TEL AVIV – After several twists down a concrete stairwell, a buzzing underground world is revealed. Ambulances unloading patients on gurneys, rows of field-hospital tents, workmen fixing overhead cables, and medical personnel in an array of uniforms.
This is the Sheba Medical Center, the largest hospital in the Middle East, with 11,000 employees, 1,700 doctors, and over 3,000 nurses. And most of it is functioning underground to stay out of reach of Iranian ballistic missiles.
“This place is not a field hospital. This is the hospital. It is just subterranean,” Yardena Koppel, a pediatric doctor, told RFE/RL.
Rattling off a list of departments that are, she said, fully functioning, Koppel added: “Each area is well-oiled and functions within itself. It's something really incredible, something I've never seen before.”
The hospital has moved some operations below ground in Israel’s previous conflicts, but never on such a scale. This location, two stories below ground, is just one of five containing hundreds of patients -- while some sections of the hospital are deemed well-protected enough to keep working in their usual places.
Lessons From Last Iran War
A hospital spokesman, who declined to be named, told RFE/RL that the 12-day Israeli-US war with Iran in June last year had been a key lesson. At that time, the hospital had two underground locations.
“After what happened in June, we realized that the missiles are much more dangerous, we started spreading even more,” he said, adding the whole move took about 36 hours. Plans to get ready appear to have begun before Israel launched surprise air strikes on Iran on February 28.
“When the military has an idea that something is in the works, they will tell us like a month in advance to start getting your act together,” the spokesman said.
Asked if this means that the hospital management knew military action was being prepared as early as the end of January, the spokesman would not be drawn.
“It wasn't a surprise to us. We saw the incremental...” he said, his answer tailing off, before adding: “Within a few moments that we knew that something was going to happen, we were told to move. Everything is done in military fashion. We have a list of who gets the priority, who goes down first.”
A tour of the facilities takes in numerous departments. Space is cramped, but Yardena Koppel, a doctor, says they can work here "indefinitely."
On a tour of the facilities, Koppel led us through pediatrics, adult oncology, ophthalmology, and cardiology. Patients lay screened from the bustle behind white curtains. On a monitor, a doctor examined a grainy image of a beating heart.
Koppel said the hospital has also had “war casualties.” This included two men who were badly injured by shrapnel a few days earlier.
“One of those patients had to have his chest opened, actually in this area, and unfortunately did not survive. The other patient is currently in ICU (also below ground) and is in critical condition,” she said.
“In this war, we have assumed that we are in this indefinitely and we simply cannot perform the procedures that we were doing above ground with the frequency of all the air raids with the same level of safety,” Koppel added.
In Israel, there are usually several alerts within each 24-hour period, occurring both day and night. Some 900 people have been injured in incidents related to the conflict since February 28, according to emergency services. Most were injured while making their way to shelters. Twelve civilians have died, along with two Israeli soldiers in Lebanon.
Israeli civilian casualties are relatively low thanks to the country’s advanced air defense capabilities and extensive network of shelters.
More Casualties In Iran
In Iran the death toll and the number of injured appear significantly higher, although getting a reliable picture is difficult.
US-based monitoring organization HRANA has counted nearly 1,300 civilian deaths in Iran. The Iranian authorities say more than 15,000 people have been injured, but this information cannot be independently confirmed.
The World Health Organization (WHO) says it has verified 18 attacks on health facilities in Iran since the beginning of US and Israeli air strikes.
"Blasts near the Motahari Hospital, in Iran’s capital, Tehran, reportedly damaged parts of the health facility and forced the evacuation of patients and health staff," WHO chief Tedros Adhanom Ghebreyesus wrote on social media, also listing other health facilities reportedly struck.
A view of debris at Motahari Hospital, Tehran, on March 3.
“The United States and Israeli regime continue their massive attack against Iran and the Iranian people without pause, day and night,” Iran’s ambassador to the United Nations, Amir Saeid Iravana, said in New York on March 10.
“They are deliberately and discriminately targeting civilians and civilian infrastructure across my country,” he added, claiming 32 “medical and pharmaceutical facilities” had been hit.
RFE/RL is unable to do its own on-the-ground reporting from within Iran, because the authorities there don’t allow it to operate in the country.
US and Israeli officials have repeatedly stated that their forces exclusively target military and security infrastructure. However, US officials are investigating whether a US missile accidentally hit a school on February 28, killing at least 175 people, including 168 children, according to local officials.