Strikes at Hospitals in Gaza Trigger Exodus of Thousands Sheltering There

FILE PHOTO: Smoke rises as displaced Palestinians take shelter at Al Shifa hospital, amid the ongoing conflict between Hamas and Israel, in Gaza City, November 8, 2023. REUTERS/Doaa Rouqa/File Photo
FILE PHOTO: Smoke rises as displaced Palestinians take shelter at Al Shifa hospital, amid the ongoing conflict between Hamas and Israel, in Gaza City, November 8, 2023. REUTERS/Doaa Rouqa/File Photo
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Strikes at Hospitals in Gaza Trigger Exodus of Thousands Sheltering There

FILE PHOTO: Smoke rises as displaced Palestinians take shelter at Al Shifa hospital, amid the ongoing conflict between Hamas and Israel, in Gaza City, November 8, 2023. REUTERS/Doaa Rouqa/File Photo
FILE PHOTO: Smoke rises as displaced Palestinians take shelter at Al Shifa hospital, amid the ongoing conflict between Hamas and Israel, in Gaza City, November 8, 2023. REUTERS/Doaa Rouqa/File Photo

Thousands of Palestinians sheltering from the Israel-Hamas war at Gaza City’s main hospital fled south Friday after several reported strikes in and around the compound overnight. They joined a growing exodus of people escaping intense urban fighting in the north -- including near other hospitals -- as Gaza officials said the territory's death toll surpassed 11,000.

The search for safety across the besieged Gaza Strip has grown desperate as Israel intensified its assault on the territory's largest city. The Israel army says Hamas' military infrastructure is nestled amid Gaza City's hospitals and neighborhoods. Israel has vowed to destroy Hamas after its deadly Oct. 7 surprise incursion.

The tens of thousands of Palestinians who fled south in the past few days face the prospect of ongoing bombardment and dire conditions. Reported overnight strikes on or near at least four hospitals in northern Gaza underscored the danger for tens of thousands more who have crowded into the facilities, believing they will be safe.

BATTLES AROUND HOSPITALS Early Friday, strikes hit the courtyard and the obstetrics department of al-Shifa Hospital, Gaza's largest, where tens of thousands of people are sheltering, according to Ashraf al-Qidra, spokesperson at the Health Ministry in Hamas-run Gaza.

A video of the courtyard recorded the sound of incoming fire waking people in makeshift shelters, followed by shouts for an ambulance. In the blood-splattered courtyard, one man writhed screaming on the ground, his leg apparently severed.

Al-Qidra blamed the attack on Israel, a claim that could not be independently verified.

The Israeli army says Hamas hides in and under hospitals and that it has set up its main command center in and under al-Shifa — claims the militant group and hospital staff deny.

For weeks, tens of thousands of displaced Palestinians — reaching as many 60,000 this week, according to the Health Ministry — have been sheltering in the al-Shifa hospital complex, hoping it would be safe.

But the overnight strikes triggered a mass exodus of the displaced. At around 10 a.m., large numbers packed up their belongings and began streaming out, walking toward the south, five people who were among those who left told the AP.

It was not clear how many remained at al-Shifa, but they said the vast majority had left. Wafaa abu Hajajj, a journalist who had been sheltering at al-Shifa hospital and arrived Friday in the south, said mainly those who could not walk or did not know where to go remained.

“The strikes were hoping to scare people and it worked. It was too intense and it became too much,” said 32-year-old Haneen Abu Awda, who had been at al-Shifa being treated for wounds from an earlier strike on their house.

At the same time, al-Shifa has been overwhelmed by thousands of wounded, even as it operates with minimal power and medical supplies.

In video released Friday by the Gaza Health Ministry, bodies of limp children are seen laid on stretchers across blood-stained floors in the hospital, some dead, some barely breathing. Other patients were strewn around the floor, unable to be treated for lack of supplies. One man is seen gasping for air.

The director of al-Shifa said Israel demanded the facility be evacuated, but he said there was nowhere for such a large number of patients to go.

“Where are we going to evacuate them?” Director Mohammed Abu Selmia asked speaking to Al Jazeera television.

In all, Gaza health officials said strikes were carried out near four hospitals overnight and early Friday, all of which were packed with displaced people and patients.

The Health Ministry said one person had been killed at al-Shifa and several were wounded. A senior Israeli security official said initial findings indicated that one strike at al-Shifa was the result of a misfire by militants. The military is conducting a review. The official spoke on condition of anonymity because the investigation is ongoing.

Another strike near the Al-Nasr Medical Center killed two people, according to the ministry. The strike forced the shutdown of Nasr's children's hospital, the only remaining specialized pediatric care in north Gaza, said World Health Organization spokesperson Margaret Harris.  

She said it was not known what happened to patients there, including children receiving dialysis and on life support — “things that you cannot possibly evacuate them safely with.”

Al-Qidra, the health ministry spokesman, said ambulances could not reach Nasr hospital to evacuate patients because of Israeli strikes.

CIVILIANS FLEE SOUTH Tens of thousands of new evacuees from the north, some coming from al-Shifa, flowed down Salah al-Din road — the central spine running the length of the Gaza Strip — and reached the central city of Deir al-Balah on Friday. With no fuel for vehicles, the crowds had walked for hours as explosions echoed a short distance away. Among them were wounded and older people.

They arrived hungry, exhausted and with a stew of emotions — relief, rage, and despair.

Reem Asant, 50, described winding through the streets on the way out of Gaza City, trying to avoid shelling.

“We’re talking about children killed in a hospital,” shouted one man, Abu Yousef, his voice rising with fury. “Hundreds of women killed every day. Houses collapsing on the heads of civilians … Where are human rights? Where is the United Nations? Where is the United States? Where is the International Criminal Court? Where is the entire world?”

The Israeli military announced an expanded six-hour window Friday for civilians to escape northern Gaza along Salah al-Din, the route used since last weekend. It also announced the opening of a second route, along the coastal road, after an agreement announced by the White House a day earlier.

The White House said Israel agreed to implement a brief humanitarian pause each day — in what appeared to be an effort to formalize and expand the process.

More than two-thirds of Gaza’s population of 2.3 million have fled their homes since the war began. Israel estimates that more than 850,000 of the 1.1 people in northern Gaza have left, according to military spokesman Jonathan Conricus. He called the pauses “quick humanitarian windows” that allow southward movement “while we are fighting.”

UN expert for the Palestinian territories Francesca Albanese called the pauses “cynical and cruel,” saying it was just enough “to let people breathe and remember what is the sound of life without bombing, before starting bombing them again.”

RISING DEATH TOLLS More than 11,070 Palestinians, two-thirds of them women and minors, have been killed since the war began, according to the Gaza Health Ministry, which does not differentiate between civilian and militant deaths. Another 2,650 people have been reported missing.

US Secretary of State Antony Blinken said Friday that “far too many” Palestinians have died and suffered and that while recent Israeli steps to try to minimize civilian harm are positive, they are not enough.

US Assistant Secretary of State Barbara Leaf told American lawmakers this week that it was “very possible” the death toll was even higher than the Gaza Health Ministry has reported, despite suggestions by President Joe Biden and others that it was exaggerated.

More than 1,400 people have been killed in Israel, mainly in the initial Hamas attack, and 41 Israeli soldiers have been killed in Gaza since the ground offensive began.

Palestinian militants have continued to fire rockets into Israel, and an attack on Tel Aviv wounded at least two people Friday, said Yossi Elkabetz, a paramedic with Israel’s rescue services. Hamas claimed credit.

Some 250,000 Israelis have been forced to evacuate from communities near Gaza and along the northern border with Lebanon, where Israeli forces and Hezbollah militants have traded fire repeatedly.



Lancet Study Estimates Gaza Death Toll 40% Higher Than Recorded

Palestinians walk through the destruction in the wake of an Israeli air and ground offensive in Khan Younis, southern Gaza Strip, Tuesday, Jan. 7, 2025. (AP Photo/Abdel Kareem Hana)
Palestinians walk through the destruction in the wake of an Israeli air and ground offensive in Khan Younis, southern Gaza Strip, Tuesday, Jan. 7, 2025. (AP Photo/Abdel Kareem Hana)
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Lancet Study Estimates Gaza Death Toll 40% Higher Than Recorded

Palestinians walk through the destruction in the wake of an Israeli air and ground offensive in Khan Younis, southern Gaza Strip, Tuesday, Jan. 7, 2025. (AP Photo/Abdel Kareem Hana)
Palestinians walk through the destruction in the wake of an Israeli air and ground offensive in Khan Younis, southern Gaza Strip, Tuesday, Jan. 7, 2025. (AP Photo/Abdel Kareem Hana)

Research published in The Lancet medical journal on Friday estimates that the death toll in Gaza during the first nine months of the Israel-Hamas war was around 40 percent higher than recorded by the Palestinian territory's health ministry.

The number of dead in Gaza has become a matter of bitter debate since Israel launched its military campaign against Hamas in response to the Palestinian militant group's unprecedented October 7, 2023 attack.

Up to June 30 last year, the health ministry in Hamas-run Gaza reported a death toll of 37,877 in the war.

However, the new peer-reviewed study used data from the ministry, an online survey and social media obituaries to estimate that there were between 55,298 and 78,525 deaths from traumatic injuries in Gaza by that time, AFP reported.

The study's best death toll estimate was 64,260, which would mean the health ministry had under-reported the number of deaths to that point by 41 percent.

That toll represented 2.9 percent of Gaza's pre-war population, "or approximately one in 35 inhabitants," the study said.

The UK-led group of researchers estimated that 59 percent of the deaths were women, children and the elderly.

The toll was only for deaths from traumatic injuries, so did not include deaths from a lack of health care or food, or the thousands of missing believed to be buried under rubble.

AFP is unable to independently verify the death toll.

On Thursday, Gaza's health ministry said that 46,006 people had died over the full 15 months of war.

In Israel, the 2023 attack by Hamas resulted in the deaths of 1,208 people, mostly civilians, according to an AFP tally based on official Israeli figures.

Israel has repeatedly questioned the credibility of the Gaza health ministry's figures, but the United Nations have said they are reliable.

- 'A good estimate' -

The researchers used a statistical method called "capture-recapture" that has previously been used to estimate the death toll in conflicts around the world.

The analysis used data from three different lists, the first provided by the Gaza health ministry of the bodies identified in hospitals or morgues.

The second list was from an online survey launched by the health ministry in which Palestinians reported the deaths of relatives.

The third was sourced from obituaries posted on social media platforms such as X, Instagram, Facebook and Whatsapp, when the identity of the deceased could be verified.

"We only kept in the analysis those who were confirmed dead by their relatives or confirmed dead by the morgues and the hospital," lead study author Zeina Jamaluddine, an epidemiologist at the London School of Hygiene and Tropical Medicine, told AFP.

The researchers scoured the lists, searching for duplicates.

"Then we looked at the overlaps between the three lists, and based on the overlaps, you can come up with a total estimation of the population that was killed," Jamaluddine said.

Patrick Ball, a statistician at the US-based Human Rights Data Analysis Group not involved in the research, has used capture-recapture methods to estimate death tolls for conflicts in Guatemala, Kosovo, Peru and Colombia.

Ball told AFP the well-tested technique has been used for centuries and that the researchers had reached "a good estimate" for Gaza.

Kevin McConway, a professor of applied statistics at Britain's Open University, told AFP there was "inevitably a lot of uncertainty" when making estimates from incomplete data.

But he said it was "admirable" that the researchers had used three other statistical analysis approaches to check their estimates.

"Overall, I find these estimates reasonably compelling, he added.

- 'Criticism' expected from both sides -

The researchers cautioned that the hospital lists do not always provide the cause of death, so it was possible that people with non-traumatic health problems -- such as a heart attack -- could have been included, potentially leading to an overestimate.

However, there were other ways that the war's toll could still be underestimated.

The study did not include missing people. The UN humanitarian agency OCHA has said that around 10,000 missing Gazans are thought to be buried under rubble.

There are also indirect ways that war can claim lives, such as a lack of healthcare, food, water, sanitation or the spread of disease. All have stricken Gaza since October 2023.

In a contentious, non-peer-reviewed letter published in The Lancet in July, another group of researchers used the rate of indirect deaths seen in other conflicts to suggest that 186,000 deaths could eventually be attributed to the Gaza war.

The new study suggested that this projection "might be inappropriate due to obvious differences in the pre-war burden of disease" in Gaza compared to conflicts in countries such as Burundi and East Timor.

Jamaluddine said she expected that "criticism is going to come from different sides" about the new research.

She spoke out against the "obsession" of arguing about death tolls, emphasizing that "we already know that there is a lot of high mortality.”