The explosion that killed and injured many civilians at al-Ahli Arab Hospital in Gaza on October 17, 2023, resulted from an apparent rocket-propelled munition, such as those commonly used by Palestinian armed groups, that hit the hospital grounds, Human Rights Watch said Sunday. While misfires are frequent, further investigation is needed to determine who launched the apparent rocket and whether the laws of war were violated.
At 6:59 p.m. that day, a type of munition that Human Rights Watch has not been able to conclusively identify hit a paved area inside the hospital compound, between a parking lot and a landscaped area where many civilians congregated to seek safety from Israeli strikes. The Ministry of Health in Gaza reported that 471 people were killed and 342 injured. Human Rights Watch was unable to corroborate the count, which is significantly higher than other estimates, displays an unusually high killed-to-injured ratio, and appears out of proportion with the damage visible on site.
“The Human Rights Watch review of videos and photos suggests that on October 17 a rocket struck the al-Ahli hospital grounds,” said Ida Sawyer, crisis and conflict director at Human Rights Watch. “The victims and families of those killed or injured while seeking safety at the hospital deserve a full investigation to determine what happened and who was responsible.”
The Ministry of Health in Gaza said Israel was responsible for the explosion. The Israeli military said the explosion resulted from an Islamic Jihad rocket that misfired. The decades-long failure of both Israeli and Palestinian authorities to credibly and impartially investigate alleged violations of international humanitarian law underscores the need for an independent investigation into the incident, which could be conducted by the United Nations Commission of Inquiry, and for all parties to fully cooperate.
Human Rights Watch investigated the explosion by reviewing publicly available photos and videos, analyzing satellite imagery, interviewing five witnesses to the incident and its aftermath, reviewing analyses published by other organizations, and consulting experts. The remote analysis assessed the explosion and the damage on site, as well as several possible trajectories of the objects visible on videos taken at the time of the attack, which also showed the moments before and after the explosion at the hospital.
“There was nowhere to walk, because there were body parts everywhere and people injured and dying,” a journalist who arrived at the hospital an hour after the blast told Human Rights Watch. “The people at the scene were mainly children, older people, women.”
There are no known images of any munition remnants publicly available, and Human Rights Watch was unable to visit the scene, preventing conclusive identification of the munition.
However, the sound preceding the explosion, the fireball that accompanied it, the size of the resulting crater, the type of splatter adjoining it, and the type and pattern of fragmentation visible around the crater are all consistent with the impact of a rocket.
Evidence available to Human Rights Watch makes the possibility of a large air-dropped bomb, such as those Israel has used extensively in Gaza, highly unlikely. The Israeli military has dropped thousands of such bombs across the Gaza Strip since October 7.
Gaza authorities appear to be in possession of remnants that would help make a conclusive determination of the munition that exploded at al-Ahli hospital. A photo taken the evening of the explosion shows employees of the Explosive Ordnance Department, a specialized Gaza police unit, working on the crater. A witness who was at the hospital on the evening of the explosion told Human Rights Watch that employees of “the Ministry of Interior took all the shrapnel that was on the site.”
A Hamas official said the remnants would “soon be shown to the world.” More than a month after the events, this has not happened. Ghazi Hamad, a senior Hamas leader and deputy minister in the Hamas-led Gaza governing authority, told the media on October 22 that “the missile has dissolved like salt in the water.… It’s vaporized. Nothing is left.” Human Rights Watched noted that substantial portions of munitions typically survive a detonation, even if parts of munitions are designed to break apart and may be made unrecognizable by thermal damage.
On November 25, Bassam Naim, head of the political and foreign relations department of Hamas, responded to several of the questions about the October 17 explosion that Human Rights Watch had sent to the Ministry of Interior in Gaza. He said that the ministry’s investigation of the strike had been slowed by the ongoing hostilities but that “the preliminary information we have definitively points to Israel’s responsibility.” He said that Israeli authorities warned the hospital to evacuate “hours” before the explosion and claimed that “no Palestinian resistance faction – to our knowledge – has among its weapons a projectile or a rocket of the destructive power capable of killing a large number of people as the bomb used in this incident of targeting” the hospital.
Human Rights Watch found that a rocket such as the larger types fired by Palestinian armed groups could inflict a high number of casualties if it struck with some of its propellent remaining in a courtyard packed with people and flammable materials. All hospitals in northern Gaza, including al-Ahli, had received general orders to evacuate on October 13 and the days that followed.
Naim did not respond to several specific questions, including about the munition remnants and military operations by Palestinian armed groups on the evening of the explosion. However, he said that Hamas, in coordination with the relevant authorities, would provide all evidence “as soon as possible” and that Hamas welcomes independent investigations into the incident.
Gaza authorities and Israel should publicly provide all information that they hold regarding the incident, in particular evidence concerning the munition remnants. Medical records showing the types of injuries sustained by the victims, subject to privacy and confidentiality protections, and other types of evidence such as unpublished videos of the explosion, could also shed light on the cause of the explosion.
Israeli forces have carried out repeated, apparently unlawful attacks on medical facilities, personnel and transport during the current hostilities, which Human Rights Watch has documented. The World Health Organization (WHO), as of November 24, had documented 187 attacks on health care in Gaza since October 7, which damaged 24 hospitals, according to data shared with Human Rights Watch. The WHO has said that, as a result of the hostilities, the majority of hospitals in Gaza were no longer functioning.
Since October 7, Palestinian armed groups have unlawfully launched thousands of rockets at Israeli communities, causing death, injuries, and property damage.
The Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel, established by the UN Human Rights Council in 2021, has a mandate to “to investigate, in the Occupied Palestinian Territory, including East Jerusalem, and in Israel, all alleged violations of international humanitarian law and abuses of international human rights law leading up to and since 13 April 2021.” On October 10, the Commission of Inquiry announced that it is “collecting and preserving evidence of war crimescommitted by all sides since 7 October 2023.”
International humanitarian law, or the laws of war, grants special protection to hospitals and other medical facilities, the injured and sick, as well as medical staff and transport: they must be protected and respected in all circumstances.
States should suspend military assistance and arms sales to Palestinian armed groups, including Hamas, so long as they continue to systematically commit attacks amounting to war crimes against Israeli civilians. Governments should suspend military assistance and arms sales to Israel so long as its forces commit widespread, serious abuses amounting to war crimes against Palestinian civilians with impunity.
“The explosion at al-Ahli hospital is one of scores of strikes damaging medical facilities across Gaza that have killed civilians and medical professionals and denied many Palestinians access to desperately needed medical care,” Sawyersaid. “Authorities in Gaza and Israel should release the evidence of munition remnants and other information they have regarding the al-Ahli hospital explosion to allow for a full investigation.”