An Israeli strike on a hospital highlights the devastation to Gaza's healthcare system

BEIRUT (AP) — A deadly airstrike on the biggest hospital in the southern Gaza Strip highlighted the devastation that Israel's campaign has wreaked on the Palestinian territory's healthcare system over the past three years.

The strike that hit Nasser Hospital's surgical wing killed six people, including a surgeon and a 13-year-old boy, and heavily damaged operating rooms and patient wards. The Israeli military said it targeted a Hamas commander using the hospital as a base, though it did not provide evidence for the claim.

Israel has carried out near daily strikes in Gaza despite a ceasefire agreement with Hamas that took effect in October 2025. Israel says it is targeting militants. Israel launched its campaign in Gaza in retaliation for Hamas' deadly October 2023 attack on southern Israel.

Direct attacks on hospitals have become rarer during the truce. But Thursday's strike underscored how Gaza's health system is still struggling to recover.

Here is a look at Israel's attacks on hospitals, its accusations against Hamas and the impact on Gaza's healthcare system.

The Israeli military besieged multiple hospitals around Gaza throughout the war, often surrounding them for weeks and battering them with strikes and gunfire while patients and staff were trapped inside and supplies ran out. Some sieges ended with troops storming hospitals, often leaving medical equipment destroyed, or with staff and patients forced to evacuate. Troops detained hundreds of healthcare workers.

Two major raids left Gaza City’s Shifa Hospital, the territory’s largest, in ruins.

Aside from the sieges, hospitals and other medical facilities have frequently come under Israeli fire or been hit by airstrikes that the military says target Hamas militants. During some of the worst months, as few as 14 of Gaza's 36 prewar hospitals were functioning, and shortages of medicine meant patients writhed in pain without painkillers and deadly infections ran rampant.

The World Health Organization says it has documented more than 1,050 attacks on health facilities in Gaza, causing more than 1,000 deaths. The U.N. says more than 1,700 medical personnel were killed in the war, including in strikes away from medical facilities. At least six medical staffers from Gaza, including three prominent doctors, have died in Israeli prisons, according to rights groups that have documented abuses in custody.

Israeli forces have struck Nasser Hospital repeatedly. In 2025, the military killed 22 people when it shelled a vantage point used by reporters on the hospital roof , then hit rescue workers and journalists rushing to help the wounded. Among those killed were five journalists, including Mariam Dagga , who was working with The Associated Press.

While attacks during the ceasefire have waned, some strikes in recent months have damaged medical facilities, according to the U.N.

Israel has sought to justify the assaults by accusing Hamas of using the hospitals as command-and-control centers, though it has provided limited evidence. Palestinian and hospital officials have denied these claims.

Hamas security men have sometimes been seen in hospitals, controlling access to certain areas.

The international medical aid group Doctors Without Borders suspended most operations at Nasser Hospital in January because of the presence of masked armed men and situations in which patients were arrested or intimidated. It resumed operations a few months later, citing “concrete improvements” after talks with Gaza authorities, including restrictions on entry of armed individuals.

In the case of Nasser Hospital, the Israeli military said Thursday that it was targeting Muhammad Abu Ismail, who it said headed Hamas’ Khan Younis Brigade and had been using the facility as a headquarters for planning attacks.

It did not explain why the hospital’s surgical unit was targeted. The strike smashed through a patient recovery area and wrecked operating rooms and a rest area for doctors.

The military did not say whether it had killed Abu Ismail. He was not on the hospital’s list of people killed.

Hospitals are protected under international humanitarian law and attacking them is a war crime.

Medical facilities can lose that protected status if they are used for military purposes “to commit acts harmful to the enemy.” But the Geneva Conventions, passed in 1949, say there must be a warning with a reasonable period of time before any attack, and that the attack must be proportional to the military threat and take care to avoid civilian casualties.

The Israeli military said it had held “warning conversations” with Gaza health officials before Thursday's strike regarding militant use of hospitals. It said it made clear that “if the activity was not halted, it would act to remove the threats posed by it.”

Medical organizations and rights groups also have criticized Israel’s restrictions on medical aid and equipment entering Gaza as a violation of international law. The Israeli military says it allows aid to enter Gaza but bars some “dual use” items it asserts could be used for military purposes.

Israel’s attacks, along with restrictions on aid, have left Gaza’s healthcare system in ruins. Twenty of Gaza’s 36 pre-war hospitals are functioning, though none is fully operational.

During much of the war, some of those hospitals offered little beyond first aid even as they dealt with scores of wounded people. They struggled to keep lights and equipment functioning because of fuel shortages.

The ceasefire deal has given aid groups and the Health Ministry breathing room to get some services functioning again. But the sector continues to suffer from Israel’s restrictions on entry or slow approvals for medicines, supplies and equipment. The World Health Organization said in a Sept. 30 report that 47% of essential medicines were out of stock and that shortages in lab supplies, medical equipment, spare parts and fuel hampered health work.

At the same time, hospitals and clinics struggle to treat a population where almost everyone has lost their homes and more than 1.6 million live in tents or other ramshackle shelters. Communicable diseases and infections are widespread, and thousands have life-changing wounds from the war.