Al-Shifa ambulance airstrike

On 3 November 2023, amid the Israeli invasion of the Gaza Strip and siege of Gaza City, an Israeli airstrike hit an ambulance convoy departing from al-Shifa Hospital carrying critically injured patients. The strike killed 15 people and wounded 60. The Palestine Red Crescent Society, which was part of the convoy, said that all 15 casualties were civilians. The airstrike also caused damage to the hospital itself.

The Israel Defense Forces (IDF) acknowledged that it carried out the airstrike, and said that Hamas militants were killed in the attack and that one of the ambulances was being used to transport Hamas personnel and weaponry. The Gaza Health Ministry, which is part of the Hamas government, denied any military use of the ambulances. Human Rights Watch said it "did not find evidence that the ambulance was being used for military purposes". The Washington Post analyzed the videos and found no evidence of weapons or individuals in military clothing. The airstrike was condemned by the World Health Organization, while Human Rights Watch labelled the incident "apparently unlawful" and called for the attack to be investigated as a potential war crime.

Background
Before the attack and since the start of the war, Israel had attacked 7 other PRCS ambulances, and killed 4 of its personnel, the organization said.

Al-Shifa Hospital is the largest medical facility in the Gaza Strip. In the week before the attack, the IDF said that al-Shifa was "the site of a significant Hamas command and control center".

On 16 October 2023, Israel ordered Al Shifa Hospital, and the rest of northern Gaza, to evacuate. Because of insufficient beds in the southern Gaza Strip and no means of transporting patients, such as newborns in incubators or patients on ventilators, the evacuation orders were widely regarded as impossible to comply with.

On 1 November 2023, it was announced that the Rafah Border Crossing would be open for foreign nationals and seriously injured patients. Hamas initially proposed evacuating wounded Hamas fighters as part of limited evacuations, but this was rejected.

On 2 November 2023, the IDF encircled Gaza City in the context of the Israeli invasion of the Gaza Strip.

Airstrike
The Israeli airstrike came as an ambulance convoy departing from al-Shifa Hospital carrying 15-20 critically injured patients. The convoy had been bound for the recently reopened Rafah crossing with Egypt when it came under attack. The convoy was attacked at multiple locations, including outside of the hospital gate and at Ansar Square. The strike killed 15 civilians, according to the PRCS. Gazan health ministry spokesman Ashraf al-Qudra stated that 15 people had been killed and 60 wounded.

Following the strike, graphic footage emerged on social media of about a dozen people lying prone amid pools of blood, as people rushed to help. Also at the scene was a dead horse tied to a cart, as well as a blood-splattered Palestinian Red Crescent ambulance. Palestinian health authorities had announced the departure of the ambulance convoy in advance. Al-Qudra stated: "We informed the Red Cross and the Red Crescent, we informed the whole world, that those victims were lined up in those ambulances. This was a medical convoy." The International Committee of the Red Cross (ICRC) confirmed to CNN that they received a request to escort the convoy, but said that it was ultimately not part of the convoy. The ICRC added “No doctors, nurses, or any medical professionals should ever die while working to save lives.”

The Palestinian Red Crescent confirmed that one of its ambulances was hit, though its staff were unharmed. However, a spokesperson noted that the area of the strike was hit was "extremely crowded" with civilians at the time.

The hospital director stated that the names of the injured in the ambulance convoy were on a list of authorized evacuees, and Egypt's health ministry that only 17 of the anticipated 28 injured evacuees passed into Egypt on 3 November 2023 as a result of the airstrike.

Israel stated that it only struck one ambulance, though the Palestinian Red Crescent disputed this, saying Israel had targeted multiple different ambulances.

Witnesses of the airstrike
Bisan Owda, a Palestinian journalist, happened to be nearby when the attack occurred. She recounted to the BBC the harrowing scene of individuals losing their limbs and struggling to carry the injured, while others were desperately searching for relatives. Moreover, apart from the patients seeking medical assistance at Al-Shifa, numerous individuals had sought refuge from the Israeli air strikes in that vicinity.

Potential war crime
A number of sources have expressed concern that the Israeli airstrike could constitute a war crime. Attacks on healthcare facilities, such as ambulances, may amount to a violation of International humanitarian law.

Alleged presence of militants
The Israeli military confirmed the strike, stating its assessment that one of the ambulances was being used by a "Hamas terrorist cell", and that Hamas fighters were killed in the strike. The Israeli military provided no evidence for these statements, but stated it shared details with unnamed "agencies". Hamas said none of its fighters were present in the ambulance convoy.

Human Rights Watch (HRW) stated it found no evidence of any military usage of the ambulances. HRW interviewed interviewed several witnesses, including an Anadolu Agency journalist and verified that his photos and videos placed him at the time and location of the airstrike. The Washington Post reported that video of the aftermath "showed women and children among the casualties, and no weapons or individuals wearing military clothing could be seen".

Military presence doesn't necessarily justify attack
Human Rights Watch pointed out, under International humanitarian law, hospitals and ambulances have a protected status, even if they are used to provide medical care to enemy fighters. The ambulances only lose their protected status if they commit “acts harmful to the enemy,” such as transporting ammunition or healthy fighters. HRW did not find any evidence of such military usage in this case.

Sari Bashi noted that Israel itself stated that Hamas fighters were merely leaving the hospital, not attacking from it. Bashi said this statement by Israel would indicate Israel has not accepted IHL rules that protect ambulances.

Children and civilian casualties
Human Rights Watch pointed out that there was a number of civilian casualties, including children, who were killed and wounded. It said deliberate attacks on civilian targets where there are no military objectives present are prohibited. Even if a military objective was present, the attack could still be a war crime, because the high number of civilian casualties was disproportionate to the likely military objective.

ICRC
The ICRC informed CNN that it had been asked to accompany the convoy before its departure. Although it was informed about the planned transfer of a convoy transporting injured patients from northern Gaza to the southern part of the enclave on Friday, the ICRC clarified in a subsequent statement that it was not involved in the convoy. It said that "any violence towards medical personnel is unacceptable," and that "No doctors, nurses, or any medical professionals should ever die while working to save lives.”

Doctors Without Borders/Médecins
Médecins Sans Frontières (MSF) doctor at Al Shifa hospital, said that they "were standing inside the hospital gate at the time that the mentioned ambulance was directly hit in front of us. On the other hand, there were bloody bodies everywhere. Many of them were killed immediately, while we rushed the other ones to the operating room for emergency care, [...] We have repeatedly called for an immediate and total ceasefire, for the protection of healthcare facilities, as well as medics, patients and people who are taking shelter there."

Inside the ambulance
Abdelsalam Barakat, a Palestinian nurse, found himself inside an ambulance in north Gaza, attempting to transport patients with skull and chest fractures. However, the situation quickly turned terrifying as explosions from Israeli air strikes shook the ambulance, placing both him and his patients in a precarious position between life and death.

Barakat reported that the initial attack occurred at a roundabout a short distance from the hospital, resulting in injuries to a paramedic and a passenger in one of the ambulances. The second strike took place near the hospital gate as the convoy was returning after abandoning their attempt to travel south. This attack hit an ambulance in front of Barakat's vehicle, resulting in the death of a paramedic and others in close proximity. Amidst the horrifying scene of bodies lying in pools of blood, Barakat's vehicle swiftly departed from the chaos and made its way towards the central ambulance station, approximately 1.2 km away. Along the way, they encountered additional attacks that shook them. Eventually, they transported the patients back to al-Shifa, further away from any possibility of evacuation and in a deteriorated condition compared to before.

Reactions
World Health Organization Director-General Tedros Adhanom Ghebreyesus stated that he was, "utterly shocked by reports of attacks on ambulances evacuating patients close to Al-Shifa hospital in Gaza, leading to deaths, injuries and damage." UN chief António Guterres stated he was "horrified" by the attack. Doctors Without Borders condemned the ambulance attack.

On 7 November, Human Rights Watch determined that the strike was "apparently unlawful and should be investigated as a possible war crime", noting that ambulances and other medical transportation must be allowed to function and be protected in all circumstances". It added that the use of ambulanced for military purposes would also be against the rules of war, but it had found no evidence of this. Remarking on an IDF spokesman telling an Israeli outlet that day "Our forces saw terrorists using ambulances as a vehicle to move around. They perceived a threat and accordingly we struck that ambulance", Human Rights Watch said ambulances would only lose their protections under international law if they were committing "acts harmful" to Israel, with their Middle East and North Africa director saying "For the Israeli authorities to claim that their deadly November 3 attack on an ambulance in a crowded area was lawful, they need to do more than just insist that Palestinian fighters were using an ambulance as transport."

The UN's undersecretary-general for humanitarian affairs and emergency relief coordinator, Martin Griffiths, emphasized that hospitals should not be treated as battlegrounds. "He stressed the importance of prioritizing the safety of newborns, patients, medical personnel, and all civilians above all else," Griffiths added.

The Palestinian Red Crescent Society released a statement saying "PRCS emphasises that the deliberate targeting of medical teams constitutes a grave violation of the Geneva Conventions, a war crime, and that the parties to the four Geneva Conventions are legally bound to ensure the protection of medical teams and civilians under all circumstances."