using hospitals and other civilian facilities as “human shields.”
Israel has long maintained that Al Shifa is among the most egregious examples, and its military has pushed its claims hard since the Oct. 7 attack by Hamas. It has shown reporters what it says is a 3-D representation of the complex, released audio recordings that purport to show Hamas fighters discussing the tunnels under Al Shifa and released two videos of interrogations in which captured militants discuss the tunnels.
None of it provides conclusive proof that a sprawling complex exists under Al Shifa. But eight current and former Israeli defense and intelligence officials, speaking on the condition of anonymity, have doubled down on the claim, describing in new detail what Israel’s security establishment believes it will find.
A large portion of the buildings that now make up the hospital were built by Israel when it ruled Gaza. It pulled out of the strip in 2005, opening a window for Hamas to take control, and by 2007 the militants had begun building the command center under Al Shifa, the Israeli officials said.
At first, Hamas simply dug out areas off the original basements of Al Shifa’s buildings, later going deeper and adding floors and connecting it to the vast network of reinforced tunnels it was building across Gaza, the officials said. They said it has since grown into one of the hubs of a vast tunnel system that crisscrosses Gaza.
A former senior official at Shin Bet, Israeli’s internal security service, said both Hamas and Israeli intelligence referred to the network as “the Metro” and compared the compound under Al Shifa to a major station of the New York subway system.
The former Shin Bet official and two other Israeli officials said the compound included several floors with designated spaces for meetings, living quarters and storage facilities. It can hold at least several hundred people, they said.
Israeli military intelligence said in a statement provided to The New York Times that “there are several underground complexes used by the leaders of the terrorist organization Hamas to direct their activities.” The complex relies in part on electricity diverted from Al Shifa, the statement said, and there are multiple entrances to it in and around the hospital.
Senior Israeli intelligence officials allowed The Times to review photographs that purported to show secret entrances to the compound from inside the hospital. Signs identifying the location as Al Shifa were clearly visible in the photographs, though their authenticity could not be independently verified.
American officials, who also spoke on the condition of anonymity to disclose sensitive intelligence, said they are confident that Hamas has used tunnel networks under hospitals, in particular Al Shifa, for command and control areas as well as for weapons storage.
The practice by Hamas has been longstanding, they said, adding that the United States and Israel have independently developed intelligence about Hamas’ use of the tunnel network under Al Shifa Hospital.
There are other accounts of Hamas using Al Shifa, as well. In 2008, armed Hamas fighters in civilian clothing were seen roving the hospital during a three-week war between the militants and Israel, according to New York Times reporting in Gaza at the time. The militants claimed to be security guards, but were seen killing alleged Israeli collaborators.
Six years later, during the next round of fighting between Israel and Hamas, the militants routinely held news conferences on the hospital grounds and used them as a safe meeting place for Hamas officials to speak with journalists, though these activities do not constitute military use.
After the war, Amnesty International said in a report that Hamas was using abandoned areas of Al Shifa, “including the outpatients’ clinic area, to detain, interrogate, torture and otherwise ill-treat suspects, even as other parts of the hospital continued to function as a medical center.”
Two Norwegian doctors who worked at Al Shifa during the war, Mads Gilbert and Erik Fosse, disputed the reporting, and insisted that there was no Hamas presence at the hospital. Mr. Gilbert, an activist who describes himself as a “political doctor,” was particularly outspoken against Israel and was reportedly banned from Israel and Gaza in 2014.
Matthew Rosenberg reported from London, Ronen Bergman from Tel Aviv, Aaron Boxerman from Jerusalem and Vivian Yee from Cairo. Julian Barnes and Peter Baker contributed reporting from Washington, and Abu Bakr Bashir from London.