Israel blames the high death toll — 12,000, according to the Gaza health ministry, a number that includes both civilians and combatants — in part on Hamas’s decision to hide its military fortifications and command centers in residential neighborhoods and hospitals like Al-Shifa.
But U.S. officials said Israel’s rapid decision to launch ground operations in the enclave left Israeli commanders little time for extensive planning to mitigate risks to civilians and all but guaranteed a high civilian death toll.
The hospital has become a particular flashpoint. The military has yet to present public evidence of an extensive tunnel network and command center under Al-Shifa, and Israel is coming under growing international pressure to show that the hospital was a critical military objective.
On Friday, Israeli military officials said the search of the hospital would take time because of the risk of encountering Hamas members and booby traps, and that they would have to use dogs and combat engineers. The Israeli forces are advancing slowly and currently control only part of the hospital site, according to three Israeli officers. They also have avoided entering a shaft that was discovered there.
But the military claims it already has proof of at least part of an underground tunnel complex under the hospital. A video, which an Israeli official said was filmed by a camera that was lowered into the shaft by troops on Friday, and which was reviewed by The New York Times, indicates that it is a man-made tunnel, with at least one lane wide enough for the passage of people. The tunnel appears to be 50 feet or more in length, and at the end of it is a door that the official said is fortified to withstand explosives. The video shows that the door has a small porthole that, according to the Israeli official, allows one-way shooting from the other side of the door into the tunnel.
Targeting Al-Shifa Hospital was “not the result of a strategy,” said Giora Eiland, a retired major general in the Israel Defense Forces and former head of the Israeli National Security Council. “It is more an important tactical maneuver” in Israel’s attempt to control the narrative about Hamas, he said.
While Hamas commanders might have been under Al-Shifa at the start of the war, Mr. Eiland said, most of them have evacuated to the south. As a result, he said, Israel will have to evacuate civilians and target Hamas brigades there in the coming weeks and months. Mr. Eiland predicted that this might be complicated by an international community losing patience with Israel.
Yagil Levy, an expert on the Israeli military, said that attacking Al-Shifa was “a show of power and might rather than part of a clear strategy.” In doing so, Dr. Levy said, Israel might have jeopardized the hostages’ lives.