OF THE 20 PALESTINIANS KILLED NEAR NASSER HOSPITAL, SIX WERE CONFIRMED HAMAS OPERATIVES ... THIS WAS A MIXED ENVIRONMENT WHERE FIGHTERS AND CIVILIANS WERE PRESENT SIDE BY SIDE

When hospitals become battlefields: The strain on Israeli soldiers

In Khan Yunis and elsewhere in Gaza, there is no surgical way to fight an enemy that tunnels beneath your feet and hides behind patients’ walls. 

 

By Shlomo Dubnov 

 

JNS

Aug 27, 2025

 

Palestinians gather outside of the Nasser hospital in Khan Yunis in the southern Gaza Strip following Israeli airstrikes on Aug. 25, 2025,

 

The headlines coming from the Gaza Strip on Aug. 26 told a grim story: A strike near Nasser Hospital in Khan Yunis left roughly 20 Palestinians dead. International reactions quickly condemned the Israel Defense Forces for firing tank shells in the shadow of a major medical facility.

But the fuller picture is far more complex—and far more troubling.

The IDF has acknowledged that its target was not the hospital itself or the civilians inside, but a Hamas surveillance camera affixed near the hospital grounds. Intelligence showed that the camera was being used to track IDF troop movements in real time. Such surveillance is no minor matter; in the urban war of Gaza, information equals ambush, tunnel raids and kidnappings.

After the strike, the IDF announced that six of those killed were confirmed Hamas operatives. Some were directly linked to the terrorist attacks and atrocities in southern Israel on Oct. 7, 2023. One individual was seen in a video entering Israel with a Palestinian flag during the massacre. This was not an incidental gathering of civilians, but a mixed environment where fighters and civilians were present side by side.

The strike must also be viewed against the operational backdrop of Khan Yunis. Only days earlier, 18 Hamas gunmen burst from a tunnel shaft within 50 yards of an IDF encampment. They hurled grenades, fired an anti-tank missile and even brought along a stretcher in an effort to kidnap soldiers. Ten of them were killed in fierce close combat; others retreated underground.

Geographically, these events are linked: Nasser Hospital sits in the center of Khan Yunis, while the ambush occurred along the “Magen Oz” corridor that cuts through the city. Both incidents unfolded in the same dense urban tunnel network and combat zone, underscoring that they are part of a single battlespace rather than separate theaters.

Kidnapping, in this context, is the IDF’s worst nightmare. For Israel, the capture of a soldier is a personal tragedy and a strategic vulnerability. Hamas has built a long-term strategy around abductions, using hostages as leverage in prisoner exchanges and as psychological warfare against Israeli society. Every surveillance camera, tunnel and ambush must be understood against that backdrop.

Critics ask why the IDF resorted to tank fire instead of a precise sniper shot. The answer lies in the nature of the threat. A sniper would have required exposure near the hospital perimeter—exposure in an area where tunnels had already disgorged armed squads just days earlier. In such an environment, “precision” is not just about the caliber of the weapon but the survivability of the soldier asked to pull the trigger.

Tank fire, while more destructive, allowed crews to remain protected, act immediately and guarantee that the surveillance device was destroyed. In a battlespace where kidnappings are a constant risk, speed and protection for one’s troops are not luxuries. They are necessities.

The IDF prides itself on its ethical code, the doctrine of tohar haneshek, or “purity of arms,” which obligates soldiers to use force only for legitimate purposes and to minimize harm to civilians. At the same time, it binds commanders to safeguard their troops. These obligations often clash most painfully in Gaza’s crowded neighborhoods.

The IDF Military Advocate General routinely investigates such incidents. This culture of self-scrutiny is rare in wartime, but it comes at a cost: Soldiers know that in addition to risking their lives, they may later face criminal inquiries for choices made under fire. Some see this as over-caution; others as vital accountability. For the men and women on the front line, it is an added strain that Hamas surely counts on.

International law does not demand perfect outcomes in war. It demands distinction, proportionality and feasible precautions. The Additional Protocol I to the Geneva Conventions (Art. 57) states that attackers must take “all feasible precautions” to avoid civilian harm—but feasible means “that which is practicable or practically possible, taking into account all circumstances ruling at the time.” Scholars like Yoram Dinstein, professor emeritus at Tel Aviv University, emphasize that commanders are not required to sacrifice their soldiers’ lives for marginal reductions in collateral damage.

Comparable practices exist elsewhere: “U.S. Joint Publication 3-60” on targeting notes that collateral damage estimation must always be balanced against “force protection and mission accomplishment.” NATO’s doctrine on urban operations similarly acknowledges that standoff firepower may be necessary in asymmetric conflicts where insurgents exploit civilian structures.

Here, the target was a legitimate military objective; at least six of the dead were confirmed combatants, including participants in Oct. 7; and feasible alternatives that posed less risk to civilians would have required unacceptable risks to IDF soldiers.

No ethical system requires troops to walk into the jaws of a tunnel war to shave down collateral damage that the enemy itself engineered. When Hamas embeds cameras, launchers and fighters in and around medical centers, it is Hamas that erases the line between combatant and civilian.

The tragedy at Nasser Hospital was not born of reckless IDF firepower but of Hamas’s calculated tactic of using civilian cover to wage war. The IDF is left balancing the impossible: protect its soldiers, fulfill its ethical code and fight an enemy that thrives on turning hospitals and homes into battlefields.

Six of the dead were not innocents. They were armed actors in a brutal conflict, some with blood from Oct. 7 already on their hands. That does not erase the grief of the other lives lost, though it does shift the moral calculus.

The hard truth of Khan Yunis is this: There is no surgical way to fight an enemy that tunnels beneath your feet and hides behind patients’ walls. The burden on IDF soldiers is immense, and the responsibility for civilian casualties rests first and foremost with those who made hospitals into fortresses.