The Hospital Attack and the Gaza War

The Need to Fully Establish the Facts and Learn a Critical Humanitarian Strategic Lesson

It is still unclear that there will be any conclusive international effort to determine the causes of the explosion that affected the Al Ahli hospital area on October 17. What is all too clear is that Hamas announced that massive damage was done to the Al Ahli hospital area—a cluster of buildings and parking lots—and that it was the result of an Israeli air attack that killed some 400 people, with some estimates rising to 500.

Israel’s Initial Political Defeat by Hamas

Israel was painfully slow (to the point of incompetence in terms of political warfare) in responding. It did deny it had made such an attack but initially made no effort to support its claims in detail and failed to call for an international investigation of the real cause of the attack and assessment of its seriousness and the number of casualties involved.

The result was that Hamas’s claim that Israel was responsible came to dominate almost all immediate reporting. There was little media effort to assess and directly report on the actual damage, its actual cause, and the true number of casualties. Within hours, Hamas’s claims captured the perceptions of much of the Arab world and overwhelmed much of the previous global sympathy that Israel had gained because of the sheer viciousness of the previous Hamas attack on Israel.

Moreover, Hamas’s claims had a major impact on President Biden’s October 18 visit to Israel and the region. The Arab world has already anti-U.S. demonstration in response to U.S. support of Israel and the president had to cancel his follow-on visit to Jordan after Jordan's King Abdullah II, Egyptian president Abdel Fattah El-Sisi, and Palestinian Authority president Mahmoud Abbas indicated that they would no longer meet with him.

Israel Does Respond in Detail

Israel did reply later—probably much too late—in more detail. General Daniel Hagari, the Israel Defense Forces (IDF) spokesperson, then stated that Israel had clear evidence from its operational records that there was no Israeli Air Force attack. He gave a formal briefing stating that it had determined Israel had no aircraft that carried out such an attack. (Israel’s command and control system tracks every combat aircraft that enters Gazan air space.)

Hagari also stated that Israel had intercepted communications by the Palestinian Islamic Jihad (PIJ), showing that the PIJ knew that it had fired a “barrage of around 10 rockets” from a cemetery around the same time there were reports of an explosion at the hospital. Hagari said the IDF’s aerial footage analysis showed “with absolute certainty” that the blast was caused by a “misfired” PIJ rocket, which was fired from a cemetery near the hospital. The IDF also claimed that it had evidence of some 450 such PIJ misfires by October 16.

Hagari said the “only location damaged” was a car park outside the hospital “where we can see signs of burning.” He argued that Israeli strikes would have caused far more damage and evidence like “craters and structural damage” and said that there was evidence of a rocket strike because its propellent was still evident. He also circulated the photos attached to this commentary and stated they showed that the effects of these rocket strikes had to be more limited than Hamas had claimed.

The Need for a Neutral International Response

Israel has made powerful claims and seems to have considerable evidence, but some of its claims about limited damage and casualties seem uncertain. Nothing Israel does alone, however, will now persuade most of the Arab world, and much of the rest of the world, that Israel was not responsible; that Hamas launched a major, unfounded propaganda strike on Israel; and that the United States backed Israel without showing proper concern for human rights and Palestinian suffering. Russia and China have already made it clear they are using Hamas’s claims to try to discredit the United States.

The only way to convince the world of the facts is to establish some form of international investigation that is led by nations or individuals who do not take sides and have shown they will pursue the facts rather than support either side. Countries like Switzerland and Japan are examples, and there are many individuals from a wide range of countries with proven objectivity in international justice efforts who could credibly carry out such an effort. Ideally, the United Nations could lead such an effort, but it has too many divisions of its own, and such a body needs to be established now—not in weeks or months of negotiating efforts to have a major impact on the present crisis.

The Broader Strategic Need to Limit the Humanitarian Cost of the Gaza War

At the same time, the massive reaction to Hamas’s claims that Israel was responsible for the Hospital attack is a major warning of what will happen if Israel pursues its war against Hamas and the PIJ without comprehensive humanitarian efforts. The hospital attack alone has made it clear that the world will not ignore the human cost of a continuing air war, a land invasion, or any form of occupation that does not sharply limit the danger and damage to Palestinian civilians. Israel cannot deny the flow of aid, food, medicine, water, and electricity to a Gaza, which had so little before the war started. It cannot push the population of the north of Gaza, or all of Gaza, into refugee status in an area where there is no refuge, housing, food, or employment.

The key problem for Israel in sustaining the war is not the military cost of the war in terms of casualties and money. It is the political and strategic cost to Israel of escalating a war that has already created a far larger tragedy than the hospital attack, one that has no clear end and one that can only breed more Palestinian and Arab hostility and eventually lead to another conflict. Einstein once stated that insanity consists of repeating the same experience and expecting a different result. This is particularly true when it involves the massive use of force.

This does not mean accepting Hamas or the PIJ, although the probability of any war ending the existence of even more hostile Gazans and Palestinians seems low to non-existent. It does mean that there must be sanctuaries, safe zones, and comprehensive aid to those Gazans who do not actually fight. Israel, the United States, and the other countries that support Israel need to operate on far more than arms and military aid. They need to cooperate in offering humanitarian options and enclaves, in keeping the war limited short, and by accepting the fact that any prolonged effort to totally destroy Hamas and the PIJ will only make things worse. More broadly, more aid and humanitarian support are needed for the Palestinians in the West Bank. The alternatives may not fully meet Einstein’s definition of “insane,” but they should meet everyone’s definition of stupid.

IDF Photo Coverage of the Attack on the Al Ahli Hospital

Photo: IDF Spokesperson’s Office
Photo: IDF Spokesperson’s Office
Photo: IDF Spokesperson’s Office
Photo: IDF Spokesperson’s Office
Photos: IDF Spokesperson’s Office, “Failed Rocket Launch by Islamic Jihad Hits Al Ahli Hospital in Gaza City,” press release, October 18, 2023,