[23] After a brief occupation by Israel during the 1956 Suez Crisis, the returning Egyptian administration, under directives by president Gamal Abdel Nasser, paid more attention to the health and social situation of Gaza, and al-Shifa was expanded to include departments for obstetrics and gynecology.

[31][32] The project was designed by Israeli architects Gershon Tzapor and Benjamin Edelson in their Tel-Aviv office, both well experienced in the construction of high standard hospitals.

[31][34][35][32] According to Newsweek and the Intercept a bunker beneath building 2 was constructed in 1983 by Israel and "includes a secure underground operating room and tunnel network.

[37][38][39] According to Israeli officials, Hamas subsequently dug out the original basement, later adding new floors and connecting it as a hub within their existing tunnel system.

[47] During the 2008–2009 Gaza war, The New York Times reported that "armed Hamas militants in civilian clothes roved the halls" killing alleged collaborators.

[48] Several reports by Israeli Shin Bet officials alleged that Hamas used Al-Shifa hospital as a bunker and refuge, knowing it would be spared by air strikes.

[49] PBS' Wide Angle programme, which interviewed a doctor from Gaza who preferred to remain anonymous, said that he believed that Hamas officials were present under the hospital.

This was seized upon by the Israeli press, prompting the journalist to take to Facebook to note that her words had been taken out of context and used as propaganda, and that the rocket had actually been fired from "somewhere behind the hospital".

UN Secretary-General Antonio Guterres said he was "horrified by the reported attack in Gaza on an ambulance convoy outside Al-Shifa hospital" while World Health Organization chief Tedros Adhanom Ghebreyesus said he was "utterly shocked".

[73] On 7 November, the 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".

[85] Upon hearing the interview, Michael Neuman, of Médecins Sans Frontières, stated that his staff had worked in Al-Shifa for many years but never saw any evidence of the hospital being use for non-medical purposes.

[2][86] The IDF says that weapons, ammunition and an operational command center were uncovered in the building, including several assault rifles and grenades found in the hospital's MRI room, an allegation that Hamas dismissed.

[87] BBC News and CNN conducted video analyses concluding the Israeli army apparently rearranged, or added, weapons for the media tour.

[4][88] The BBC News also reported it found an Israeli video with the alleged discoveries had been edited despite the IDF Spokesperson's statement that footage was unedited and filmed in one take.

[2][34] Many political commentators such as Jeremy Bowen of BBC News and Mouin Rabbani, were not convinced that the Israeli evidence proved this was the headquarters of the Hamas operation.

[95] A Gaza engineer who talked with an Al Jazeera English analyst reasoned the videos shown by the IDF were of two different tunnels spliced together; the source also raised suspicions over the fact that the IDF has not tried to open the blast door, even though disarming a trap "usually takes a few hours, not over a day": "You say smoking gun, you get to it and then you don't show the smoking gun.

[99][100][101] The director of the hospital Mohammad Abu Salmiya was detained on 23 November by Shin Bet for questioning when traveling on a World Health Organisation convoy with other staff.

[107] On February 12, 2024 classified Israeli intelligence documents, obtained and reviewed by the The New York Times suggested Hamas did store weapons and took cover at the hospital, using tunnels 213 meters long, twice the size previously known.

The tunnels included bunkers, living areas, and computer and communications rooms, and established documents showed that Hamas masked its activities using the hospital.

Critics of the Israeli military say the evidence does not support its early claims, noting that it had distributed material before the raid showing five underground complexes and also had said the tunnel network could be reached from wards inside a hospital building.

[114] According to Mondoweiss, an individual that they described as a survivor of the subsequent siege reported that hundreds of members of the non-military wings of Hamas and Palestinian Islamic Jihad who were employed in the hospital had gathered there to receive their salaries.

Israeli officials claimed some 900 suspects had been apprehended,[116] 200 Hamas and Islamic Jihad fighters killed,[117] weapons and almost US$3 Million in cash seized.

[117] United Nations special rapporteurs Tlaleng Mofokeng and Francesca Albanese issued a statement on April 3 stating "The extent of the atrocity is still unable to be fully documented due to its scale and gravity – and clearly represents the most horrific assault on Gaza's hospitals.

The besieging and destruction of a hospital and the killing of health workers, the sick and wounded, and the people who protect them, is prohibited by international law."

and "At this point, we are no longer discussing availability, accessibility, acceptability and quality of health care received in dignity, but the annihilation of any infrastructure capable of providing basic first aid.

[122][123] A week later, Palestinians buried dozens of unidentified bodies taken from Al-Shifa hopistal and the Indonesian hospital in a mass grave in Khan Yunis.

The Office of the United Nations High Commissioner for Human Rights (OHCHR), stated that "Among the deceased were allegedly older people, women, and the wounded, while others were found tied and stripped of their clothes.

The Nation described the campaign as propaganda, and stated that the video was widely mocked, with many Arabs questioning its authenticity, and the ministry deleting the tweet in a day.

[7] The Daily Beast, remarking on the video, said "Everything about it smacked of high school theater—from the botched accent that sounded like it was straight out of an Israeli soap opera to the perfectly scripted IDF talking points rolling off her tongue.

They discussed how the failure of the incubators in the Neonatal intensive care unit of al-Shifa caused by the denial of fuel deliveries by Israel and the cutting of electricity was responsible for the deaths of three prematurely born babies.