The Answer Speaks Volumes

What lies under Israeli and Gazan hospitals?

"We are still ready to transfer 700 patients underground within eight to 14 hours," says Dr. Esther Saiag.

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While Hamas spent the past decade embedding tunnels and military assets underneath hospitals across Gaza, Israel’s healthcare system had embarked on the construction of bombproof underground medical facilities amid the aftermath of the Second Lebanon War, in a stunning dichotomy from what was then underway in the Palestinian enclave.

Working at Tel Aviv Medical Centre’s international affairs department on October 7 was to bear witness to the frantic transformation of Israeli hospitals as they prepared to treat survivors of Hamas’s brutality and gear up for the war that we knew would engulf us all.

Hospital administrators were desperately trying to protect patients from random and psychologically torturous rocket fire on Tel Aviv, while the threat of Hezbollah’s precision-guided missiles loomed powerfully in the back of our minds in the immediate wake of that unfathomable Black Saturday massacre.

The city hospital rushed to convert its four-storey parking lot into an underground emergency hospital and transfer select departments there, after having begun the process of assessing the safety of its patients in the early hours of October 7. The parking lot was built under the medical centre 12 years ago with all the infrastructure needed to be converted into an underground hospital safe from rockets, precision-guided missiles, and even chemical and biological weapons.

“We are still ready to transfer 700 patients underground within eight to 14 hours,” says Dr. Esther Saiag, director of emergency preparedness at the Tel Aviv hospital. Why not transfer all patients there now? Because three months into the war, the medical centre is still in a constant and dangerous trade-off. To go fully underground, it would have to stop many of its routine activities, including limiting the number of surgery rooms available.

The 800 or so patients who couldn’t go underground would be transferred to the hospital’s Arison Tower – which is most fortified against rocket attacks – and hundreds more would have to be selected for discharge due to lack of capacity. Of those able to remain hospitalised, many would have to be stationed in corridors.

Receiving new patients would also be rendered a selective and limited process, requiring the Tel Aviv hospital to place caps on its capacity to receive members of the diverse public it serves – which includes Arab Israelis as well as the city’s undocumented asylum seeker and homeless communities.

While the Tel Aviv hospital had embarked on this excruciating endeavour in the early days of the war, the world’s scrutiny was focused sharply on the Israeli army’s operation in Al-Shifa Hospital in northern Gaza. Hamas had embedded a military command centre at the hospital, using its sophisticated network of subterranean tunnels there to give sanctuary to some of the terrorists responsible for the October 7 attack – rather than open them up to the ill and frightened patients directly above them.

The juxtaposition between Tel Aviv Medical Centre’s underground emergency hospital and the tunnels that were revealed in Al-Shifa Hospital couldn’t have been more striking: while Israel had invested tens of millions of dollars building underground medical facilities such as these, Hamas had diverted millions towards the construction of tunnels under hospitals across Gaza.

In Al-Shifa, it seems almost impossible that the hospital’s administrators weren’t aware of what was happening and how it could ultimately endanger their patients. In fact, the director of the Kamal Adwan Hospital – another hospital in northern Gaza – tragically professed that around 16 employees including doctors, nurses and other staff members were “military operatives of the al-Qassam Brigades” during an interrogation by Israeli security forces in December.

This bizarre association of Gazan hospitals with Hamas’s military wing is a travesty that should be the subject of international scrutiny and condemnation.

Yet in the twisted Gaza-Israel paradigm, the world seems unable to see the tragedy that Hamas imposed on Palestinian patients. In the era of misinformation, Hamas’s despicable weaponisation of its hospitals has largely been a public relations success: its guiding imperative is to destroy the Jewish state, for which the delegitimisation of that state is essential.

Nothing could coax the world into despising Israel that much more than seeing images of Israeli soldiers storming a Gazan hospital, after having been forced to treat it as a military target. Nothing could paint an uglier picture of Israel and its army, nor intersect more perfectly with pre-existing tropes about the small nation-state. Nothing could have been more effective in stoking the flames of leftist antisemitism across the Western world.

It takes moral fortitude to recognise how truly grotesque the violent value system that underpins Hamas’s worldview is. In its perpetual and undying commitment to annihilating the “Zionist enterprise”, Hamas sacrificed Palestinian hospitals and patients across Gaza – and imposed devastating consequences on Israeli hospitals.

Tel Aviv Medical Centre has kept most of its operations above-ground for the time being, all the while in a constant state of angst over the moment when this war may turn into an all-out multi-front conflict.

The international community and journalists worldwide must acknowledge and investigate the unprecedented challenges that Israeli hospitals are having to cope with in the face of actors who gleefully target Israeli civilians and who still, most disturbingly, are basking in what they see as the glory of October 7.

Australian expat Dana Segall lives in Tel Aviv and is news editor at Haaretz.

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