Gaza: Attack on Kamal Adwan Hospital. Israel and the al-Shifa Precedent – A New Humanitarian Standard.
by Claudio Bertolotti.
Article from the book by C. Bertolotti, Gaza Underground. La guerra sotterranea e urbana tra Israele e Hamas. START InSight (2024).
The Israeli Defense Forces (IDF), during a raid on the Kamal Adwan Hospital in northern Gaza—used by Hamas as a command post for the terrorist organization—eliminated 19 militants, including key figures involved in the October 7, 2023, attack on Israel.
In coordination with Shin Bet (the Israeli Security Agency), the IDF also arrested over 240 terrorists as part of an operation aimed at thwarting Hamas’ latest attempt to re-establish itself in northern Gaza. The Palestinian militia leadership had deliberately exploited the Kamal Adwan Hospital in Jabaliya, employing the well-documented strategy of using human shields—this time, patients inside the hospital. This incident not only highlights Hamas’ criminal intent but also underscores the IDF’s efforts to minimize the war’s impact on Palestinian civilians, despite widespread media narratives depicting the conflict as disproportionately violent. In fact, this war has resulted in historically low civilian casualties compared to other urban conflicts.
Operation at al-Shifa Hospital: A New Humanitarian Standard?
The Israel-Hamas war has provided Israeli forces with the opportunity to conceptualize and implement an unprecedented standard of urban warfare. In March 2024, the IDF conducted a targeted operation at al-Shifa Hospital in Gaza—repurposed by Hamas as a logistical and operational base—while adopting extraordinary measures to protect civilians during the approach, entry, and management of the facility. This approach integrated not only military personnel but also Israeli medical teams and paramedics tasked with assisting Palestinian patients, along with logistical units ensuring the supply of food, water, and medical resources.
This strategy aimed to limit the collateral damage caused by Hamas’ presence within civilian infrastructure, while simultaneously prioritizing patient welfare and minimizing civilian casualties. It stands as a first in the history of urban warfare—an innovative yet costly standard in terms of resources and the inherent risks faced by military personnel operating within hostile environments. From a doctrinal and historical perspective, this marks the first instance of an army undertaking such extensive measures to safeguard an adversarial civilian population, even as offensive military operations unfolded within the same building.
Military analyst John Spencer, in his article Israel Has Created a New Standard for Urban Warfare. Why Will No One Admit It?, remarked that Israel had implemented “more precautions to prevent civilian harm than any military in history—exceeding international legal requirements and surpassing the measures taken by the U.S. in recent wars in Iraq and Afghanistan.”
The al-Shifa precedent stands as a case study in urban warfare and civilian protection in operational areas. Despite posing a tactical disadvantage, this approach allows militaries engaged in highly scrutinized operations to prevent accusations of violating jus in bello and international conventions. It prompts reflection on the tactical applications and self-imposed limitations designed to protect civilians—not purely for humanitarian reasons but also as a defensive measure against adversary propaganda and cognitive warfare. Hamas, by using civilian infrastructure for military purposes and exploiting civilian casualties to bolster international pressure on Israel, demonstrates how lawfare (the use of legal frameworks as a weapon) plays a central role in modern conflicts.
The dominant Western military doctrine, as described at the beginning of this chapter, revolves around “maneuver warfare”—designed to physically and morally overwhelm an enemy through overwhelming force and speed, striking political and military centers of gravity to compel surrender or destruction. This doctrine underpinned the invasions of Panama (1989), Afghanistan (2001), Iraq (2003), and Russia’s attempt to swiftly capture Ukraine in 2022. In each case, civilians were given little warning or time to evacuate, resulting in significant non-combatant casualties.
Israel, however, has deviated from this entrenched “textbook” approach, prioritizing civilian protection. The IDF pre-announced nearly every operation, allowing civilians time to relocate—often forfeiting the element of surprise. This gave Hamas the opportunity to reposition military and political leaders (along with Israeli hostages) within urban areas, concealing them among civilians or through underground tunnels during evacuations. Unlike the IDF, Hamas fighters do not wear uniforms, granting them a tactical advantage—striking from within civilian populations and blending in to retreat alongside them.
As a result, Hamas has successfully pursued a dual strategy—inflicting suffering on the Palestinian population while crafting a narrative that leverages images of civilian casualties to amplify international pressure on Israel to halt its operations.