Until the war sparked by Hamas's October 7 attack on Israel, patients received for years the best care Gazan doctors and nurses could offer, but earlier this year, they had to cease all operations.

Al-Shifa was all but destroyed in two Israeli military operations -- one in November 2023, the other in March 2024.

Israeli troops detained the director of Al-Shifa, Mohammed Abu Salmiya, for more than seven months. He claimed he was "tortured" during that time.

An emergency department has since reopened, though the rest of the sprawling complex lies in ruins, charred by the flames of war.

To revive the ward, staff had to "pull dialysis machines from under the rubble", Abu Jaafar, a doctor there, told AFP.

When Israeli tanks stormed the complex on the night of November 15, at least 2,300 people were in the hospital complex, according to the United Nations.

Many of those on the site were Gazans who had sought shelter in what they had hoped would be a safe place.

Gunfire and explosions terrified patients, staff and others seeking refuge from the war, said one AFP correspondent who was among the displaced.

On March 19, Israeli forces launched a second assault, again using tanks. For 11 days, soldiers then combed through the premises.

When they finally withdrew, Israel's military said they had killed "200 terrorists", and that they had found many weapons.

Gaza's civil defence agency, which carries out rescue work across the Palestinian coastal enclave, said at least 300 bodies were found.

- Command centre or health facility? -

Israel's military said it raided Al-Shifa, accusing Hamas and other Palestinian militants of using it as a command centre to conduct operations.

To defend its claim, it held press events and aired videos it said proved that troops had found tunnels beneath the site, though some specialists have questioned the veracity of the footage.

Israeli authorities have also said that several of the 251 hostages seized during Hamas's attack on Israel on October 7 have been held in hospitals.

Hostages released during a brief truce in November reported being held in hospitals or places that resembled them.

The military has also said that the bodies of at least two hostages, Noa Marciano and Yehudit Weiss, were found close to Al-Shifa.

Hamas has consistently denied using hospitals as command centres, while human rights organisations have criticised Israel over its conduct of the war.

The Hamas attack resulted in the deaths of 1,205 people on the Israeli side, most of them civilians, according to an AFP tally based on official Israeli figures.

Israel's retaliatory military campaign has killed at least 41,431 people in Gaza, the majority of them civilians, according to data provided by the health ministry in the Hamas-run territory. The United Nations has described these figures as reliable.

Ninety-seven hostages are still being held captive in Gaza, including 33 the Israeli military says are dead.

- 'Pursuit of life' -

Established in 1946, two years before the founding of Israel, Al-Shifa evolved from a "rather almost colonial and basic" health facility into Gaza's largest health care centre, said Palestinian-American Yara Asi, an academic at the University of Central Florida who specialises in access to healthcare in war zones.

"It wasn't just a hospital itself, but it was a representation of the Palestinian pursuit of life and willingness to live on the land in many ways," Asi said.

Al-Shifa became one of Gaza's best-known institutions, said Ghassan Abu-Sittah, a Palestinian-British surgeon who spent the first 43 days of the war treating the wounded.

"With each war, this hospital became more important," said Abu-Sittah, referring to the previous four wars in Gaza in 2008-9, 2012, 2014 and 2021.

"After the fall of Al-Shifa, people felt there was nothing left in the north (of the Gaza Strip) that could help them," he said.

Beyond Al-Shifa, the Palestinian territory's health system has largely collapsed, with the World Health Organization estimating that just a handful of clinics remain operational.

The wounded, who number in the dozens every day, must seek treatment in field hospitals run by international aid organisations.

Al-Shifa "was the nerve centre of the health care system, and the raids broke it," Abu-Sittah said.