The sound of explosions and gunfire once again rings out in Gaza as violence flares up between Israel and Palestinian militant groups. At the center of the conflict this time is Gaza’s Indonesian Hospital, which suffered a direct artillery strike on Monday that killed at least 12 Palestinians on the premises.
With some 700 people sheltering inside, including medical staff and patients, the situation at the hospital remains perilous. Israeli tanks have the facility surrounded as intense urban warfare rages just meters away. For the staff and civilians trapped inside, there is no escape from the enveloping violence.
This latest incident underscores the vulnerability of Gaza’s healthcare system to periodic outbreaks of conflict. During the 2014 war, 18 hospitals and clinics were damaged along with 24 ambulances. This prompted the UN to warn about the dire state of Gaza’s medical infrastructure.
Eight years later, the health system is on the verge of total collapse once again. The Indonesian Hospital attack is just the latest in a series of Israeli strikes targeting medical facilities. With Gaza’s main Shifa Hospital also affected, most of the enclave’s hospitals are now non-operational.
For Israel, its military contends that Palestinian militant groups use hospitals and schools to hide weapons and establish underground command centers. While firm evidence is lacking, Israeli authorities maintain their right to strike sites being used for military purposes.
But repeated attacks on medical facilities and the resulting civilian casualties have led to accusations that Israel is deliberately targeting key infrastructure to turn the populace against Hamas. Whatever the motives, the outcome is a deepening health crisis that disproportionately affects women, children and the infirm.
The Situation at Indonesian Hospital
Of all the medical facilities targeted during the latest surge in violence, the situation at Indonesian Hospital is among the most dire. A project funded by the Indonesian government at a cost of $8 million, the hospital sits on 16,000 sqm of land in northern Gaza’s Beit Lahiya.
Having opened its doors in 2016, the facility fills a crucial gap in providing maternal and child health services to the surrounding community. This includes the Jabalia refugee camp which hosts tens of thousands of displaced Palestinians.
The three-story hospital campus also housed hundreds of civilians seeking shelter from bombardments. Its location close to the border with Israel has made it vulnerable to repeated artillery barrages and airstrikes.
The latest direct hit on Monday has effectively shut down operations. Without electricity and running water, doctors and nurses are unable to provide even basic care to the wounded. Making matters worse is the constant threat of shellfire and snipers positioned on nearby rooftops.
With just a fence separating the hospital from Israeli tanks, staff are effectively trapped along with patients who cannot be evacuated. The situation grew increasingly desperate through Monday evening despite calls from Indonesia for an immediate ceasefire.
Militant mortar teams deployed close to the hospital further complicate the dynamics for those holding out inside. Any counter-battery fire from Israel risks inflicting further collateral damage.
For Indonesian citizens trapped inside, the Foreign Ministry said all contact had been lost with three volunteers. Besides hospital staff, other Indonesians reside in Gaza providing humanitarian assistance, although exact numbers remain unknown.
Jakarta has no formal ties with either the elected Hamas government in Gaza or the Palestinian National Authority headquartered in the West Bank. But it has long supported the Palestinian cause with funding for infrastructure projects including the Indonesian Hospital.
The latest violence puts Jakarta in a difficult position diplomatically and jeopardizes its aid efforts including running the hospital. With Israel intent on halting all militant rocket attacks, the crisis looks set to drag on.
Israel’s Justifications for Targeting Hospitals
This is not the first time that Israel has faced criticism over striking medical infrastructure during its periodic offensives in Gaza. The pattern has recurred with each major outbreak of hostilities going back to 2009.
The Israeli Defence Forces (IDF) insist that although civilian structures are not deliberately targeted, exceptions have to be made. These include instances where military activity is conducted nearby or from within hospitals, mosques and schools.
More specifically, Israel alleges that Palestinian militant factions including Hamas use tunnels beneath hospitals to conceal weapons caches. In the case of Shifa Hospital, Israel claims it also housed a clandestine command center.
While evidence to back up such assertions is limited, Israel argues that the mere presence of militant activities within or nearby medical facilities strip them of protected status. This has enabled the IDF to repeatedly strike sites like Shifa and Indonesian Hospital.
Israel also cites instances of rockets or mortars being launched in the vicinity of such facilities by Palestinian militants themselves. This has occurred during the latest escalation of violence as well, placing hospitals at risk of counter-battery strikes.
At Indonesian Hospital, located along Gaza’s northern frontier, the IDF says militant rocket teams have been deploying nearby. Any launching sites in the proximity of the hospital compound could prompt Israeli return fire regardless of the humanitarian implications.
More broadly, Israel accuses Hamas of using civilians as human shields and weaponizing sites with humanitarian purposes. While Hamas’ presence within densely populated areas no doubt complicates military operations, critics say this does not detract from Israel’s responsibility to avoid civilian casualties.
The damage and loss of life from strikes on medical facilities like Indonesian Hospital has added to accusations that Israel is pursuing a deliberate strategy of debilitating Gaza’s healthcare system. Without hospitals to treat the injured, public resentment and opposition to Hamas will increase as the argument goes.
Israel insists civilian infrastructure is not specifically targeted but that collateral damage is an unfortunate inevitability when rocket fire emanates from populated areas. Questions remain however about the proportionality of Israel’s tactics and its toll on civilians and key infrastructure.
Concerns Over ‘Psychological Warfare’
Israel’s repeated strikes on healthcare facilities have led to allegations that a form of psychological warfare underlies its targeting strategy. While firm evidence of deliberate intentions to spread fear is lacking, the narrative refuses to go away.
Gaza has just 15 hospitals serving a population of 2 million. Damage to the enclave’s sole cancer clinic at Shifa Hospital carries heavy symbolic weight alongside the shuttering of pediatric facilities. The outbreak of hostilities every few years leaves Gaza’s health system in perpetual crisis.
Striking sites like Shifa Hospital and Indonesian Hospital inevitably takes a severe psychological toll on residents. Nowhere seems safe for the sick and injured when even so-called protected facilities come under fire. Faith in healthcare institutions to function even during conflict is seriously eroded.
Guardian columnist Owen Jones argues that Israel’s military regularly engages in psychological operations, or PSYOPS. Undermining morale and mental health, as well as forcing civilians to exert pressure on militants, are among the goals.
While impossible to definitively prove such allegations, Israel’s tactics tick many boxes for what might constitute PSYOPS. The cumulative effect on Palestinian psychology amid a situation of unending occupation creates a potent mixture of outrage and despair.
As the crisis at Indonesian Hospital demonstrates, Gaza’s healthcare system remains highly vulnerable as civilian sites get caught up in the crossfire. Whether intentional or not, the humanitarian costs for Gazans continue to mount with each new Israeli offensive.
Indonesia’s Aid Efforts Take a Hit
The crisis centering around Indonesian Hospital also has significant implications for Indonesia as one of Gaza’s biggest international benefactors. The entire medical facility was designed and constructed using funds donated by Indonesian citizens and organizations.
Besides hospitals, Indonesia also funded the construction of mosques, schools and other facilities with several million dollars worth of aid. These projects aimed to alleviate economic hardship in Gaza stemming from years of isolation and border restrictions.
With the hospital now heavily damaged after being engulfed by clashes, Indonesia’s aid efforts have been directly impacted. The targeting of the facility also constitutes a major setback for improving living standards in northern Gaza.
While demanding an immediate ceasefire, Jakarta finds itself with limited diplomatic options to pressure Israel. Indonesia has no formal ties with Israel over the Palestinian issue. Communication typically takes place via the United Nations or third parties like the United States.
Lacking direct leverage, Indonesia will likely have to rely on public condemnation and cooperation with the global Muslim community to draw attention to Israeli actions. But with ceasefire hopes receding, the crisis looks set to erode Jakarta’s aid footprint in Gaza.
Indonesia does maintain contact with Hamas which it does not designate as a terrorist entity unlike countries such as the U.S. and Israel. But leverage is still restricted, making for limited Indonesian influence over events on the ground.
As a staunch supporter of Palestinian statehood, however, Indonesia will remain vocal during a crisis that strikes at the heart of its aid efforts. With long-running projects like Indonesian Hospital under fire, Jakarta’s humanitarian response faces severe disruption.
The View From Gaza – Infrastructure in Tatters
The latest escalation in violence could not have come at a worse time for Gaza’s healthcare sector. Still struggling to cope with the fallout from wars in 2008, 2012 and 2014, hospitals were already on the brink of collapse. With most ambulances and medical equipment obsolete, any hit to infrastructure is a major setback.
What distinguishes the current round of fighting is the precision targeting of hospitals and clinics. Previous offensives resulted in sporadic hits as collateral damage during broader bombing campaigns. The Orthodox Church’s Ahli hospital, for example, came under fire during 2008’s Operation Cast Lead.
But the widescale and deliberate targeting of hospitals marks a departure this time around. Facilities ranging from the European Hospital to the Middle East Hospital have been evacuated or severely damaged. The fate of Indonesian Hospital is just the latest incident in an emerging pattern.
Gaza’s Health Ministry is warning of a total systemic collapse as medical crews struggle to handle thousands of casualties amidst crippled infrastructure. More than a week into the crisis, almost no hospital has escaped unscathed as the deadliest fighting since 2014 rages on.
With the enclave’s solo cancer clinic completely shut down, even basic diagnostics and treatment have ground to a halt. Dialysis, MRI scans and other critical care are totally inaccessible to Gazan patients, even if a ceasefire comes into effect.
Rebuilding shattered infrastructure will take months if not years during which time Gaza faces acute shortages of beds and even medical supplies. Stopgap clinics set up in schools and shelters cannot provide more than rudimentary first aid.
For the ruling Hamas administration, the latest Israeli offensive has cemented perceptions that Tel Aviv is set on debilitating all spheres of Gazan society. Without an end to the 14-year blockade, public health infrastructure will remain stuck in a cycle of repeated destruction.
Gaza’s medical sector had already been brought to its knees by a lack of equipment, chronic power shortages and inadequate supplies of medicines. The current targeting of hospitals could signal the final tipping point toward systemic collapse.
The crisis unfolding at Gaza’s Indonesian Hospital encapsulates the tragedy and complexity of the Israeli-Palestinian conflict. Questions of terrorism, occupation, proportionality and morality have no simple answers.
But the price of this perpetual cycle of violence is being disproportionately borne by Gaza’s civilian population. Infrastructure built up painstakingly through foreign aid is being rapidly destroyed.
Hospitals and schools should constitute protected zones even amid armed conflict. This is a principle enshrined in the Geneva Conventions. Instead Gaza’s healthcare system finds itself repeatedly caught up in the crossfire of ferocious urban warfare.
The damage to hospitals risks leaving lasting scars measured in shortened lifespans and lost livelihoods long after any ceasefire. Rebuilding Gaza’s shattered infrastructure requires enormous funding that may not be forthcoming.
For Indonesian Hospital, the current crisis also highlights the limits of Jakarta’s diplomacy on the Palestinian issue. Lacking ties and leverage with Israel, aid and infrastructure funded by Indonesian donors remains hostage to the ebbs and flows of the conflict.
But beyond state donors, it is Gaza’s civilians who ultimately pay the steepest price from the recurring bloodshed. The starting point to any lasting solution must be affirming the basic principle of humanitarian sanctity when it comes to hospitals, schools and places of worship.