Introduction
In an area of 360 square kilometers, the Israeli colonial occupation has fragmented the Gaza Strip into ever smaller and constantly changing subdivisions of land, forcing the population to move without a destination, starved and injured from one numbered block to another. This besieged death march amounts to an extermination tactic that does not aim to move people to a new location, but to exhaust and slowly murder them in an endless march. This innovative lunacy is a genocidal strategy that seeks to seize control over social-spatial relations in the Gaza Strip, annihilating the city's infrastructure while its owners still live in it—thus, writing the blueprint of a genocidal death march under confinement, using space and mobility to exterminate the biological and social body.
In this perpetual besieged death march, mobility, space, and death are domains that the colonial sovereign aims to control. However, mobility and space are tools for colonized people to resist, and hospitals play a crucial role in this struggle. Hospitals are life-sustaining institutions where people seek healing, shelter, water, electricity, and telecommunications networks. Decentralized across the Strip, hospitals were shaped by the repeated military invasions and campaigns on Gaza and the death world created by Israel for decades. Throughout these decades and to this day, hospitals form a network that resists colonial fragmentation of land. Thus, the besieging and targeting of hospitals are intricately intertwined with the Israeli genocidal aims of maiming Gazan lifelines and splintering space and communities. This paper provides a summarized exploration of the historical context of Gaza's health infrastructure as a life-sustaining structure in a continuous confrontation with the Zionist life-exterminating apparatuses to unveil the motives behind declaring the hospital as a space of exception and siege.
A Space of Exception
Analyzing Israeli colonial modes of governance, and the excess use of violence, requires a shift from the juridical edifice toward frameworks that can explain the Zionist desire for unrestrained violence and murder; frameworks of domination and necropower. The sovereign's power stems from the ability to violate and transgress prohibitions and taboos, with death standing as the ultimate taboo, the sovereign's power comes from degenerating and violating death.[1] Making a spectacle of death displays ultimate power, and what more impudent way of displaying necropower than to display it precisely in the hospital?
Zionist governance, similar to Western democracies, is marked by a contradiction. Two modes of governance coexist within it and depend on each other; it sustains the life of the settler society in the colonial metropole while employing necropolitical strategies to kill and maim the group of colonized people in spaces on the outskirts of the metropole. Within this space resides a group of humans stripped of their political subjectivity, nonhuman, and legal subjectivity, noncitizen. In this space law is suspended, a state of exception and emergency that is spatially and temporally defined. Nazi political theorist Carl Schmitt defines sovereignty as the ability to suspend the law.[2] The creator of the law can get his power to create because he can exist outside it. Thus, the sovereign derives the authority to legislate through the ability to suspend laws. This explains the Zionist entity's need for Gaza as a space to exercise the capacity to suspend the law and display necropower. However, the Zionist necropolitical regime is sustained by creating more death in ever more shrinking spaces. In incarceration camps, refugee camps, and hospitals, it continuously fractures and manufactures new spaces of exception.
Moreover, the state of exception rests on moral and authoritative sovereignty, viewing the colonized as akin to animal life, similar to Frantz Fanon's analysis of colonial logic and its construction of native identity in zoological terms.[3] Designations of “terrorism” are the contemporary equivalent to Fanon's “animal life,” a rationale explicitly declared by Israeli officials. Israeli Defense Minister Yoav Gallant blatantly stated that the entire besieged population of two million humans are “human animals.” “There will be no electricity, no food, no water, no fuel, everything will be closed. We are fighting against human animals and will act accordingly.”[4] Similarly, Israeli attorney Aviad Visoli declared that the Gazan population has “no citizens,” effectively placing the Strip as a piece of land outside legal order.[5] The celebration of the besieging and destruction of al-Shifa Hospital, designating the internally displaced people, the injured, and medical staff as “the terrorists” they defeated, points to the rationale of turning the hospital into a space of exception and martial law inhabited by bare life—lives stripped of political and legal subjectivity.[6]
Suspending the normal order in the space of the hospitals, Israeli soldiers had no restraint: organ harvesting, physical, psychological, and sexual torture and kidnapping of medical staff and patients, kidnapping of Palestinian corpses, public executions of amputated children and patients, desecration of graves, and digging of mass graves.[7][8][9][10][11][12] The Zionist entity epitomized and perfected the military institution of siege and the creation of spaces of exception in the vicinity of the hospital, degrading Palestinian death in the most grotesque ways. The vicious Zionist atrocities committed in Gazan hospitals, specifically targeting them as reproductive institutions, have surpassed the previously conceptualized colonial death worlds and spaces of exception.
The Hospital—A Life-Sustaining Node
While necropower offers a framework that partially conceptualizes Zionist governance, it is necessary to further interrogate how people under this necropolitical regime seek to contest and rearrange the struggle over life and death. The ongoing genocide attempts to finalize a longer project of annihilating Gazan life-sustaining infrastructure, rendering the Gaza Strip unlivable, unable to regenerate and heal. The Gazan hospital is a site of political struggle; it has reproduced life in an environment designed by the Zionist entity to impose slow death through policies of siege and suffocation, as well as fast death through relentless physical destruction. Hospitals in Gaza confronted the slow death and spatial fragmentation imposed by the 18-year-long blockade by building medical capacities that could receive patients otherwise deprived of healthcare. Almost one-third of hospitals in the Gaza Strip were built during the blockade between 2007 and 2023 despite immense hurdles imposed by the occupation and a scarcity of funding, construction materials, and medical equipment. To illustrate, al-Haya Specialized Hospital in Gaza opened in 2010 under siege and was contracted by the Ministry of Health to provide chemotherapy for patients who would otherwise receive treatment outside the Strip.[13]
For nearly eight decades, Gaza had no respite from being the target of Zionist military campaigns. Consequently, almost all hospitals in Gaza have emergency responses built into them. One example is the Patient Friends Association Hospital, which was demolished and burned in February 2024. The hospital resumed providing services in April 2024, and was reopened and reconstructed in June 2024.[14][15] Afterward, Israeli colonial forces destroyed the hospital again in July 2024, only for the hospital to announce that even in its demolished state, it had started to provide pediatric medical services two days after the withdrawal of the occupation forces.[16][17][18][19] However, the resilience of the Gazan hospital should not be mistaken for invincibility, but rather to shed light on the historical context of the sites that the Zionist entity is pouring much of its desire to murder and annihilate on.
Each hospital in Gaza, in its specific locality, has a story that recounts the Gazan struggle against suffocating colonialism. Every hospital's inception, development, destruction, and rebuilding have existed in a death world created by the Zionist entity and in a maneuver against it. For decades, medical equipment—no longer allowed to be replaced due to the siege—was maintained despite the embargo on medical spare parts, and bombed surgical rooms were rebuilt despite restrictions on construction materials.[20] The Gazan hospital creatively reproduces life while it generates and repairs itself, despite being given nothing but violence and death. The hospital in Gaza is an incarnation of the Gazan body, which is precisely why the Zionist entity seeks to maim it. The hospital was declared a space of exception because it embodies the essence of resisting necropower: to heal, regenerate, and live.
Circumventing a Spatially Fragmented Death World
In Palestine, living under necropolitical colonial occupation means that the subjects of colonization live a shared life under the same symbolic order of death. Thus, they are forced to maneuver the meanings and structures established by a necropolitical symbolic order, where politics is a domain of death. Hospitals, as institutions shaped under this order, react to a sovereign that creates a death world with continuously shrinking fragments of land by creating a network that circumvents spatial fragmentation. Before 1948, the Gaza Strip had only two hospitals, both in Gaza City, and by 1993, all hospitals except Nasser Medical Complex were exclusively in Gaza City. In September 2023 Gaza had 37 hospitals, over half outside Gaza City. It is important not only to point out that one-third of the hospitals on the Strip were built under siege, but to pay attention to the distribution of hospitals across the Strip. Despite the relatively stable population distribution across the municipalities[21] during the siege, 25 percent of Gaza City's hospitals were built, 39 percent of new hospitals were established in other municipalities, and 60 percent of hospitals in North Gaza and Deir Al-Balah. Moreover, this trend of decentralization had already begun after 1993, whether by design or spontaneous adaptation to repeated military invasions and campaigns. Gazan hospitals have become a decentralized network that counters these subdivisions, resisting a death landscape with healing and reproduction. This observation is significant, as it illustrates how Gaza's health infrastructure has adapted to repeated military invasions and campaigns and points to the Zionist motive behind besieging the hospital: to encircle those nodes and to shatter the network that circumvented Israeli spatial fragmentation.
The Israeli colonial occupation has long employed a strategy of cutting off roads to hospitals during invasions, hindering injured people from receiving medical care. In response to repeated military invasions into North Gaza, Beit Hanoun Hospital opened in 2006 as an emergency measure to address the hindering of ambulances from reaching Kamal Adwan Hospital. Kamal Adwan Hospital itself had been expanded from a clinic into a hospital in 2002, during the Second Intifada. The largest hospital in North Gaza, the Indonesian Hospital, opened after five years of construction delays due to the siege. Its establishment eased burdens from North Gaza hospitals, allowing Kamal Adwan Hospital to temporarily shut down for repairs. All three hospitals were partially or completely destroyed during the latest genocidal campaign. The history of these three hospitals in North Gaza illustrates how the Gazan health infrastructure has developed to break through the cement of barracks.
Many examples suggest that hospitals in Gaza have not developed as autonomous, isolated cells but as a network. The enclosure of hospitals aims to shatter this network as does the fragmentation of roads between hospitals. According to WHO, during the latest genocidal attack, the Israeli colonial forces have conducted 920 attacks on medical transport in Palestine—another strategy to complement the fracturing of the healthcare network.[22] This is coupled with the besieged death march perpetrated by the Zionist entity. A dismembered health infrastructure and network, and a besieged hospital ensure the destruction of healing spaces and a colonially controlled movement of people. While it has forced the population to move and wander without a destination in a besieged death march, it has simultaneously destroyed the medical reproductive pathways. Thus, the Zionist entity seeks to control all movement of people, where the movement that inflicts death is the only one possible.
Conclusion
International organizations failed to hold the Zionist entity accountable by reiterating international norms and protocols that do not recognize the fundamental dichotomy between the colonizer and the colonized. Reproductive institutions such as hospitals existing under a necropolitical order that aims to ethnically cleanse cannot be politically neutral; they are inherently political for sustaining the lives of those deemed excess and unwanted. Thus, the aspirations of INGOs to uphold a discourse of impartiality and medical neutrality will continue to fall short because they fail to acknowledge that health and reproductive institutions have existed under the same colonial and violent conditions, they seek protection from. In doing so, INGOs naturalize the illusion that colonial violence can be understood as either legitimate or illegitimate. Local and international actors working toward protecting health and reproductive spaces in the Gaza Strip should direct their efforts and solidarity based on an interrogation of the historical and political conditions that have made these institutions the primary target of destruction and annihilation. This paper sheds light on the historical conditions that have repeatedly undermined these moral norms and calls for dismantling the myth of a dichotomy of legitimate or illegitimate violence conducted by a colonial entity against a colonized population.
[1] Mbembé, Necropolitics, Duke University Press, 2019.
[2] Schmitt, Dictatorship, Oxford, England: Polity Press, 2013.
[3] Fanon, The Wretched of the Earth, Penguin, 1961.
[4] Sharma, “‘We Are Fighting Human Animals': Dehumanization of Palestinians,” Palestine Chronicle, May 21, 2024.
[5] A. Visoli, “There Are No Civilians Uninvolved in Combat in Gaza, Channel 7, “Arutz Sheva,” cited in “Selections from the Hebrew Press,” Institute for Palestine Studies, December 14, 2023.
[6] Ebrahim, S. N. Haq, K. Al Za'anoun, and A. Salman, “Why Israeli Forces Are Raiding Gaza's Al-Shifa Hospital – Again," CNN, March 28, 2024, retrieved on August 3.
[7] Anadolu News Agency, “Gaza Officials Suspect Organ Theft from Some Bodies Found in Mass Graves at Naser Hospital,” April 26, 2024, retrieved August 3, 2024.
[8] Euro-Med Human Rights Monitor, “Gaza: Israeli Army Systematically Uses Police Dogs to Brutally Attack Palestinian Civilians, with at Least One Reported Rape," June 27, 2024.
[9] Euro-Med Human Rights Monitor, “Gaza: Shifa Medical Complex Witnesses One of the Largest Massacres in Palestinian History," April 1, 2024.
[10] الفلسطينية, و. ا., & Atyaf.Co. (n.d.). بالفيديو | “الدفاع المدني” يعقد مؤتمراً صحفياً يؤكد خلاله على ارتكاب جيش الاحتلال “الإسرائيلي” جرائم ضد الإنسانية وإنشاء مقابر جماعية.
[11] United Nations Office for the Coordination of Humanitarian Affairs - Occupied Palestinian Territory “Hostilities in the Gaza Strip and Israel | Flash Update #164,” 2024.
[12] Middle East Policy Council, “Mass Graves Found at Gaza's Nasser and al-Shifa Hospitals," May 1, 2024.
[13] United Nations Office for the Coordination of Humanitarian Affairs - Occupied Palestinian Territory, “Additional Treatment Option Available to Cancer Patients in Gaza amid Tightening of Access Restrictions," 2020.
[14] Anadolu News Agency, 2024,
مستشفى “أصدقاء المريض” بغزة يحترق بنيران الجيش الإسرائيلي.
[15] ٌRT Arabic, 2024, افتتاح مستشفى “أصدقاء المريض” شمال قطاع غزة بعد انتهاء أعمال ترميمه وصيانته. RT Arabic.
[16] United Nations Office for the Coordination of Humanitarian Affairs - Occupied Palestinian Territory, “Humanitarian Situation Update #188 | Gaza Strip,” July 8, 2024.
[17] Anadolu News Agency, 2024,
غزة.. خروج مستشفى “أصدقاء المريض” عن الخدمة بفعل القصف الإسرائيلي. (n.d.).
[18] The Palestinian Information Center, 2024,
جيش الاحتلال يدمّر مستشفى أصدقاء المريض في غزة بعد ترميمه. (2024, July 12). المركز الفلسطيني للإعلام - أخبار فلسطين - أخبار القدس.
[19] Patient Friends Charity Hospital, Facebook, 2024.
[20] Institute for Palestine Studies, “The Targeting of Gaza's Healthcare Sector in Israel's Ongoing War,” Gaza Health Sector, 2024.
[21] Palestinian Central Bureau of Statistics, “Estimated Population in Palestine Mid-Year by Governorate, 1997–2026".
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