On 17 October 2023, an explosion took place in a courtyard of al-Ahli Arab Hospital in Gaza City during the Gaza war, resulting in a large number of displaced Palestinians seeking shelter there being killed or injured.
International media initially reported that over 500 Palestinians were killed according to the Gaza Health Ministry (GHM), but this was a mistranslation of a report that had mentioned over 500 total victims, including injured. The Gaza Health Ministry (GHM) later reported a more precise figure of 471 killed and 342 wounded. A report by Human Rights Watch (HRW) questioned the Health Ministry's casualty figures. The Anglican Diocese of Jerusalem, which manages the hospital, reported 200 people killed, while the U.S. assessed a figure between 100 and 300.
The cause of the explosion is contested. Israel, the United States, France, the United Kingdom, and Canada said that their intelligence sources indicated that the cause of the explosion was a failed rocket launch from within the Gaza Strip by the Palestinian Islamic Jihad (PIJ). Hamas and PIJ stated the explosion was caused by an Israeli airstrike.
In the days after the incident, several organizations concluded that an errant rocket from Gaza was the likeliest explanation, including the Associated Press (AP), CNN, The Economist, The Guardian, and The Wall Street Journal (WSJ). Le Monde and the New York Times (NYT) rejected the Israeli interpretation of Al Jazeera and Hevrat HaHadashot footage cited as evidence of a stray rocket from Gaza hitting the hospital, while noting that other evidence was consistent with that hypothesis and concluding that the cause of the blast remained uncertain. In November 2023, Human Rights Watch (HRW) said that the available evidence made an Israeli airstrike "highly unlikely".
Investigations by Channel 4 News, Al Jazeera, and research groups Earshot and Forensic Architecture (FA) contested Israeli claims of a misfired Palestinian rocket being responsible for the blast. In its investigation on 20 October 2023, Forensic Architecture concluded that the blast was the result of a munition fired from the direction of Israel. Subsequent investigations by Forensic Architecture published in February and October 2024—the first one tracking, in 3D, each rocket in a volley of Palestinian rockets that Israel accused of striking the hospital, and the latter including situated testimony from Dr. Ghassan Abu-Sitta—were said by the organisation to cast further doubt on the errant rocket launch theory.
The al-Ahli Arab Hospital is an 80-bed hospital in Gaza City. It was run by the Foreign Mission Board of the Southern Baptist Convention (SBC) between 1954 and 1982, and is still known as the Baptist Hospital (Arabic: المستشفى المعمداني) despite currently being under Anglican management.
The Anglican Archbishop of Jerusalem described the cancer treatment centre as the "Crown Jewel of Ahli Hospital" that had provided cancer diagnoses as a prelude to treatment options at Ahli and other hospitals.
The World Health Organization (WHO) indicated that there were 51 attacks on health facilities in Gaza between 7 and 17 October 2023, killing 15 hospital workers and injuring 27 others.
Before the explosion, there was also a history of Palestinian militant groups firing rockets from within the Gaza Strip that fell short of their target, resulting in property damage and casualties. According to Human Rights Watch (HRW), armed Palestinian groups had unlawfully launched thousands of rockets towards Israel since 7 October. The Israel Defense Forces (IDF) said that in the 11 days preceding the explosion at the al-Ahli Hospital, 450 rockets fired by Palestinian militant organizations landed inside Gaza. The rockets which are fired on Israel by Palestinian groups usually "have only basic guidance capabilities"; Palestinian groups often use Qassam rockets and military-style Grad-type rockets, and both are, in most variants, unguided rocket artillery.
In addition to this, HRW claims that these rockets are prone to misfire, a term which means a rocket does not fire properly or its propellant fails to function properly, or alternatively that its payload does not explode on impact.
Human Rights Watch (HRW) said that Israeli and Palestinian armed groups have both demonstrated a longstanding failure to impartially and credibly investigate violations of international humanitarian law (IHL).
Israel made allegations of the Palestinian Islamic Jihad (PIJ) rocket launches killing Gaza civilians during the August 2022 conflict between Israel and the PIJ. Three munition strikes in Gaza that resulted in a notably high number of child deaths (together these three hits accounted for 12 out 15 child deaths in that conflict so far) were all attributed by Israel to PIJ munitions falling inside Gaza. The Associated Press (AP) examined two sites, of the first strike and of the second strike, both of which took place around the times when the PIJ announced they had just launched a rocket attack; in both places they: "saw none of the telltale signs of an Israeli [F-16 or drone] strike" which "lent support to suspicions they were caused by rockets that went off course". However the Israeli military later took responsibility for the second strike.
Concerning the first strike, the Israeli military published a video "purportedly showing a barrage of militant rockets, with one falling short", similar to initial claims after the al-Ahli explosion.
On Saturday 14 October, according to a statement by the Archbishop of Canterbury, Justin Welby, an Israeli rocket had damaged the upper two floors of the hospital's cancer treatment center, which contained the ultrasound and mammography wards, and injured four staff members. The Washington Post, Le Monde, and Human Rights Watch (HRW) reported that the munition on 14 October was likely an illumination shell.
The Washington Post reported that an Anglican pastor working for the diocese had filmed a video of a shell in the hospital's ultrasound room and that the video showed a 155mm artillery illumination shell. The report said:"[I]llumination rounds are not fired directly at targets and descend on a parachute to signal, illuminate areas or mark targets, while the body of the shell falls from the sky."An Israeli military spokesman said:If an artillery round landed there, then it was probably a result of it falling or landing after having been fired, but definitely not targeting the hospital."Le Monde published an article containing an analysis of a photo shared on social media depicting the damage from 14 October and the remnant of a shell. According to several experts consulted by Le Monde, the photo shows a 155 mm caliber shell. Richard Stevens, of the CAT-UXO collective, a specialist in collating information about explosive devices, told Le Monde that the color of the shell was consistent with an illumination projectile.
The Human Rights Watch (HRW) report published on 26 November 2023 said that the damage resulting from the 14 October incident appeared kinetic and not explosive, and that an illumination flare was visible in social media posts depicting the event.
On Friday 13 October, Israel ordered hospitals and the population of northern Gaza to evacuate to southern Gaza. Because of insufficient beds in the southern Gaza Strip and no means of transporting patients, such as newborns in incubators or patients on ventilators, the evacuation orders were widely regarded as impossible to comply with.
The Anglican Diocese of Jerusalem said the hospital had received at least three evacuation warnings from the Israeli military on Saturday, Sunday, and Monday. Human Rights Watch (HRW) reported that all hospitals in northern Gaza—not just al-Ahli—received general evacuation orders on 13 October and the days after. On Saturday 14 October, the World Health Organization (WHO) issued a statement: "Evacuation orders by Israel to hospitals in northern Gaza are a death sentence for the sick and injured". In his statement on Sunday 15 October 2023 Archbishop of Canterbury, Justin Welby said: "The seriously ill and injured patients at the Anglican-run Ahli Hospital – and other healthcare facilities in northern Gaza – cannot be safely evacuated".