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Gaza’s hospitals have been a flashpoint of fighting, claims and counterclaims.

Tens of thousands of people sought shelter in medical facilities after being driven from their homes by the risk of airstrikes.

But many have fled elsewhere as hospitals ran out of fuel and power and the fighting circled closer.

Al Shifa, the largest hospital in Gaza, is now surrounded by Israeli troops as gunfire and explosions rage around it.

The hospital’s last generator ran out of fuel at the weekend, leading to the deaths of at least 32 patients, including three babies, according to the Hamas-run Gaza health ministry.

Al Quds hospital is also now also closed to new patients. The Red Cross tried to evacuate about 6,000 people from the hospital but said its convoy had to turn back because of shelling and fighting.

Hospitals have protected status in wartime – but there are caveats to when this applies.

Here Sky News looks at what the rules are, and what both sides are saying.

Follow Israel-Gaza latest: Communications in Gaza could fail in two days

What are the rules on the protection of hospitals?

The International Criminal Court’s Rome Statute states it is a war crime for combatants to “intentionally direct attacks against… hospitals and places where the sick and wounded are collected, provided they are not military objectives”.

Under international humanitarian law (IHL) hospitals have protected status during war.

This means they cannot be attacked or otherwise prevented from performing their medical functions, according to the International Committee of the Red Cross (ICRC).

However, hospitals can lose those protections if they are used in a way that is harmful to the enemy – this includes being used to hide fighters or store weapons, the ICRC said.

But this does not give the other party free licence to attack, ICRC legal officer Cordula Droege said.

A warning must be given – first to stop the misuse of the hospital and then to allow evacuation of staff and patients if the misuse continues.

Any attack must be proportionate, Ms Droege added. If harm to civilians from an attack is disproportionate to the military objective, it is illegal under international law.

Also, using hospitals for military purposes is a violation of international humanitarian law, according to Amnesty International.

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What status do hospitals have in war? Sky military analyst Sean Bell explains

What does Israel say?

Israel claims Hamas uses hospitals for military purposes – but has not provided verified visual evidence of this.

It says Hamas has built a vast underground command complex centre below al Shifa hospital, connected by tunnels.

Israel also claims hundreds of Hamas fighters sought shelter at al Shifa after the 7 October attack.

The IDF released footage on Monday of a children’s hospital that its forces entered over the weekend, showing weapons it said it found inside, as well as rooms in the basement where it believes Hamas was holding hostages.

“Hamas uses hospitals as an instrument of war,” said Israel’s chief military spokesman Rear Admiral Daniel Hagari from a room at the Rantisi Children’s Hospital where explosive vests, grenades and RPGs were displayed on the floor.

Israel also accuses Hamas of using ambulances to carry fighters, using this as justification for a strike on an ambulance convoy that officials in the Hamas-run health ministry said killed and injured scores of people.

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Ambulance convoy hit by airstrike

What does Hamas say?

Both Hamas and al Shifa hospital staff deny Israeli allegations militants are operating a command centre from within its grounds.

Ghazi Hamad, a senior Hamas official, rejected the Israeli claims about al Shifa as “false and misleading propaganda”.

“The occupying forces have no evidence to prove it,” he said. “We have never used civilians as human shields because it goes against our religion, morality and principles.”

In a statement on its Telegram channel, Hamas said the video of Rantisi hospital showed “fabricated scenes that misled public opinion”, adding that it was a “failed attempt” by Israel to justify the targeting of hospitals.

At al Shifa, spokesperson for the health ministry Ashraf al Qidra said Israeli snipers and drones were firing into the hospital, making it impossible for medics and patients to move around.

Israel said the east side of the hospital was a safe passage for people to leave al Shifa, but people who tried to leave said Israeli forces had fired at evacuees and that it was too dangerous to move the most vulnerable patients.

The World Health Organisation said there was “no safe passage out of the hospital”.

Goudhat Samy al Madhoun, a healthcare worker, told the AP news agency that about 50 people left on Monday and were fired at several times, wounding one man who had to be left behind.

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This photo released by Dr. Marawan Abu Saada shows prematurely born Palestinian babies in Shifa Hospital in Gaza City on Sunday, Nov. 12, 2023. Gaza's Shifa Hospital has become the focus of a days-long stalemate in Israel's war against Hamas.(Dr. Marawan Abu Saada via AP)
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Premature babies share a bed at Shifa hospital. Pic: Dr Marawan Abu Saada via AP

What has the international response been?

The international NGO Human Rights Watch has called for the attacks on “medical facilities, personnel, and transport” to be investigated as war crimes.

Israel’s claims about Hamas activity in hospitals are contested, Human Rights Watch said.

“Human Rights Watch has not been able to corroborate them, nor seen any information that would justify attacks on Gaza hospitals,” it said.

It added that Israel’s general evacuation warning to hospitals in northern Gaza was “not an effective warning” because it did not account for the safety needs of patients and medical staff.

The 27 European Union nations have jointly condemned Hamas for what they described as the use of hospitals and civilians as “human shields”.

US president Joe Biden said hospitals “must be protected” as he called for “less intrusive action” in relation to hospitals.

Insecurity Insight collects data on attacks on healthcare in Israel and Gaza. Its data – which it notes is not complete – from 7 October to 5 November records 219 incidents of violence against or obstruction of access to healthcare facilities in Gaza and 10 in Israel.

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It’s a stunning shift in US policy – but Biden’s announcement will trigger fury and fresh threats from Moscow

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It's a stunning shift in US policy - but Biden's announcement will trigger fury and fresh threats from Moscow

Joe Biden’s belated decision to allow Ukraine to use US-supplied, long-range missiles inside Russia will be cheered by Kyiv and will almost certainly prompt the UK to follow suit.

But the stunning shift in US policy – just weeks before Donald Trump takes over as US president – will also trigger fury and fresh threats from Moscow at a time of increasing uncertainty about the future course of its war.

President Vladimir Putin has warned the West they would be playing with fire if they allowed Ukrainian forces to launch Western-supplied cruise and ballistic missiles at Russia, saying it could even trigger a global conflict.

British and US officials, though, have repeatedly advised their respective capitals not to be intimidated by Moscow’s sabre rattling.

Ukraine war latest: Biden lifts ban on Russia strikes

Yet there has been hesitancy, particularly in Washington, over the unleashing of US Army Tactical Missile System (ATACMS) ballistic missiles beyond the borders of Ukraine.

However, it seems that a move by North Korea to send thousands of its troops to fight with Russia has changed US calculations.

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The New York Times, which was among the US media organisations to break news of the Biden administration’s decision on long-range missiles, reported that the first time the American weapons will be used inside Russia will likely be against Russian and North Korean troops battling a Ukrainian incursion in the Russian region of Kursk.

While a significant step up in support for Ukraine, the ability to use American long-range missiles inside Russia is not a war-winning development.

But it does expand Kyiv’s capacity to hit important military targets deliberately positioned by Russian commanders far back from the frontline. This includes stockpiles of missiles, drones and other ammunition used to strike Ukraine.

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Biden lifts ban on Russia strikes

Just as important as the military impact, though, is the political signal that the US decision sends to the Kremlin about Washington’s willingness to defy Russian warnings about dire consequences should Mr Biden dare to grant Ukraine the permission it’s so long been seeking.

The dramatic move by the United States comes after months of lobbying by Ukraine’s leader, Volodymyr Zelenskyy.

A key thing to watch now will be how Mr Putin reacts the first time an American missile kills Russian soldiers on Russian soil.

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Moscow does not want a direct war with the United States and NATO – nuclear-armed forces with far greater combined firepower – but the Kremlin could well ramp up an already heightened campaign of sabotage and other forms of hybrid warfare across Europe.

Another important reaction to track will be how Mr Trump responds to Mr Biden’s move and whether he continues to allow Ukraine this permission once he takes over as the US commander-in-chief.

The president-elect has vowed to end Russia’s war in Ukraine quickly but he has not said how. Yet he has voiced fierce opposition to the continued gifting of vast quantities of American weapons to the Ukrainian military.

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Russia fires more than 200 missiles and drones at Ukraine in largest attack since August

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Russia fires more than 200 missiles and drones at Ukraine in largest attack since August

Several people have been killed after Russia launched its largest aerial attack on Ukraine since August.

More than 200 missiles and drones were deployed, Volodymyr Zelenskyy said, as he condemned a “massive combined strike” on “all regions”.

Andrii Sybiha, Ukraine’s foreign minister, said “peaceful cities” and “sleeping civilians” were targeted.

Ukraine war – latest updates

Moscow is focused on the “energy infrastructure throughout Ukraine” and is trying to intimidate Ukrainians with “cold and lack of light”, Mr Zelenskyy said.

The president added: “The whole world sees and knows that we are defending ourselves against absolute evil, which does not understand any language but force.

“We need unity [and] the world needs unity. Only together can we stop this evil.”

A firefighter at the site of a Russian drone strike in Mykolaiv in southern Ukraine. Pic: State Emergency Service of Ukraine/Reuters
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A firefighter at the site of a Russian drone strike in Mykolaiv in southern Ukraine. Pic: State Emergency Service of Ukraine/Reuters

Two people were killed and a 17-year-old boy was injured after a Russian attack in the Black Sea port of Odesa, regional governor Oleh Kiper said.

Energy infrastructure was damaged, he said, leading to “interruptions in the supply of heat, water and electricity”.

In Mykolaiv, southern Ukraine, officials said two people were killed in a Russian drone attack.

Ukraine’s state emergency service said a multi-storey building, cars and a shopping centre were hit.

Two women were killed and six injured, including two children, it added.

In the central Dnipro region, two people died and three were wounded in a strike on a rail depot, while in Lviv, on the border with Poland, a woman was killed in a car.

Emergency services remove part of a Russian missile from an apartment building in Kyiv. Pic: Reuters
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Emergency services remove part of a Russian missile from an apartment building in Kyiv. Pic: Reuters

In the capital, Kyiv, mayor Vitali Klitschko said Russian attacks had caused a fire to erupt on the roof of a residential building, injuring at least two people.

People took refuge in metro stations, while emergency services were pictured removing part of a Russian missile from an apartment block.

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The Ukrainian military said it had destroyed 102 missiles and 42 drones launched by Russia.

Hypersonic missiles were among the 120 fired at Ukrainian territory, it said.

Air defences were active in “almost all” regions of Ukraine.

Equipment at thermal power stations has been “seriously damaged” during Russian air strikes, Ukraine’s largest private energy provider said. DTEK said its staff were working on repairs.

People sheltering in a metro station in Kyiv. Pic: Reuters
Image:
People sheltering in a metro station in Kyiv. Pic: Reuters

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Russia’s defence ministry confirmed it had attacked energy resources supporting Ukraine’s military-industrial complex, Russian news agencies reported.

Poland scrambled its air force early on Sunday because of the “massive attack by the Russian Federation using cruise missiles, ballistic missiles and unmanned aerial vehicles”.

Mr Zelenskyy sent his condolences to anyone affected by the latest Russian attacks.

He said “all necessary forces” were involved in restoring power and facilities.

On Tuesday, it will be 1,000 days since Russia launched what it calls its “special military operation”.

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Under siege in Ukraine, schools go underground to keep life as normal as possible for children

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Under siege in Ukraine, schools go underground to keep life as normal as possible for children

If you know a teacher, or you are a teacher, you’ll understand that many in the profession consider their jobs one of the best in the world, while also acknowledging it can be one of the most stressful.

Teaching in a war zone takes it to another level on both fronts.

But imagine teaching in a war zone in say the London Underground or the Paris or New York metros?

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Students learning in lessons

Well, that’s exactly what is happening in Kharkiv, Ukraine’s second largest city – a city attacked by Russia on a constant basis.

In 2023, the authorities banned children from being taught in regular school buildings here because of the threat they were under from missile strikes.

So Kharkiv city and its education department started working on a plan.

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That plan has concluded with the construction of six schools in six metro stations, teaching 4,800 children daily whose families haven’t fled the war.

Intrigued by this new educational experiment, as it’s still considered, we were told to meet at the University metro station in the centre of the city and wait to be taken to the school.

Soviet-era metro stations, and particularly the platforms, are universally grand and ornate, although Ukraine’s are slightly more modest.

A young child at school in Kharkiv's underground system
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A young child at his desk in the underground school

The school (left) and the metro system (right)
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The school (left) and the metro system (right)

Pedestrian walkways though are always crammed with florists, newspaper stands, mobile phone shops and cafes, and Kharkiv’s are no different.

What is different though is that next to the main platform entrance, an adjacent passageway has been sealed off by a white wall with three doors built into it.

We were ushered inside, past a guard and into a concourse with two desks.

Inside the classrooms in a city under siege
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Inside the classrooms in a city under siege

The classrooms are brightly decorated to try and maintain morale for the children
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The classrooms are brightly decorated to try and maintain morale for the children

In front of us, we could see a wide staircase leading to a long corridor. Above us, large, shiny silver metal tubes stretched into the distance, pumping in air from above ground.

Lining the corridor, we could see a series of white interconnecting cabins, all brightly lit, and from them, we could hear the sounds of children laughing, music, and teachers conducting class in this strange subterranean school.

Perhaps the only school in the world with one corridor.

A door to one of the classes opened, and in pairs, a class of six and seven-year-olds emerged – their teacher at the front and an assistant at the rear.

They’re heading to the bathroom for a toilet break, the staff must keep an eye on them.

If any of the children were to make it out of the school, they could easily get lost in the underground system.

The pupils are spread across seven classrooms with a mix of yellow and green desks and chairs, and walls decorated with bright pictures like rainbows, sunshine and sunflowers, to try to create a cheery atmosphere.

“At first, the children were bewildered by studying here, it felt unfamiliar to them, but interacting with each other and with their teachers helped them to adapt,” Iryna Tarasenko from Kharkiv’s education department told me.

Iryna Tarasenko from Kharkiv's education department
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Iryna Tarasenko from Kharkiv’s education department

Sky News chief correspondent Stuart Ramsay and Kharkiv education official Iryna Tarasenko
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Sky News’ Stuart Ramsay and Kharkiv education official Iryna Tarasenko

Iryna is showing me around the school. They feel it’s their way of contributing to the war effort.

She said: “In the summer of 2023, the Defence Council didn’t permit children to study in regular school buildings, so, we had to find a solution. This is our frontline – our educational frontline.”

There are of course health concerns for both the teachers and the pupils spending so much time underground, so medical examinations are done on a regular basis.

It is an opportunity for doctors and behavioural specialists to monitor the effects of this war on them.

Dmytro Mitelyov is the neurologist on duty monitoring the children’s behaviour, checking for any signs of stress – physical and mental.

He gently asks each child how they’re feeling, and asks if they have any aches and pains.

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Dmytro Mitelyov (centre), the neurologist on duty monitoring the children as they spend large parts of their days underground, speaks to a child
Image:
Neurologist Dmytro Mitelyov (centre) monitors children as they spend large parts of their days underground

“These are children who haven’t left Kharkiv since the war began, they live in a constant state of stress, multifaceted stress caused by a range of factors. They are exposed to things they see and hear, like alarms, explosions, and they feel it all,” Dmytro told me.

“When these children grow older, all the trauma they’ve endured during their formative years can, unfortunately, leave a lasting and serious imprint on their mental health. They haven’t had a healthy, carefree childhood – the kind where they can learn, play, and feel safe as children normally would.”

As the first group’s school day ends, children from one of Kharkiv’s most bombed districts, wrap up warm before being led to the surface to catch a school bus to their old school – which was hit by a missile.

It’s still where they meet their parents for normal pick-up.

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Students eating in their classrooms in Kharkiv's metro system
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Students eating in their classrooms in Kharkiv’s metro system

We jump on the bus with them for the journey past destroyed government buildings, shopping centres and restaurants.

When the air raid suddenly sounds, I look around to see how the children and teachers on this bus will react.

They barely flinch it’s so common.

“People have, to some extent, adapted,” one of the headmistresses, Olena Nikolienko, said.

“If we see missiles coming, heaven forbid, we’ll stop near a designated shelter, following our evacuation plan, and that’s where the children will go for cover.”

Headmistresses Olena Nikolienko
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Headmistress Olena Nikolienko

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Remember, these children are safe underground at school, up here they are not.

During the bus ride, 10-year-old Alisa began quietly sobbing. Her teacher told me her grandfather was killed four months ago on the frontline, and since then she has been prone to tears.

Alisa’s teacher comforted her and told her everything would be ok.

It feels like everyone here has to carry their own sadness.

Everyone.

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‘Ukraine war will end sooner under Trump’

Parents, standing in the first snowfall of the season, greet the children as they get off the bus.

The kids run off the bus, and start throwing snowballs at each other, enjoying this precious moment.

It will be the last time they’re outside today.

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