In Their Own Words: Hamas Turns Hospitals into Military Assets with NGO Compliance

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• For years, claims that Hamas used hospitals to shield its leadership and fighters have been met by skepticism and disregarded by the international community and media. Newly-revealed internal Hamas documents prove that the terror group’s exploitation of medical facilities in Gaza has been systematic.
• Hamas ministry documents, dated February and March 2020, detail Hamas’ strategy of embedding its military infrastructure, fighters, and leadership within hospitals and medical facilities in Gaza, blatantly violating international law and endangering civilian lives. As with all such installations and services in Gaza, Hamas cynically exploits the healthcare system to provide cover for and expand its terror operations.
• Hamas explicitly states that health facilities in Gaza are not neutral spaces, but instead play a critical role in Hamas’ terror network. Hamas officials expressed alarm at the prospect of “hostile parties” gathering intelligence on medical facilities, since these “serve as places that the wounded” – who “hold sensitive positions in the resistance” (emphasis added) – “are gathered in during times of escalation.” In addition, they described medical facilities as places of “gathering for many commanders of the movement [i.e. Hamas] and the government in times of escalation” (emphasis added).
• Hamas also deliberately maintains a physical presence within hospital buildings. For example, Hamas officials note that the International Committee of the Red Cross (ICRC) “has chosen [to operate] in a wing inside Al-Shifa Hospital that is adjacent to the [Hamas] movement’s offices” (emphasis added).
• Despite being aware of Hamas’ control and exploitation of medical spaces, NGOs and UN agencies with a medical and humanitarian focus continued to operate under Hamas-imposed restrictions. They accepted Hamas’s surveillance, movement limitations, vetting of their teams, and were exposed to pressures and directives from Hamas security personnel.
• The NGOs also refuse to publicly admit their knowledge of Hamas’ use of medical spaces for military purposes, while simultaneously and hypocritically condemning Israeli attacks on terror targets in the vicinity of hospitals and medical centers. This selective reporting distorts reality, prevents the international community from obtaining reliable information from the field, encourages terror groups to continue exploiting areas that ought to be neutral, undermines humanitarian efforts in Gaza, and contributes to the demonization of Israel.

Introduction​

Under international law, hospitals and medical facilities are designated as protected spaces, explicitly safeguarded from military use. However, in Gaza, Hamas systematically violates these protections by exploiting health centers for military purposes.
For Hamas, hospitals are not just places of medical care. They are command and control centers, entry and exit points for terror tunnel infrastructure, weapons storage sites, and hubs for intelligence-gathering and surveillance. Medical facilities serve as locations where wounded Hamas operatives, many of whom hold sensitive positions in the organization, are treated and concealed. They also provide cover for high-level meetings of Hamas commanders, secure communications, and coordination with terror networks. These practices transformed Gaza’s healthcare system from humanitarian spaces into critical components of Hamas’s terror apparatus.
NGO Monitor has examined documents originating with the Gaza Interior Security Mechanism (ISM), an official organ under the Hamas Ministry of Interior and National Security (MoINS – see Appendix for additional details on the MoINS and its Hamas leadership). The (Arabic language) documents have been declassified by the IDF and can be accessed by the public. The two documents, dated February and March 2020, contain very similar content focusing on perceived threats to the Hamas government and its security interests emanating from foreign non-governmental presence in Gazan health facilities. The February 2020 document is an internal memo submitted by the ISM’s Branch of Foreign Associations to the director of the Division of Foreign Activity, Aqid (Hamas rank for Colonel) Ayman Rouqa, (nom de guerre “Abu Islam”). The division is in charge of overseeing international NGOs and international government bodies, such as UN organs, and enforcing Hamas policies on said parties in Gaza. The March 2020 document is an internal memo submitted by an unknown party to the deputy general-director of the Intelligence Affairs Sector, Aqid Abu Rabi. ISM’s Intelligence Affairs Sector (IAS) is in charge of gathering intelligence and counterintelligence activities, such as recruiting informants across Gaza; as of mid-2022, the Branch of Foreign Activity (formerly the Division of Foreign Activity) is subordinate to the IAS. Both documents are intended to better coordinate NGO-linked decisions by the Hamas-run Ministry of Health, in line with Hamas’ security apparatus’ agenda and demands.
In addition – as described in these documents – Hamas tightly monitors and restricts the activities of foreign medical NGOs. The presence and support of foreign medical personnel provides Hamas with a number of benefits, such as promoting the organization’s messaging on casualties, as well as allowing Hamas to neglect its health care responsibilities towards the local population. At the same time, Hamas imposes strict restrictions on foreign medical delegations, monitors their movement, and forces compliance with its security policies to prevent exposure of military activities and leaks of information regarding activity inside health facilities. This control extends to pre-approving medical staff, dictating where NGOs can operate, and having Hamas security personnel accompany foreign medical teams during their work. The NGOs present in Gaza operate under Hamas’ terms, making them complicit in a system that exploits medical facilities to shield militant operations.
This report details Hamas’ military exploitation of Gaza’s medical infrastructure and its policy of managing, restricting, and co-opting foreign medical NGOs. It documents a system in which aid is constricted and forced to serve the agenda of a terror organization under the facade of objective and impartial healthcare and humanitarian assistance.

Hamas Military Exploitation of Medical Facilities​

Hamas has long embedded elements of its military and security apparatus within medical facilities, systematically transforming hospitals into spaces that serve its operational purposes. This includes housing military personnel, maintaining offices within hospitals, and exploiting NGO facilities for secure communications and logistical operations.
In documents dated February and March 2020, the Hamas Ministry of Interior and National Security (MoINS) explicitly stated that health facilities in Gaza are not neutral spaces, but instead play a critical role in Hamas’ terror network. MoINS expressed alarm at the prospect of “hostile parties” gathering intelligence on medical facilities, since these “serve as places that the wounded” – who “hold sensitive positions in the resistance” (emphasis added) – “are gathered in during times of escalation.” In addition, MoINS described medical facilities as places of “gathering for many commanders of the movement [i.e. Hamas] and the government in times of escalation” (emphasis added).

Excerpts and translations from leaked Hamas documents​

Hamas also deliberately maintains a physical presence within hospital buildings. For example, MoINS notes that the International Committee of the Red Cross (ICRC) “has chosen [to operate] in a wing inside Al-Shifa Hospital that is adjacent to the [Hamas] movement’s offices” (emphasis added). MoINS further states that Hamas maintains secure communications infrastructure inside hospitals, including in spaces where NGOs operate. For instance, when listing concerns about the Ministry of Health inadvertently authorizing NGO operations without consulting Hamas’ security apparatus, MoINS reports that “Doctors Without Borders (MSF) France chose the only room in Abu Yousef El-Najar Hospital that has a (safe) communication landline which belongs to the positive’s activity, in order for MSF to work in it separately.” “The positive” is a known term for Hamas’ Izz ad-Din al-Qassam Brigades. 1

Excerpts and translations from leaked Hamas documents​

The documents list a number of other NGOs and international agencies, as well as the medical installations in Gaza within which they work within, that are subject to Hamas’ diktats: World Health Organization (WHO), MSF Belgium, MSF Spain, Medecins Du Monde (MDM) France, MDM Switzerland, MDM Spain, Palestine Children’s Relief Fund (PCRF), Handicap (France), Karolinska Institutet (Sweden), Physicians for Human Rights Israel (PHR-I), MAP-UK, Norwegian Aid Committee (NORWAC), Palestinian Medical Relief Society‎ (PMRS) (Palestinian), Save the Children, Al-Khebra Center for consultant and development (Palestinian), Yeryüzü Doktorları [Doctors of the Earth Association] (Turkey), and the Gaza Community Mental Health Programme (GCMHP) (Palestinian).
These examples illustrate the extent to which Hamas has embedded itself into Gaza’s medical infrastructure, transforming hospitals from protected humanitarian spaces into strategic assets under a facade of medical neutrality.

Hamas’ Policies Towards Medical NGOs​

Hamas views the presence of foreign medical NGOs in Gaza’s health sector as both a resource to be exploited and a security threat. As noted above, Hamas imposes tight restrictions on foreign medical delegations to prevent exposure of its military use of hospitals.
According to MoINS, the underlying concern is that foreign delegations might gather intelligence or uncover Hamas activities within medical facilities. To mitigate this risk, Hamas enforces strict protocols on foreign medical NGOs and delegations, designed to control their movement, limit access and operations, and prevent unwanted observation.
Foreign medical teams are permitted to operate only in specific, pre-approved areas of hospitals. According to MoINS, “MoH [Hamas-run Ministry of Health] allows medical delegations to move in specific places, such as the outpatient department, the specialized departments and operations rooms, but it prohibits the delegation from going inside the hospital where it is located” (emphasis added). Additionally, MoINS demands that “medical delegations should not be engaged when there’s a case of resistance leaders [present on the premises], and regular personnel [of Hamas] should be warned.” Additionally, when NGOs are given workspace in Gaza’s health facilities, these locations are deliberately set apart from Hamas’s sensitive operations. As ordered by MoINS, “When designating a place for these associations, it must be outside the main building of the clinic or hospital and far away from [Hamas] movement’s locations and [only] following security approval” (emphasis added). Moreover, “medical members [of Hamas] from Gaza will join incoming delegations, whether they work in hospitals and their [NGOs] designated locations” (emphasis added).

Excerpts and translations from leaked Hamas documents​

To further control foreign medical delegations, Hamas requires extensive pre-approval procedures. MoINS demands that arriving NGO medical delegations “submit a request… attached with CVs of the doctors, listing the need [of arrival].” According to the documents, as part of coordinating medical NGO delegations, “The Ministry Of Health, in cooperation with the World Health Organization (WHO), formed a team for [coordinating with] emergency medical delegations that will visit the Gaza Strip.”
Even after entry is approved, foreign medical teams are placed under direct security surveillance, with “[Hamas] security personnel present with health delegations as they move from place to place” to ensure compliance and prevent exposure of Hamas activities.
Despite the humanitarian nature of their work and the generally sympathetic approach of the foreign personnel in Gaza, MoINS views NGOs with deep suspicion. Foreign medical delegations are treated not just as healthcare partners, but as potential intelligence threats because “much of the services provided have a security aspect to them since these involve people wounded as a result of the occupation’s aggression and burns, mainly resistance members or activists [in Hamas-guided operations].”
As a result, Hamas’s overarching approach is to allow medical NGOs to operate only when their activities are tightly managed and kept away from areas connected to Hamas’s military and security apparatus, as well as other sensitive locations. At the same time, the agencies and NGOs in Gaza agree to these limitations imposed by Hamas.

Conclusion​

The internal Hamas documents reviewed in this report expose a systematic Hamas strategy to militarize Gaza’s healthcare system, using hospitals and medical facilities as extensions of its military and security apparatus. Medical centers in Gaza are not merely spaces of treatment, but rather they serve as hubs for Hamas leadership, gathering points for operatives, safe zones for wounded terrorists, and locations for secure communications infrastructure. To protect these operations, Hamas imposes strict control over personnel from foreign medical NGOs and international agencies, restricting their access, surveilling their personnel, and forcing them to operate under Hamas’ security directives. This arrangement is fundamentally inconsistent with the principle of medical neutrality in Gaza, transforming humanitarian spaces into dual-use facilities that serve both medical and military purposes.
Compounding this reality is the role of foreign medical NGOs and related institutions, whose activity under Hamas’ restrictive system raises serious ethical concerns. Many continue to present themselves as impartial humanitarian actors while concealing the reality of their complicity with Hamas’ security apparatus. They fail to disclose Hamas’ cynical use and violation of humanitarian spaces, nor do they report the conditions imposed upon them and the reasons behind said policy. This lack of transparency not only violates the core principles regarding the independence and neutrality of humanitarian aid, but also renders these organizations morally compromised as yet another party in Hamas’ exploitation of medical spaces.
At the same time, the public reports and statements issued by these NGOs frequently condemn Israeli military actions targeting hospitals or medical facilities, without acknowledging Hamas’s military activity embedded in these sites. By omitting this critical context – which they are clearly aware of – these organizations contribute to a distorted and misleading narrative, continuing to present hospitals as purely civilian zones, thereby helping to promote unjustified condemnations of Israeli actions.

Appendix: The Gaza Interior Security Mechanism​

The Gaza Interior Security Mechanism (ISM) is an official organ under the Hamas Ministry of Interior and National Security (MoINS).
The Ministry commands the police force, along with other interior security forces responsible for surveillance, counter-espionage, political dissent, civil defense, border crossings, enforcement of Islamic law, and handling of prisoners in Gaza. After seizing control of Gaza in 2007, Hamas assigned the Izz Ad-Din Al-Qassam Brigades to oversee the security forces under the Ministry.
The Interior Security Mechanism is responsible for uncovering, preventing, and investigating crimes that threaten national security and government bodies. It combats espionage, provides protection and security for officials and leaders, and responds to external threats that may affect security, including political opposition. It is also responsible for operating informants and defending against cyber attacks.
In January 2021, Naser Maslah was appointed as Minister of Interior and National Security in the Hamas government. A month prior to the October 7th Hamas attacks, Maslah met with “representatives of the resistance factions in Gaza” in a meeting set up by the ministry’s “unit for factions coordination” in order to strengthen cooperation and coordination with the terror groups. Participants included members of Hamas and PIJ.
Prior to Maslah, Tawfiq Abu Naim headed the Ministry (2016-2020). Abu Naim is a leading member of Hamas and one of the founders of its military wing. He served more than 20 years in Israeli prison for murdering Palestinian collaborators.
As of January 2025 and until his death in March 2025, the Minister of Interior and National Security was Mahmoud Abu Watfa, named by multiple news outlets as “a leading commander in Hamas.”