What we know about the deadly blast at Gaza City’s al-Ahli hospital

• The blast

Early on Tuesday evening in Gaza, reports emerged of an explosion at al-Ahli hospital in Gaza City, which was crowded both with victims of 10 days of Israeli air strikes and with families and others who had taken refuge on the hospital grounds.

Video footage from the hospital showed an orange ball of fire and flames engulfing the building and grounds. The video showed the outside of the hospital, where countless Palestinian families had been camping out. Torn bodies covered the grass, with slain children lying among dead adults.

Ghassan Abu Sitta, a plastic surgeon working at al-Alhi, said the hospital was filled with internally displaced people seeking shelter from Israeli air strikes when he heard a loud explosion and the ceiling of his operating room collapsed.

“The wounded started stumbling towards us,” he wrote in an account posted to Facebook. He saw hundreds of dead and severely wounded people. “I put a tourniquet on the thigh of a man who had his leg blown off and then went to tend to a man with a penetrating neck injury,” he said.

Located in the Zeitoun neighbourhood of Gaza City, in the northern part of the Gaza Strip, the al-Ahli hospital is fully funded by the Anglican Church, which says the facility is independent of any political factions in Gaza.

Hospital director Suhaila Tarazi said the aftermath of the blast was “unlike anything I have ever seen or could ever imagine”.

• Casualties

The health ministry in the Hamas-controlled territory said at least 471 people were killed in the strike on the Gaza hospital, adding that more than 300 others were wounded.  Health ministry spokesperson Ashraf Al-Qudra said the death toll was likely to rise further as rescuers pulled bodies from the rubble.

Ambulances and private cars rushed some 350 casualties to Gaza City’s main hospital, al-Shifa, which was already overwhelmed with wounded from other strikes, said its director, Mohammed Abu Selmia. Doctors in the overwhelmed hospital resorted to performing surgery on the floor and in the halls, mostly without anesthesia.

“We need equipment, we need medicine, we need beds, we need anesthesia, we need everything,” Abu Selmia said. He warned that fuel for the hospital’s generators would run out within hours, forcing a complete shutdown, unless supplies enter the Gaza Strip.

The death toll at al-Ahli was in dispute, even among those in Gaza, with Selmia saying he thought it was closer to 250.

• Israel, Palestinians trade blame

Gaza’s Hamas officials promptly blamed an Israeli air strike for causing a "horrific massacre" at the hospital. Israeli authorities denied involvement, blaming a misfired rocket from the Palestinian militant group Islamic Jihad – which in turn denied the claim.

On Wednesday, an Israeli military spokesperson told journalists that there was no structural damage to buildings around the Al-Ahli al-Arabi hospital and no craters consistent with an air strike. The spokesperson accused Hamas of inflating the number of casualties from the explosion and said it could not know as quickly as it claimed what caused the blast.

Asked to explain the size of the explosion at the site, Rear Admiral Daniel Hagari said it was consistent with unspent rocket fuel catching fire. "Most of this damage would have been done due to the propellant, not just the warhead," the Israeli spokesperson said.

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Hagari added that some 450 rockets fired from Gaza had fallen short and landed inside the strip in the last 11 days. The Israeli military also released a recording they said was between two Hamas militants discussing the blast, during which the speakers say it was believed to be an Islamic Jihad misfire and that the shrapnel appeared to be from the militant group’s weapons, not Israel’s.

Islamic Jihad dismissed Israel’s claims, accusing Israel of “trying hard to evade responsibility for the brutal massacre it committed". The group pointed to Israel’s order that al-Ahli be evacuated and reports of a previous blast at the hospital as proof that the hospital was an Israeli target.

The Anglican bishop of Jerusalem, Hosam Naoum, confirmed that the hospital had received at least three Israeli military orders to evacuate in the days before the blast, though he declined to cast blame on either party. The hospital had been hit by Israeli shelling on Sunday, wounding four staffers, he said.

On a solidarity visit to Israel on Wednesday, US President Joe Biden voiced support for the Israeli position, telling reporters that "data" from the US Defense Department backed his assertion that Palestinian militants, not Israel, were to blame.

The White House later said it was still collecting evidence about the attack but that its “current assessment” was that Israel was not responsible.

"While we continue to collect information, our current assessment, based on analysis of overhead imagery, intercepts and open source information, is that Israel is not responsible for the explosion at the hospital in Gaza yesterday," National Security Council spokeswoman Adrienne Watson said on social media.

• Diplomatic fallout

The bloodshed unfolded as the US was trying to convince Israel to allow the delivery of supplies to desperate civilians, aid groups and hospitals in the tiny Gaza Strip, which has been under a complete siege since Hamas’s deadly rampage last week.

Outraged over the hospital blast, Palestinian President Mahmoud Abbas and Jordan’s King Abdullah II announced they were pulling out of a planned summit with Biden that was scheduled to take place later on Wednesday. The White House and Jordan's government announced within hours of the attack that Biden’s meeting with Arab leaders was off.

As he opened his meeting with Prime Minister Benjamin Netanyahu in Tel Aviv, Biden said he backed Israel's version of events but warned that many in the Arab world were persuaded otherwise.

"I was deeply saddened and outraged by the explosion at the hospital in Gaza yesterday. And based on what I've seen, it appears as though it was done by the other team, not you," Biden told the Israeli leader. "But there's a lot of people out there not sure so we have to overcome a lot of things."

• Condemnation

Most Arab countries swiftly condemned Israel for the blast, including the United Arab Emirates and Bahrain, which both established ties with Israel in the Abraham Accords of 2020. So did Morocco, which also recognised Israel in 2020, and Egypt, the first Arab country to normalise relations in 1979.

Turkish President Recep Tayyip Erdogan described the incident as "the latest example of Israeli attacks devoid of the most basic human values”, while Lebanon's Iran-backed Hezbollah movement called for a "day of rage against the enemy", blaming Israel for what it called a "massacre".

EU chief Charles Michel said that targeting civilian infrastructure in Gaza breaks international law, while French President Emmanuel Macron called for humanitarian access to the coastal strip "without delay", adding that "nothing can justify targeting civilians". Speaking in Cairo, where he stopped for talks on Wednesday after a visit to Israel, German Chancellor Olaf Scholz said he was "horrified" by the hospital blast and called for a "thorough investigation of the incident".

British Foreign Minister James Cleverly urged people to wait for the facts instead of jumping to conclusions. "Getting this wrong would put even more lives at risk," he wrote on X, formerly Twitter. "Wait for the facts, report them clearly and accurately. Cool heads must prevail."

As Russia and the United Arab Emirates called for an emergency UN Security Council meeting to discuss the hospital blast and the worsening humanitarian situation, the UN's human rights chief Volker Turk called the hospital strike totally unacceptable, insisting that the perpetrators must be held to account.

"Words fail me. Tonight, hundreds of people were killed – horrifically – in a massive strike at Al Ahli Arab Hospital in Gaza City, including patients, healthcare workers and families that had been seeking refuge in and around the hospital," he said. "This is totally unacceptable."

Read moreOutrage and condemnation after deadly Gaza hospital strike

• Outrage in the streets

In Beirut, protesters roamed the city on motorcycles and gathered outside the French embassy and a UN facility, in protest against the international community’s response to the civilian deaths in Gaza. Throngs of Jordanians also gathered outside the Israeli Embassy in Amman.

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There were angry protests outside the French embassy in Tunisia late on Tuesday, with protesters accusing France and the US of siding with Israel and demanding the recall of both countries' ambassadors. Protesters rallied again the next day outside the French and US missions.

Scuffles also broke out outside the Israeli consulate in Istanbul, where protesters burned debris and clashed with Turkish riot police.

The carnage at al-Ahli hospital also triggered angry protests in the occupied West Bank, where Palestinian protesters chanted slogans against Israel and the US. Some held Hamas banners and derided Abbas, whose Fatah movement has been criticised over its collaboration with Israel.

(FRANCE 24 with AFP, AP and Reuters)