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.
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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0:59
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.
Image: 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.
To the sound of mournful chants and the slow beat of drums, they march, whipping their backs with metal flails.
It is an ancient ceremony going back almost 14 centuries – the Shia commemoration of Ashura.
But this year in particular has poignant significance for Iranians.
The devout remember the betrayal and death of the Imam Hussein as if it happened yesterday.
Image: Iranians gather ahead of Ashura
We filmed men and women weep as they worshipped at the Imamzadeh Saleh Shrine in northern Tehran.
The grandson of the Prophet Muhammad was killed by the armies of the Caliph Yazid in the seventh century Battle of Karbala.
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Shia Muslims mark the anniversary every year and reflect on the virtue it celebrates – of resistance against oppression and injustice. But more so than ever this year, in the wake of Israel and America’s attacks on their country.
The story is one of prevailing over adversity and deception. A sense of betrayal is keenly felt here by people and officials.
Image: Men and women weeped as they worshipped at the Imamzadeh Saleh Shrine
Many Iranians believe they were lured into pursuing diplomacy as part of a ruse by the US.
Iran believed it was making diplomatic progress in talks with America, which it hoped could lead to a deal. Then Israellaunched its attacks and, instead of condemning them, the US joined in.
“Death to Israel” chants resounded outside the mosque in skies that for 12 days were filled with the sounds of Israeli jets.
There is a renewed sense of defiance here.
One man told us: “The lesson to be learned from Hussein is not to give in to oppression, even if it is the most powerful force in the world.”
Image: ‘I don’t think about Trump. Nobody likes him,’ one woman tells Sky News
A woman was dismissive about the US president.
“I don’t think about Trump. Nobody likes him. He always wants to attack too many countries.”
Pictures on billboards nearby link Imam Hussein’s story and current events. They show the seventh century imam on horseback alongside images of modern missiles and drones from the present day.
Other huge signs remember the dead. Iran says almost 1,000 people were killed in the strikes, many of them women and children.
Officially Iran is projecting defiance, but not closing the door to diplomacy.
Government spokeswoman Dr Fatemeh Mohajerani told Sky News that Israel should not even think about attacking again.
“We are very strong in defence, and as state officials have announced, this time Israel will receive an even stronger response compared to previous times. We hope that Israel will not make such a mistake.”
Image: Dr Fatemeh Mohajerani said it would be a mistake for Israel to attack again
But there is also a hint of conciliation. Senior Iranian officials have told Sky News back-channel efforts are under way to explore new talks with the US.
Israel had hoped its attacks could topple the Iranian leadership. Those hopes proved unfounded. The government is in control here.
For many Iranians it seems quite the opposite happened – the 12-day war has brought them closer together.
Two American security workers in Gaza were injured after grenades were thrown during food distribution in Khan Younis, the Gaza Humanitarian Foundation (GHF) has said.
In a statement, the US and Israeli-backed aid group said a targeted terrorist attack was carried out at one of its sites in southern Gazaon Saturday morning.
The two Americans injured “are receiving medical treatment and are in stable condition,” it said, adding that the delivery of aid was “otherwise successful” and that “no local aid workers or civilians were harmed”.
GHF didn’t say exactly when the incident happened but claimed Hamaswas behind the attack, adding: “GHF has repeatedly warned of credible threats from Hamas, including explicit plans to target American personnel, Palestinian aid workers, and the civilians who rely on our sites for food.
“Today’s attack tragically affirms those warnings.”
Later, the aid group posted a picture on social media, which it said showed “fragments of a grenade packed with ball bearings” that was used in the attack.
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Asked by Sky’s US partner network, NBC News, whether the two injured individuals were responsible for handing out aid or were responsible for providing security, GHF said they were “American security workers” and “two American veterans.”
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The aid group did not provide specific evidence that Hamas was behind the attack.
The US and Israeli-backed group has been primarily responsible for aid distribution since Israel lifted its 11-week blockade of the Gaza Strip in May.
According to Gaza’s health ministry, 600 Palestinians have been killed while seeking aid from GHF sites as of 3 July, which charities and the UN have branded “death traps”.
Meanwhile, the Associated Press has reported that Israeli-backed American contractors guarding GHF aid centres in Gaza are using live ammunition and stun grenades.
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Contractors allege colleagues ‘fired on Palestinians’
GHF has vehemently denied the accusations, adding that it investigated AP’s allegations and found them to be “categorically false”.
Israel’s military added that it fires only warning shots and is investigating reports of civilian harm.
It denies deliberately shooting at any innocent civilians and says it’s examining how to reduce “friction with the population” in the areas surrounding the distribution centres.
Hamas has said it has “submitted its positive response” to the latest proposal for a ceasefire in Gaza to mediators.
The proposal for a 60-day ceasefire was presented by US President Donald Trump, who has been pushing hard for a deal to end the fighting in Gaza, with Israeli Prime Minister Benjamin Netanyahu set to visit the White House next week to discuss a deal.
Mr Trump said Israel had agreed to his proposed ceasefire terms, and he urged Hamas to accept the deal as well.
Hamas’ “positive” response to the proposal had slightly different wording on three issues around humanitarian aid, the status of the Israeli Defence Forces inside Gaza and the language around guarantees beyond the 60-day ceasefire, a source with knowledge of the negotiations revealed.
But the source told Sky News: “Things are looking good.”
Image: A woman cries after her son was killed while on his way to an aid distribution centre. Pic: AP/Jehad Alshrafi
Hamas said it is “fully prepared to immediately enter into a round of negotiations regarding the mechanism for implementing this framework” without elaborating on what needed to be worked out in the proposal’s implementation.
The US said during the ceasefire it would “work with all parties to end the war”.
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A Hamas official said on condition of anonymity that the truce could start as early as next week.
Image: An Israeli army tank advances in the Gaza Strip, as seen from southern Israel. Pic: AP/Leo Correa
But he added that talks were needed first to establish how many Palestinian prisoners would be released in return for each freed Israeli hostage and to specify the amount of humanitarian aid that will be allowed to enter Gaza during the ceasefire.
He said negotiations on a permanent ceasefire and the full withdrawal of Israeli troops from Gaza in return for the release of the remaining hostages would start on the first day of the truce.
Hamas has been seeking guarantees that the 60-day ceasefire would lead to a total end to the nearly 21-month-old war, which caused previous rounds of negotiations to fail as Mr Netanyahu has insisted that Israel would continue fighting in Gaza to ensure the destruction of Hamas.
The Hamas official said that Mr Trump has guaranteed that the ceasefire will extend beyond 60 days if necessary to reach a peace deal, but there is no confirmation from the US of such a guarantee.
Speaking to journalists on Air Force One, Mr Trump welcomed Hamas’s “positive spirit” to the proposal, adding that there could be a ceasefire deal by next week.
Image: Palestinians dispersing away from tear gas fired at an aid distribution site in Gaza. Pic: AP
Image: A girl mourns the loss of her father, who was killed while heading to an aid distribution hub. Pic: AP/Jehad Alshrafi
Hamas also said it wants more aid to flow through the United Nations and other humanitarian agencies, which comes as the UN human rights officer said it recorded 613 Palestinians killed in Gaza within a month while trying to obtain aid.
Most of them were said to have been killed while trying to reach food distribution points by the controversial US- and Israeli-backed Gaza Humanitarian Foundation (GHF).
The spokeswoman for the UN human rights office, Ravina Shamdasani, said the agency was not able to attribute responsibility for the killings, but added that “it is clear that the Israeli military has shelled and shot at Palestinians trying to reach the distribution points” operated by GHF.
Image: Palestinians carry aid packages near the GHF distribution centre in Khan Younis. Pic: AP/Abdel Kareem Hana
Ms Shamdasani said that of the total tallied, 509 killings were “GHF-related”, meaning at or near its distribution sites.
The GHF accused the UN of taking its casualty figures “directly from the Hamas-controlled Gaza health ministry” and of trying “to falsely smear our effort”, which echoed statements to Sky News by the executive director of GHF, Johnnie Moore.