Gaza: How the Israeli army besieged and attacked Nasser hospital

Executive Summary

The sources to which we have had access include first-hand accounts from MSF staff members; exchanges of information between our coordination team in Jerusalem and our teams in Gaza, recorded in the MSF logbook; media and humanitarian actors publications. All these sources corroborate this story.

In early December, airstrikes and ground fighting intensified in the south of the Gaza Strip, following a seven-day truce that began on 24 November. Many people took refuge in and around Nasser hospital, in Khan Younis. At that time, the medical complex was receiving recurrent mass influxes of wounded; it was also treating displaced people and those who could not be treated elsewhere in Gaza, where two-thirds of hospitals had already been forced out of service. On 21 January, medical staff reported that the hospital was surrounded by Israeli forces. On 23 January, the Israeli army sent evacuation orders to the residents of blocks 107 to 112, which include Nasser hospital. From that day, the hospital was in the center of intense fighting and was considered by the medical staff inside to be under siege. No one could enter or leave the hospital without risking their lives and ambulances were denied access. From 8 February, MSF staff reported sniper fire targeting Nasser hospital, resulting in several deaths and injuries. On 13 February, the Israeli army issued an evacuation order for displaced people who had taken refuge inside the facility but said medical staff, their families, patients and one caretaker per patient were allowed to remain inside the hospital. On the night of 14-15 February, despite security guarantees from the Israeli army that those remaining in the medical complex would be safe, an Israeli shell hit the orthopaedic ward, killing one person and wounding eight others. Israeli forces ordered everyone inside Nasser hospital to evacuate and then stormed the hospital early in the morning on 15 February. Everyone who left the hospital was screened by the Israeli forces and one MSF staff member was detained, but he has since been released. As of April 2, he is still being held in Israel, and we still have no news from him. In the days following 15 February, patients were evacuated in small groups to several nearby field hospitals. On 22 February, the Israeli army withdrew from Nasser hospital and left it severely damaged and unable to function.

1 December 2023 | Fighting resumed between the Israeli army and Hamas, ending a seven-day truce that began on 24 November.

17 December 2023 | MSF logbook*

"Maternity ward targeted. A 13-year-old girl killed, many casualties."

25 December 2023 | MSF logbook

"Heavy bombing around Nasser following evacuation order of blocks 64 and 112 beside Nasser."

8 January 2024 | The Israeli army shelled an MSF shelter housing over 100 MSF staff members and their families in Khan Younis. The five-year-old daughter of one of them is killed

13 January 2024 | Testimony of Thomas Lauvin, MSF project coordinator

“We’re gradually being cornered in a very restrictive perimeter in southern Gaza, with dwindling options to offer critical medical assistance, while the needs are desperately growing. As the assault on Gaza has progressed, we have had to evacuate several health facilities in the north of Gaza, then in the Middle Area. Today we are limited to mainly working in the south because we cannot work elsewhere. In short, we’re running out of hospitals. We are forced to leave patients behind.”

15 January 2024 | Field report by Aurélie Godard, MSF medical team leader, and Léo Cans, MSF head of mission, following a visit to Nasser hospital

“On 15 January at around 3 pm an airstrike hit trucks that were unloading food at 150 metres east of the hospital. The noise was so loud that it was painful for the ears. After a few minutes, many wounded arrived at the hospital, some carried by people on foot, some by ambulances and some in private cars. Total of eight killed, including two boys four/five years old, and 80 injured, including 20 who had to undergo surgery. The next morning we visited a young boy around 10 years old who was hurt by the blast when crossing the street.”

18 January 2024 | MSF logbook

"Nasser: Heavy bombing and tank shelling at night. Staff and patients very scared."

On the same day, the Israeli army bombed a residential complex housing the emergency medical team (EMT) of the International Rescue Committee (IRC) and members of Medical Aid for Palestinians (MAP) and their families. Israeli forces were aware of the presence of those teams on site. Following the attack, the EMT was forced to suspend its medical activities at Nasser Hospital.

21 January 2024 | MSF logbook

"Nasser hospital: totally surrounded by troops. Heavy bombing and fighting all around the hospital."

23 January 2024 | MSF logbook

"New evacuation order in Khan Younis, including Nasser hospital, Al-Amal hospital and Jordanian hospital. Nasser under heavy fighting, no one can enter/exit. Still many casualties, OT [operating theatre] not functioning."

On the same day, three MSF staff members tried to evacuate the hospital, but were unable to do so. They reported gunfire and explosions all around the hospital.

26 January 2024 | MSF staff member trapped in Nasser hospital

“There was no staff left at the emergency room [ER] of Nasser hospital. There were no beds, just a few chairs and no staff, just a few nurses. We took the patients to the ER to provide first aid; we managed with what we had, tried to stop the bleeding and sort the patients there. It was a horrible event and really affected me psychologically. (...) I went to the surgical room to receive a patient in our department and asked the few remaining staff if they could supply an abdominal gauze. They said that they didn’t have any to spare and that the ones they had were already being used on several patients. They use it once, then squeeze out the blood, wash it, sterilise it and reuse it with another patient. This is the situation in Nasser’s operating theatre, can you imagine?”

29 January 2024 | MSF logbook

"WHO delivered medical supply to Nasser hospital."

30 January 2024 | MSF logbook

"UNRWA sent fuel to Nasser."

6 February 2024 | MSF logbook

"Heavy fighting in Khan Younis, near Nasser. Nasser hospital still under siege. 450 wounded, 300 medical personnel, 10000 displaced."

8 February 2024 | MSF logbook

"Nasser surrounded by tanks. Snipers shooting towards the hospital. One nurse injured (live bullet in the chest)."

11 February 2024 | MSF logbook

"Nasser surrounded by tanks. Snipers shooting towards the hospital (one man shot dead at the entrance of the hospital)."

13 February 2024 | MSF logbook

"Nasser: order of evacuation of IDPs [internally displaced people]. 402 patients, 35 on dialysis, 18 ICU, three neonatal ICU, three to four women post-delivery and just under 200 are stretcher patients. Three people were killed and 10 others injured by Israeli fire inside Nasser medical complex."

That day, an Israeli military bulldozer destroyed the gate at the northern entrance of the hospital, followed by a tank. The soldiers on site ordered displaced people to leave the hospital. A handcuffed Palestinian prisoner wearing white personal protective equipment (PPE) was later sent into the hospital by the Israeli army to order displaced people to evacuate once again. Images available online, published by several media, show that he was then executed.

Night of 14 to 15 February 2024 | MSF logbook

"At night: shelling on orthopaedic department of Nasser. One person killed, eight injured. Israeli forces entered Nasser hospital destroying a lot of equipment, ambulances… Staff started to evacuate the hospital in the middle of the night. MSF staff member arrested by Israeli forces."

15 February 2024 | Flash update #119, United Nations Office for the Coordination of Humanitarian Affairs (OCHA)

“As of the time of writing of this update, on 15 February, Israeli forces reportedly entered Nasser Hospital in Khan Younis, including the maternity department, according to MoH in Gaza. The Israeli military has alleged that Hamas was holding hostages or withholding the bodies of Israelis within the compound.

The World Health Organization (WHO) Director-General, Tedros Adhanom Ghebreyesus, reported that two planned missions to reach the hospital over the past four days had been denied access and his staff have lost contact with the hospital personnel.”

16 February 2024 | MSF logbook

"Five patients died without appropriate healthcare due to the lack of electricity. Israeli forces arrested 20 people."

17 February 2024 | MSF logbook

"Israeli forces still inside Nasser. No water, no food. Evacuation of 14 patients (United Nations/Palestine Red Crescent Society). WHO team was not permitted to enter the hospital to assess the conditions of the patients and critical medical needs, despite reaching the hospital compound to deliver fuel.

Still active combat zone around, ambulances couldn’t enter the compound, patients carried out manually."

20 February 2024 | Guillemette Thomas, MSF medical coordinator

“The situation in Nasser hospital is yet another example of the way healthcare facilities are being dismantled one by one in this war. Even though they were initially told they could stay

inside the facility, medical staff and patients were put in danger in a place where they should have been protected.”

21 February 2024 | Flash update #123, United Nations Office for the Coordination of Humanitarian Affairs (OCHA)

“On 20 February, PRCS [Palestine Red Crescent Society] ambulances evacuated 21 injured people from Nasser hospital, also in Khan Younis, to two field hospitals in Rafah, in collaboration with WHO and OCHA. The previous two days, the same partners had evacuated 32 patients in critical condition from Nasser hospital to three other hospitals in Gaza following the siege and raid on the hospital complex by the Israeli military.”

22 February 2024 | MSF logbook

"Israeli forces withdrew yesterday from Nasser hospital. Evacuation of patients to Deir Al-Balah, Khan Younis and Rafah. No water, no electricity, no food. Accumulation of waste, sewage overflowing."

27 February 2024 | MSF logbook

"Evacuation of 72 critical cases in total. 120 patients still there. 70 health workers still detained."

12 March 2024 | BBC releases verified footage showing detained and kneeling people inside Nasser hospital after it was raided by the Israeli army.

17 March 2024, Leo Cans | MSF head of mission in Palestine, describes his visits to Al-Shifa and Nasser hospitals.

According to the World Health Organization, only a third of Gaza's hospitals are partially functional. Between 7 October 2023 and 12 March 2024, there have been 410 attacks on healthcare reported by the Ministry of Health and the WHO3.

MSF reiterates its call for an immediate, sustained ceasefire in Gaza – the only way to bring an end to the massacre of civilians and to allow humanitarian organisations to respond to the immense needs of a terrified, starving and exhausted population.

* The MSF logbook is an internal document in which daily information is recorded relating to the management of MSF projects. It includes the medical activities of teams working in Gaza's health facilities, security incidents, patient evacuations via Rafah and fuel supplies. It reflects the exchange of information between MSF’s coordination team in Jerusalem and MSF’s teams in Gaza.