Hospitals are supposed to be safe. Not in Gaza.

The Israel Defense Forces raided Gaza’s largest still-operating hospital on Thursday in Khan Younis, a southern city that once sheltered over 100,000 displaced Palestinians but that has been under siege for weeks.

The IDF told Vox that it has “credible intelligence that Hamas held hostages in Nasser Hospital. Terrorists appear to be operating from within the hospital too.” IDF spokesperson Rear Adm. Daniel Hagari said in a statement that IDF special forces are undertaking a “precise and limited mission” to find and recover bodies of Israeli hostages that it believes to be in the hospital, citing their own intelligence and testimony from released hostages. Hamas has refuted those claims, and Vox is unable to independently verify them.

This is only the latest of many hospital raids that Israel has conducted since the war began, both in Gaza and in the occupied West Bank. The raids have been a source of bitter controversy, with Israel claiming Hamas has left it with no choice but to resort to such measures while opponents of the country’s war strategy argue that nothing Hamas does can warrant the civilian suffering Israel exacts.

In this and other instances, even if the IDF’s claims are true, human rights advocates say that under international humanitarian law, Israel cannot justify the dire humanitarian consequences of the raid. The IDF’s operation has forced doctors, patients, and displaced Palestinians sheltering there to flee, though many remain trapped inside, unable to leave. That’s despite the IDF’s assurances that the hospital would continue to operate and that civilians would be granted safe passage.

The raid comes as Israel is reportedly considering a ground invasion of Rafah, the southernmost city in Gaza whose border crossing with Egypt has remained largely closed. Israel claims Rafah is the last remaining Hamas stronghold, but any operation there would lead to “carnage,” according to the United Nations. That’s in large part because the city’s population is roughly five times larger than it was before the war, swollen by refugees fleeing the fighting further north, including in Khan Younis.

It’s not clear how the US government will respond to the operation at Nasser Hospital, given increasingly critical rhetoric from top officials and the president himself. Last week, Biden said that Israel had been “over the top” in its approach in Gaza and that civilian suffering and death “had to stop.” However, he has shown no sign of wanting to withdraw any of the US’s ongoing military support to Israel. The White House and the State Department did not immediately respond to requests for comment.

“There is a cost for the United States in not being seen as consistent in how it judges these situations,” Michael Wahid Hanna, US program director for the International Crisis Group, told Vox in an interview. “And for many, there is a sense that such accidents elsewhere would necessarily be seen as unacceptable.” Attacks on hospitals in Syria and Ukraine, for example, have rightly been condemned by the US and the international community.

What we know about the raid

According to the IDF, its attack on Nasser Hospital in Khan Younis was an operation to recover the remains of Israeli hostages thought to be at the facility.

The IDF told Vox, without providing any evidence to support this assertion, that “Hamas terrorists are likely hiding behind injured civilians inside Nasser Hospital right now and appear to have used the hospital to hide our hostages there too.”

IDF spokesperson Hagari said in a video statement that IDF soldiers had captured suspected militants within Nasser Hospital, including some that participated in the October 7 attacks, in Thursday’s raid. A nurse in the hospital’s emergency department, whose name Vox is withholding for their safety, told Vox that there were no militants in the hospital at the time of the raid.

“In a sense, [the IDF is] not trying anymore” to justify its attacks on hospitals, Hanna said. “They have sort of created the precedent and have replicated it. The preparatory steps are just being skipped at this point, and it seems like now it’s just something more akin to a standard operating procedure.”

Israeli forces initially ordered the evacuation of Khan Younis in January, but many patients, medical staff, and displaced people remained at the facility. Such an evacuation is difficult — if not impossible — for the seriously sick and injured, especially without transportation like helicopters and a guaranteed safe evacuation route. And for people already displaced in Gaza, there are few other options.

On Tuesday, Israel commanded everyone to evacuate prior to the raid. Vox has reviewed video footage of some medical staff and others evacuating, as well as footage of patients and displaced people crowded into an older building in Nasser Hospital, leaving the surgical and obstetrics and gynecology wards for inspection.

Prior to Thursday’s IDF raid, a drone attack wounded one of the doctors working at the hospital; a separate overnight strike on the hospital wounded six patients and killed one, according to the Associated Press. The Gaza health ministry told the BBC that Israeli sniper fire killed three people and injured two on Tuesday and that a further seven people were shot and killed Monday.

Medecins Sans Frontieres, one of the medical charities operating in Gaza, also said that Israel had shelled the hospital early Thursday morning, even though Israeli forces had told patients and medical staff they could stay there.

“Our medical staff have had to flee the hospital, leaving patients behind,” the group wrote on the platform X on Thursday. “Israeli Forces set up a checkpoint to screen people leaving the compound; one of our colleagues was detained at this checkpoint. We call for his safety and the protection of his dignity.”

There is a narrow exception to medical facilities’ protected status under international humanitarian law (IHL), but it’s not yet clear that what Israel has found at Nasser makes it exceptional. Absent overwhelming evidence that Hamas is using a given hospital to launch military attacks, experts said the facility should not be considered a military apparatus and should maintain its special protected status — and even should an attack be legal, it must be proportional.

In any case, civilians inside the hospital — patients and medical staff — are still protected under IHL.

Israel has been raiding hospitals for months

Throughout the war in Gaza, the IDF has raided hospitals — which are protected by international humanitarian law even above other civilian infrastructure — on the basis that Hamas fighters are hiding there.

Israel and the US have accused Hamas of using “human shields,” or deliberately stationing themselves in locations (like hospitals) that would make them immune to attack through the laws of war by their proximity to civilians and other protected people. The use of human shields constitutes a war crime.

Hamas has denied the allegations, which Vox is unable to independently verify. Hamas does operate an extensive tunnel network under Gaza; there is evidence, including that examined by independent media outlets, that Hamas has placed some operations under hospitals before, if not established command and control centers there.

Even taking those allegations to be true wouldn’t mean that Israel can just claim hospitals as legitimate military targets. Hospitals can lose their protected status under the law “when acts harmful to the enemy are being committed” at the site, said Omar Shakir, Israel and Palestine director for Human Rights Watch. Israel has presented what it says is evidence that the hospitals it has targeted are Hamas “command and control centers,” but that evidence has previously proven to be shaky.

Before storming the al-Shifa hospital in November, the IDF made specific claims about how the hospital was being used by Hamas: The militant group’s activities were concentrated in five buildings atop a tunnel network that could be accessed from the hospital, which was used as a command center for rocket launches and militants. They then released photos and video of the operation that they said proved as much. But a detailed Washington Post forensic analysis later found that the “evidence presented by the Israeli government falls short of showing that Hamas has been using the hospital as a command and control center.”

Even if a hospital were being used as a command and control center to commit acts harmful to the enemy, “Israeli authorities cannot treat a hospital as a free fire zone,” Shakir said.

“The protections against indiscriminate and disproportionate attacks not only continue to apply, but actually are heightened at a hospital because even what may seem like a relatively minor attack can have life-altering consequences for patients who are being treated there, as well as for the medical workers that are providing lifesaving care to patients,” he said.

International humanitarian law also requires that Israel provide safe evacuation for civilians in the area. IDF spokesperson Hagari said in a statement that the military had opened a humanitarian corridor at the Nasser Hospital, but reports have indicated that people have been blocked from leaving the premises, with some coming under attack when they tried to flee.

“The Israeli government has consistently failed to provide a safe passage,” Shakir said. “They made these promises, over and over again, with evacuations from Northern Gaza from other hospitals. And consistently there have been well-documented reports of people being killed in airstrikes in purportedly safe zones. So these statements need to be read with a high degree of skepticism.”

The IDF also led raids on the al-Ahli Hospital in Gaza City and the Kamal Adwan hospital in northern Gaza in December, the Ibn Sina Hospital in the West Bank town of Jenin in January, and others. And it has been accused of targeting ambulances and of conducting shelling near hospitals. Human Rights Watch has called for some of these “repeated, apparently unlawful attacks on medical facilities, personnel, and transport” to be investigated as war crimes.

As Israel has made Gaza uninhabitable, hospitals have been the last safe place for civilians to shelter, even while facing a critical shortage of medical supplies. For those still trapped inside Nasser Hospital, that is no longer the case.