The Israeli military campaign in the Gaza Strip has been unlike any other in the 21st century.
In response to the unprecedented assault by Hamas on Oct. 7, Israeli airstrikes and a ground invasion that began 20 days later have destroyed large swaths of the besieged territory, killed at least 20,057 people and displaced a vast majority of the population.
The most ferocious attacks have come from the air, flattening entire city blocks and cratering the landscape.
The Washington Post analyzed satellite imagery, airstrike data and U.N. damage assessments, and interviewed more than 20 aid workers, health-care providers, and experts in munitions and aerial warfare. The evidence shows that Israel has carried out its war in Gaza at a pace and level of devastation that likely exceeds any recent conflict, destroying more buildings, in far less time, than were destroyed during the Syrian regime’s battle for Aleppo from 2013 to 2016 and the U.S.-led campaign to defeat the Islamic State in Mosul, Iraq, and Raqqa, Syria, in 2017.
The Post also found that the Israeli military has conducted repeated and widespread airstrikes in proximity to hospitals, which are supposed to receive special protection under the laws of war. Satellite imagery reviewed by Post reporters revealed dozens of apparent craters near 17 of the 28 hospitals in northern Gaza, where the bombing and fighting were most intense during the first two months of war, including 10 craters that suggested the use of bombs weighing 2,000 pounds, the largest in regular use.
“There’s no safe space. Period,” said Mirjana Spoljaric Egger, the president of the International Committee of the Red Cross, who visited Gaza on Dec. 4. “I haven’t passed one street where I didn’t see destruction of civilian infrastructure, including hospitals.”
The war has wounded more than 53,320 people, according to the Gaza Health Ministry. More than 7,700 Palestinian children have been killed, and women and children make up around 70 percent of the dead, according to the U.N. Office for the Coordination of Humanitarian Affairs, which also says that 1.9 million people have been displaced, equivalent to 85 percent of the population. The vast majority of Gazan civilians fleeing the invasion are not allowed by Israel and Egypt to leave.
“The scale of Palestinian civilian deaths in such a short period of time appears to be the highest such civilian casualty rate in the 21st century,” said Michael Lynk, who served as the U.N. special rapporteur on human rights in the Palestinian territories from 2016 to 2022.
In a reply to questions from The Post, the Israel Defense Forces sent a statement saying: “In response to Hamas’ barbaric attacks, the IDF is operating to dismantle Hamas military and administrative capabilities. In stark contrast to Hamas’ intentional attacks on Israeli men, women and children, the IDF follows international law and takes feasible precautions to mitigate civilian harm.”
Soon after the Oct. 7 attack by Hamas, Israeli military leaders signaled their intent to retaliate with widespread devastation.
On Oct. 10, Defense Minister Yoav Gallant told troops he had “released all the restraints” and that “Gaza will never return to what it was.” The same day, IDF spokesman Daniel Hagari said that “while balancing accuracy with the scope of damage, right now we’re focused on what causes maximum damage.”
In a little over two months, Israeli air forces fired more than 29,000 air-to-ground munitions, 40 to 45 percent of which were unguided, according to a recent assessment from the U.S. Office of the Director of National Intelligence. The bombing rate has been about two and a half times as high as the peak of the U.S.-led coalition’s effort to defeat the Islamic State, which at its height fired 5,075 air-to-ground munitions across both Iraq and Syria in one month, according to data from the research and advocacy group Airwars.
“There’s no safe space. Period.”
— Mirjana Spoljaric Egger, president of the International Committee of the Red Cross
One hallmark of the 21st century’s most indiscriminate air campaigns, as in Syria and Ukraine, has been the bombing of hospitals, which cannot be attacked under the laws of war unless they are actively being used to “commit acts harmful to the enemy.”
The Israeli military made no secret of its view that Gaza’s hospitals were military targets.
“Hamas systematically exploits hospitals as a key part of its war machine,” Hagari, the military spokesman, said on Nov. 5. “We will not accept Hamas’s cynical use of hospitals to hide their terror infrastructure.”
By Dec. 14, Israeli bombardment and fighting had forced the closure of more than two thirds of the 28 hospitals identified by The Post in northern Gaza.
As Israel’s military campaign went on, satellite imagery reviewed by The Post showed how heavy strikes around Gaza’s hospitals destroyed entire neighborhoods, wrecked infrastructure and displaced civilians, often making it impossible for hospitals to function.
To assess destruction around hospitals, The Post analyzed U.N. Satellite Center data in areas within 180 meters — the distance at which the smallest commonly used bombs, weighing 250 pounds, can cause enough damage to make a building uninhabitable, and the largest, weighing 2,000 pounds, can damage a structure beyond repair, according to a report by Armament Research Services commissioned by the International Committee of the Red Cross.
The data showed that Israel’s bombardment and other fighting had damaged structures within 180 meters of all of northern Gaza’s 28 hospitals.
Hospitals with damage within 180m
Across northern Gaza, visual evidence and other accounts showed how Israeli forces shot at, bombed, besieged and raided hospitals.
Turkish-Palestinian Friendship Hospital, Gaza’s only cancer treatment center, shut down on Nov. 1 after nearby airstrikes. At least four cancer patients died afterward, according to the health ministry. Al-Rantisi Hospital, the only hospital with a pediatric cancer ward, evacuated on Nov. 10 along with three nearby hospitals after being struck on Nov. 5 and surrounded by Israeli troops days later. Four premature babies left behind on breathing machines at one of the hospitals would later be found dead.
Video shot by a journalist in the parking lot of al-Awda Hospital showed nearby strikes filling the air with dust and smoke and raining debris down on ambulances.
(Feras al-Ajrami/Instagram)
Indonesian Hospital evacuated on Nov. 22, three days after artillery fire struck the hospital and killed 12 people. Israeli raids on Kamal Adwan Hospital over several days in mid-December resulted in the hospital’s “effective destruction” and the death of at least eight patients, World Health Organization Director General Tedros Adhanom Ghebreyesus tweeted on Dec. 17.
In Gaza City, Israeli strikes destroyed much of the neighborhood surrounding al-Quds Hospital, operated by the Palestine Red Crescent Society. Israeli forces pushing toward the center of the city fought with Hamas in the vicinity, and videos posted by the PRCS showed the impact of heavy nearby strikes. On Nov. 12, the hospital ceased operating.
Damage within 180m of al Quds Hospital
“What we have been witnessing is a campaign that was planned, it was a plan, definitely, to close down all the hospitals in the north,” said Léo Cans, head of mission for Palestine with Doctors Without Borders.
There have been 239 attacks on health-care workers, vehicles and facilities in Gaza that have killed 570 people since the war started, the WHO said on Dec. 13.
The IDF has published videos and images that show weapons and other military items, which it said were found in multiple hospitals. Underneath al-Shifa Hospital, Israeli troops excavated a tunnel with multiple empty rooms, alleging that they had been used by Hamas. The military said Hamas fighters there and elsewhere had fled before Israeli troops arrived and taken materiel with them. None of the evidence was possible to verify independently, because Israel does not allow journalists to enter Gaza except on strictly guided tours.
“What we have been witnessing is a campaign that was planned.”
— Léo Cans, head of mission for Palestine with Doctors Without Borders
“Only the current misuse of the hospital deprives it of its protection, but if that misuse ends, that protection is restored,” said Adil Haque, an international law expert and Rutgers University professor. If there were a tunnel or underground structure beneath the hospital, and troops weren’t sure what was inside them, any doubts should “caution in favor of restraint,” he added.
The satellite imagery reviewed by The Post revealed other evidence of how hospitals had come under attack: large craters close to hospitals, many of them bearing the telltale characteristics of large, airdropped bombs.
The Post reviewed nearly 100 satellite images taken between Oct. 8 and Dec. 10 and found about three dozen apparent craters within 180 meters of 17 of the 28 hospitals in northern Gaza. At The Post’s request, five satellite imagery analysts reviewed images of each crater large enough to suggest the use of a bomb weighing 2,000 pounds or more. While The Post’s findings represent a conservative undercount of the actual number of bombs dropped near Gaza’s hospitals, the imagery shows that hardly a hospital in the north has been left untouched.
Officials at humanitarian and health-care organizations with lengthy experience in major conflict zones said Israel’s war in Gaza was the most devastating they had seen.
Tom Potokar, a chief surgeon with the International Committee of the Red Cross working in Gaza for the 14th time, said explosive injuries were responsible for all the wounds he and his colleagues at European Hospital in southern Gaza had been treating. Many patients had necrotic wounds requiring amputation due to the lack of supplies and equipment at battered and besieged hospitals in the north.
“For me, personally, this is without a doubt the worst I’ve seen,” said Potokar, who has worked during conflicts in South Sudan, Yemen, Syria, Somalia and Ukraine.
Zaher Sahloul, the president of MedGlobal and a doctor who worked in Aleppo during the battle for the city, said he believed that “what’s happening right now in Gaza is beyond any disaster that I’ve witnessed at least in the last 15 years or so.”
Sahloul estimated it will take decades to rebuild the health-care infrastructure destroyed in Gaza and the knowledge and expertise of the scores of doctors and other health-care workers who have been killed.
Preliminary data provided to The Post by Airwars suggested that strikes in Gaza were killing civilians at twice the rate of the U.S.-led campaign in Raqqa. Emily Tripp, the director of Airwars, said that the data they provided The Post represented “just a fraction” of the strikes they were currently researching in Gaza, which averaged about 200 strikes per week. In Airwars’s 10 years of work, Tripp said, the group had never documented more than about 250 civilian casualty strikes per month in any conflict.
“Make no mistake — U.S. operations in Iraq and Syria, especially in densely populated cities like Mosul and Raqqa, caused devastating civilian harm and destruction,” said Annie Shiel, the U.S. advocacy director at the Center for Civilians in Conflict. “But what we are seeing in Gaza, the level of death and destruction in this relatively short period of time, is absolutely staggering in comparison. Nowhere is safe for civilians.”
“For me, personally, this is without a doubt the worst I’ve seen.”
— Tom Potokar, a chief surgeon with the International Committee of the Red Cross
Pnina Sharvit Baruch, a former high-ranking military lawyer who was responsible for advising Israeli commanders, said that Israel is currently facing “the biggest threat to its existence” from enemies determined to destroy it. Hamas made Gaza a “fortified military area” and operates from within civilian structures, she said, adding that “Hamas’s strategy of using civilians as shields means that attacking its military capabilities leads to unfortunate yet inevitable civilian casualties.” When Israeli commanders weigh civilian harm against military advantage when deciding whether to strike, she said, the “level of threat posed by Hamas [to Israel] is a legitimate component of evaluating the military advantage.”
Several humanitarian workers interviewed by The Post noted that Israel’s campaign in Gaza, and its destruction of hospitals and homes, will likely create additional suffering, such as hunger, lack of shelter and the spread of communicable diseases, that could eventually kill more people than the bombs and fighting.
Sahloul said he believed the only explanation for so many attacks on civilian sites, which should have been protected by the laws of war, was that such attacks were intentional.
“People in Syria told me they can tolerate bombs and missiles, but if there’s no doctors in town and no hospitals, they usually leave,” he said. “So I would have to assume that if it is intentional, the goal is to force the population to leave. And when they leave, they don’t come back.”
Methodology
The quality of satellite imagery, irregular coverage and even the angle of a satellite’s camera can all affect the ability to identify clear craters. In some cases, craters could be located but not conclusively attributed to a specific munition or payload size. In other cases, damage from the air campaign was clear, but craters were not visible.
The Post relied on a conservative assessment of what is and is not a crater and asked multiple experts to review any crater found in within 180 meters of a hospital in northern Gaza that had diameter of at least 40 feet, or 12.1 meters. Any crater with a diameter greater than 11.7 meters found in light soil like Gaza’s, experts said, suggests a bomb weighing 2,000 pounds or more could have been used. To account for inconsistencies in measurements, The Post relied on the slightly larger, 40-foot diameter.
The Post focused its analysis on this size because a 2,000-pound bomb dropped 180 meters away could damage a building beyond repair. At 90 meters, that same munition could destroy a building. Only craters that experts agreed on with high confidence were included in this report.
Experts cautioned The Post against ascribing particular damage to particular craters, as the amount of damage caused by a bomb can vary widely, especially in a dense urban environment. Damage depends on nearby structures, building materials, the soil, whether a bomb has been set to explode above or below ground, and other factors. Experts also noted that even the largest munitions can be employed to ensure that nearby civilian infrastructure is not damaged or is minimally affected when they explode. But even then, large munitions have inherent characteristics that can only be mitigated to a certain degree, making collateral-damage assessments done before the munition is used key to avoiding civilian harm, they said.
About this story
Louisa Loveluck in London, Claire Parker in Cairo, Jonathan Baran in San Francisco, and Cate Brown and John Hudson in Washington contributed to this report.
Design and development by Junne Alcantara and Irfan Uraizee.
