Hayfa Charity Hospital in Gaza City had already been evacuated by the time projectiles plunged into the building on Dec. 27, a hospital project manager said. It was a “terrifying” day in which bombing was “everywhere and random,” Shaima Raafat said in a voice message.

That strike was one of about 90 documented incidents involving hospitals in Gaza since the war between Israel and Hamas began on Oct. 7, according to information from sources including aid groups and hospitals analyzed by The Washington Post. Some, such as Israeli raids on al-Shifa Hospital in Gaza City and Nasser Hospital in Khan Younis, drew international headlines. Others — such as the destruction of Hayfa, once a bustling six-floor facility serving about 9,000 patients a month — have gone relatively unnoticed as the fighting rages on.

Of the 36 hospitals in Gaza tracked by the U.N. humanitarians affairs office, only four have not been reported damaged by munitions, raided by the Israel Defense Forces or gone out of service over more than seven months of war, The Post found. Of those, two — Kuwait and al-Helal al-Emirati hospitals — are in Rafah. Earlier this month, al-Najjar Hospital, also in the southern city where Israel is expanding its assault, was the latest to be shuttered.

Israel has made hospitals a key target of its military campaign in Gaza, damaging or destroying the Strip’s most important medical facilities after claiming Hamas used them for militant activity. (In the Hayfa attack, for instance, an IDF spokesperson said the strike was against a military target inside the building.) In other instances, hospitals and clinics were struck as part of the fighting between the Israeli military and Hamas.

They have been damaged by Israeli ground and air bombardment, and also by munitions fired by Palestinian militant groups, including rockets falling back onto Gaza’s territory, as appeared to be the case at al-Ahli Hospital in October. The source of damage by munitions is often not possible to confirm because The Post and other media outlets are not able to enter the Strip.

Israel has consistently said that when it raids or inflicts damage on hospitals, the attacks are justified because Hamas and other militant groups are embedded inside them. Hamas and staff at individual hospitals have rejected this.

“A central feature of Hamas’ strategy is the exploitation of civilian structures for terror purposes,” the IDF said in an emailed statement. “ … It should be clear that it is absolutely prohibited to misuse hospitals for military purposes, and turn patients into human shields.”

The IDF also accused Hamas of holding hostages within hospitals. It said its strikes were always an “operational necessity.”

The evidence that Israel has publicly provided has at times fallen short of supporting its claims of hospitals being used for military purposes. The Post is unable to independently verify the accounts.

Ravina Shamdasani, a U.N. Human Rights Office spokesperson, said in February that there appeared to be “a pattern of attacks by Israeli forces striking essential lifesaving civilian infrastructure in Gaza, especially hospitals.”

As of May there were 15 hospitals partially functioning, according to the World Health Organization and communication from hospitals. Some have gone out of service after they were raided or damaged, but have later reopened, causing the number of operating hospitals to fluctuate throughout the war. Aid organizations have also set up field hospitals inside the Strip.

Functioning hospitals are severely overcrowded and have faced shortages of important supplies such as anesthetics, antibiotics and gauze, relief groups have said.

The maps in this story draw on information released over the course of the war by aid groups (U.N. agencies including the Office for the Coordination of Humanitarian Affairs and the WHO, Doctors Without Borders, Human Rights Watch and the Palestine Red Crescent Society) as well as staff at hospitals and the organizations that run them, media reports, nonprofit research group Insecurity Insight, the IDF and the Gaza Health Ministry. The Post has not been able to independently verify some accounts.

International law governing war prescribes that hospitals must not be attacked during conflicts. They only become viable targets if they are being used to commit harm and if the attacking force takes measures to protect civilians.

“Even if Israel contends that a medical facility has lost its protection as a result of being used for acts harmful to the Israeli forces, it must nevertheless comply with the principles of precautions and proportionality,” Shamdasani said.

But the facilities’ widespread destruction since Oct. 7 may reflect the overall rate of devastation in Gaza, where experts say housing has been destroyed at a rate of intensity unseen since World War II, almost 90 percent of school buildings have been damaged, and the rate of infrastructure loss in the early months of the war outstripped recent conflicts including in Aleppo, Syria, and Mosul, Iraq.

Medical complexes in Gaza were damaged by bombardment at about the same rate as other buildings between Oct. 7 and Nov. 7, according to a Yale University-led analysis of satellite imagery published in April.

Lead author Danielle Poole, an associate research scientist with Yale’s Humanitarian Research Lab, said in an interview that a follow-up study, which is undergoing peer review, found that over subsequent months there was a fourfold increase in hits to hospitals, which were damaged at a “statistically significant” higher rate than other buildings.

“Even one attack raises concerns about international humanitarian law,” she said.

After 1 month of war

On Oct. 7, Hamas fighters broke through the barrier separating Gaza and southern Israel and carried out an attack that killed about 1,200 people, including more than 300 soldiers, according to Israel.

More than 35,500 Palestinians have since been killed and almost 80,000 injured, according to the Gaza Health Ministry, which does not distinguish between civilians and combatants but says the majority of the dead are women and children. Israel says more than 280 of its soldiers have been killed since the launch of its military operation in Gaza.

Hospitals in Gaza were drawn into the war from the very start. Indonesian Hospital in the Strip’s north was damaged by a strike in its vicinity on Oct. 7, according to Doctors Without Borders.

On Oct. 17, an explosion at al-Ahli Arab Hospital in Gaza City killed at least 100 people and caused global condemnation. Hamas blamed Israel; Israel, backed by the United States, denied culpability. Israel said the source of the munition was a militant group operating in Gaza, Islamic Jihad. A Washington Post analysis found that fighters in Gaza launched a barrage of rockets toward Israel and in the direction of al-Ahli Hospital 44 seconds before the blast.

The IDF launched its ground operation on Oct. 27.

After 3 months of war

In November, a pattern began that would be repeated against at least seven hospitals, according to The Post’s analysis: the IDF surrounding the building, cutting off movement in and out — including, in at least five examples, with sniper fire, according to aid agencies with staff on the ground and the Gaza Health Ministry; often facilitating an evacuation; and entering the hospital in a raid.

The most high-profile example of this was at al-Shifa, Gaza’s largest medical facility, which was raided in November.

At al-Nasr Children’s Hospital that month, staff were ordered by the IDF to evacuate and given assurances that babies left behind would be taken care of, they told The Post. Two weeks later, a Palestinian journalist returned to the empty building and found the decomposing bodies of four babies left behind. His video of the horrific scene was verified by The Post. An IDF spokesperson later cast doubt on the account during a question-and-answer session on social media.

In December, an analysis of satellite imagery published by The Post found evidence of dozens of apparent craters near the majority of hospitals in northern Gaza, including 10 craters that suggested the use of bombs weighing 2,000 pounds, the largest in regular use.

In early December, the IDF’s ground operation, which began at the Strip’s northern border and moved through Gaza City and the central Strip, continued into Khan Younis, the biggest population center in the enclave’s south.

After 6 months of war

Nasser Hospital, the most significant hospital in Gaza’s south, was raided and rendered nonfunctional for months in February after a siege lasting at least a week. Eight patients in intensive care died of lack of oxygen and some departments were flooded with sewage, the U.N. humanitarian affairs office said, citing the Gaza Health Ministry. The IDF detained about 70 staff members, the ministry said.

Israel described its operation as “precise and targeted.” It added it had found weapons at the hospital as well as medicine marked with names of hostages.

Al-Shifa Hospital, which had resumed providing limited services, was raided for a second time in March after the IDF said Hamas members returned to the building. After days of heavy fighting, it was left an “empty shell” with no patients, most buildings damaged or destroyed and most equipment unusable or reduced to ashes, according to the WHO. The IDF called its operation precise and said weapons, ammunition and fighters were found in the building.

In May, Israel started ordering mass evacuations from Rafah, heightening fears for the two partially functioning hospitals in that city that have not been reported damaged or raided during the war. One of them, Kuwait Hospital, is within an evacuation zone.

The WHO is “extremely worried” about the prospect of a full-scale Israeli military operation in Rafah, its representative for the region, Rik Peeperkorn, told the United Nations in Geneva this month. An incursion, he said, is something “the ailing health system will not be able to withstand.”

Victoria Bisset and Meg Kelly contributed to this report.

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