Working at Tel Aviv Medical Center’s international affairs department on October 7 meant bearing witness to the frantic transformation of Israeli hospitals as they prepared to treat survivors of Hamas’ massacre and gear up for the war we knew was about to engulf us.

Hospital administrators were desperately trying to protect patients from the unrelenting rocket fire raining down on Israeli towns and cities, while the threat of Hezbollah’s enormous arsenal of precision-guided missiles loomed powerfully in the back of our minds.

After beginning the process of assessing the safety of its patients in the early hours of October 7, this metropolitan hospital rushed to convert its four-story underground parking garage into an emergency medical center and transfer select departments there.

The bomb-proof parking garage had been constructed under Tel Aviv Medical Center 12 years ago, with a $30 million price tag, to incorporate all the infrastructure that would allow it to be converted into an underground hospital safe from rockets, missiles, and even chemical and biological weapons.

The hospital remains ready to transfer 700 patients underground within eight to 14 hours. Why not transfer all of them immediately? Because more than three months into the war, the medical center is still faced with a constant and dangerous trade-off. To go fully subterranean, it would have to stop many of its routine activities and limit the number of operating rooms available.

The 800 or so patients who couldn’t be moved underground would be transferred to the hospital’s Arison Tower – the hospitalization section most fortified against rocket attacks – and hundreds more would have to be discharged early due to the lack of available space. Of those chosen to be kept hospitalized, many would have to be stationed in corridors.

Receiving new patients would also become a selective process, requiring the hospital to place caps on its capacity to treat members of the diverse public it serves, which includes Arab-Israelis as well as patients from Tel Aviv’s undocumented asylum seeker and homeless populations.

While Israeli hospitals embarked on this excruciating endeavor in the early days of the war, the world’s scrutiny was focused sharply on Al-Shifa Hospital in northern Gaza. Hamas had embedded a military command center there and used the section of its network of tunnels that had been dug under the hospital compound to give sanctuary to some of those responsible for the October 7 massacre.

The juxtaposition between Tel Aviv Medical Center’s underground emergency hospital and the tunnels that were revealed under Al-Shifa Hospital couldn’t have been more striking. While Israel had invested heavily in building a subterranean medical facility to protect patients and medical staff from attacks, Hamas had diverted countless millions of dollars that could have been used to improve medical services towards the construction of a sophisticated tunnel system to shield its terrorists and military capabilities, clearly endangering patients and staff at Al-Shifa and other hospitals in Gaza.

Irrefutably, Al-Shifa was not an isolated incident. Hamas buried terror tunnels under medical facilities across the Gaza Strip. In fact, the director of the Kamal Adwan, a smaller hospital in northern Gaza, professed in December that around 16 employees - including doctors, nurses, and other staff members - were “military operatives” of Hamas’ al-Qassam Brigades.

This bizarre connection between Gazan hospitals and Hamas’ military capabilities is a travesty that should be the subject of international scrutiny and condemnation. Yet in the twisted Gaza-Israel paradigm, many seem unable to see the tragedy that Hamas has imposed on Palestinian patients at Al-Shifa and other medical facilities.

In the era of misinformation, Hamas’ despicable weaponization of its hospitals has handed this terrorist organization a public relations success. Nothing could coax some audiences into despising Israel more than seeing images of a hospital being searched after Israel was forced to treat it as a military target, or of a clinic damaged after being used to launch attacks on Israeli soldiers. Nothing could have been more effective in stoking the flames of antisemitism across the Western world. Hamas knew this and it perversely benefitted from the tragedies it deliberately created.

It takes moral clarity to recognize how malevolent the violent value system that underpins Hamas’ worldview truly is. In its perpetual and undying commitment to annihilating the “Zionist entity,” Hamas sacrificed Palestinian hospitals and patients across Gaza to the cause, all while imposing devastating consequences on Israeli hospitals.

The monumental lengths that Israeli hospitals have gone to in order to protect their patients stand in sharp contrast to Hamas’ actions. Tel Aviv Medical Center has kept most of its operations above ground for the time being, yet remains in a constant state of angst over the moment when this war may turn into an all-out multi-front conflict as Hezbollah and other Iranian proxies continue their attacks.

The international community and journalists worldwide should acknowledge and investigate the causes of the unprecedented challenges that Israeli hospitals are having to cope with in the face of actors who gleefully target Israeli civilians while hiding behind Palestinian ones, and who still, grotesquely, are basking in what they see as the glory of the October 7 massacre.

*Dana Segall worked as a foreign relations executive at Tel Aviv Sourasky Medical Center in 2023, and previously served as a consultant for the Israel Ministry of Foreign Affairs.