al-Ahli Arab Hospital explosion

In 1882, the hospital was established in what was then the Ottoman Empire as a medical mission of the Anglican Church's Church Missionary Society (CMS) following the Anglo-Egyptian War. In 1954, the hospital was purchased by the Foreign Mission Board of the Southern Baptist Convention, which renamed it the Gaza Baptist Hospital. In the early 1980s, it was returned to the CMS, which turned it over to the Anglican Diocese of Jerusalem. The Diocese promptly changed the name of the hospital to Ahli Arab Hospital.[6] Because of its history, the hospital was still known as "the Baptist hospital" (Arabic: المستشفى المعمداني) in common parlance as of 2023. For this reason, much of the news coverage related to the al-Ahli Arab Hospital explosion–especially in Arabic–refers to the hospital by this name.[lower-alpha 1] As of the date of the explosion, the hospital had about 80 beds.[7] It was the only Christian hospital in the Gaza Strip.[8]

On Saturday 14 October, according to a statement by the Archbishop of Canterbury, Justin Welby, Israeli rocket fire damaged two upper floors of the hospital, leaving four staff members injured.[9][7][10][11] The damage to the uppermost floors of the facility specifically impacted the Ultrasound and Mammography wards.[12] The damaged area included the Diagnostic Cancer Treatment Centre, which was described as the "Crown Jewel of Ahli Hospital" by the Anglican Archbishop of Jerusalem, before the damage it provided cancer diagnosis as a prelude to treatment options at Ahli and other hospitals.[9]

The Anglican Diocese of Jerusalem stated the hospital had received at least three evacuation warnings from the Israeli military on Saturday, Sunday, and Monday.[13]

In his statement on 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."[10]

On Monday 16 October, Israel ordered the al-Ahli Arab Hospital, and the rest of northern Gaza, to evacuate.[14][15][16] 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.[14][15][16][17] Many people displaced by the evacuation of northern Gaza sought shelter at al-Ahli Arab Hospital to avoid Israeli airstrikes.[18] The hospital sheltered many displaced persons, with many in the courtyard.[19]

Throughout Tuesday 17 October, Hamas published numerous posts on its Telegram channels providing updates on rocket attacks aimed at Israeli territory.[5] According to the IDF, in the 11 days preceding the explosion at the Al-Ahli Hospital, 450 rockets fired by Palestinian militant organizations landed inside Gaza.[20] Before the explosion, there was 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.[21][22][23][24]

The explosion sparked protests in a number of countries, including Canada, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Qatar, Syria, Tunisia, Turkey, United Kingdom, and Yemen. In Ramallah and other cities in the West Bank, protestors chanted against Mahmoud Abbas and threw stones, leading to police using tear gas and stun grenades in an attempt to disperse protestors. Thousands of protestors marched outside the Israeli Consulate in Istanbul to protest against the war,[41] and in Jordan, protestors attempted to storm the Israeli embassy.[42] The US and French embassies in Beirut also faced protests aimed at their support for Israel.[41]

Jordan canceled a quadrilateral summit that had been scheduled to take place between Jordanian King Abdullah II, President of the Palestinian National Authority Mahmoud Abbas, Egyptian President Abdel Fattah el-Sisi, and U.S. President Joe Biden, after Abbas withdrew from it in protest of the explosion.[43]

News coverage of the event changed quickly, with conflicting reports from Gazan, Israeli and American sources.[44] The Guardian initially reported that "the scale of the blast appeared to be outside either of the militant groups' capabilities."[45] BBC correspondent Jon Donnison told BBC News viewers on the evening of the explosion: "It's hard to see what else this could be, really, given the size of the explosion, other than an Israeli air strike, or several air strikes", adding, "When we've seen rockets being fired out of Gaza, we never see explosions of that scale."[46] Days later, BBC's deputy director of news Jonathan Munro said that the corporation had made a "mistake" in is live coverage, and that Donnison "was wrong to speculate about the cause of the explosion of the hospital."[47][48] BBC also issued a clarification and apology on 23 October, writing: "We accept that even in this fast-moving situation it was wrong to speculate in this way about the possible causes and we apologise for this, although he did not at any point report that it was an Israeli strike."[49]

On 23 October 2023, The New York Times published an Editors' Note indicating that its early coverage of the event "relied too heavily on claims by Hamas, and did not make clear that those claims could not immediately be verified" and stated that "Times editors should have taken more care with the initial presentation, and been more explicit about what information could be verified."[50]

On 25 October 2023, Le Monde published an explanation lamenting that they "were not cautious enough" in their initial coverage, which suggested that the Israeli army was responsible for the explosion and was not explicit in disclosing that the health ministry in the Gaza Strip is "administered by Hamas." The explanation noted that the inability to verify information because of the Israeli army's ban on press access to Gaza made cautious coverage especially important, and pledged to "regularly remind [its] readers that some news coming out of the Gaza Strip, in particular casualty figures, cannot be verified" and to clarify Hamas's control over the health ministry.[51]

According to the video analysis of The Wall Street Journal, a long-range rocket was launched from Gaza in a northeastern direction toward Israel. Ten seconds after the rocket was launched, it malfunctioned and veered back toward the west, with the hospital in its path. The Wall Street Journal's analysis also concluded that the impact crater was consistent with a rocket fragment incoming from the east.[23]

On 20 October 2023, the Associated Press (AP) reported that it concluded from analyzing "more than a dozen videos from the moments before, during and after the hospital explosion, as well as satellite imagery and photos" that "the rocket that broke up in the air was fired from within Palestinian territory, and that the hospital explosion was most likely caused when part of that rocket crashed to the ground", while acknowledging the unavailability of definitive proof. AP reported that its preliminary conclusion was supported by experts in open-source intelligence, geolocation, and rocketry, "who all agreed the most likely scenario was a rocket from within Gaza that veered off and came apart seconds before the explosion." Andrea Richardson, an experienced war crimes investigator, told AP: "From the video evidence that I have seen, it’s very clear that the rockets came from within Gaza." Justin Crump, an intelligence consultant, said: "You can see obviously it fails in flight, it spins out and disintegrates, and the impacts on the ground follow that." Henry Schlottman, another intelligence expert, indicated that the most likely scenario based on available video evidence is that a rocket was launched within Gaza, failed mid-air, and accidentally struck the hospital.[21]

Channel 4 News said that the trajectory of the missile that appeared on Al Jazeera Live is inconsistent with the missile launching location stated by the IDF and noted a contradiction in IDF statements on the location of the launching site of the alleged Palestinian missile that hit the hospital in their presentation.[25] Channel 4 News also used Doppler effect sound analysis of the strike and visual analysis of the crater created by the strike. Both analyses indicated that the object that caused the blast would have come from points "east of the hospital not west as the IDF claimed."[52] Markus Schiller, a missile expert who has provided analyses for NATO and the European Union, told CNN that it would be impossible to predict the flight path of a malfunctioning rocket based on normal flight path and burn time.[28]

CNN consulted a leading American acoustic expert who spoke anonymously due to a lack of permission to speak publicly from the expert's university. The acoustic expert analyzed the sound waveform and concluded that although the changes in frequency indicated the projectile was in motion, no information could be gleaned regarding the direction of the motion. CNN also reported that the dark scorch marks on the "dark patches on the ground fanning out in a southwesterly direction from the crater," and burnt trees and a knocked-over lamppost behind the crater were consistent with a rocket approaching from the southwest. CNN noted that, if the projectile were an artillery munition, this could indicate a trajectory from the northeast, but the direction on impact would be inconclusive if the projectile malfunctioned and broke apart in the air.[28]

The New York Times published an analysis on 24 October 2023 casting doubt on the theory that the rocket seen in the al-Jazeera video had caused the explosion at the hospital. According to their analysis, some 25 seconds elapsed between the firing of the last Palestinian missile towards Israel and the explosion at the hospital. The al-Jazeera footage cited by the IDF as depicting a rocket aimed at Israel that exploded close to the time of the Al-Ahli Arab Hospital blast showed instead, the Times said, a rocket fired from an Israeli position near Nahal Oz that exploded on the border at a distance of some two miles from the hospital, making it unrelated to the blast. The Times analysis concluded that while responsibility for the hospital blast is unknown, the contention by Israeli and American intelligence agencies that a failed Palestinian rocket launch might have been to blame remains plausible. However, they added, "the Times analysis does cast doubt on one of the most-publicized pieces of evidence that Israeli officials have used to make their case and complicates the straightforward narrative they have put forth." In addition, the videos analyzed by the Times showed two things: firstly, that militants were firing dozens of rockets from southwest of the hospital, so a failed rocket falling well short of its target with unspent fuel might have caused the fiery explosion, and secondly, that there appears to have been Israeli bombardment in the area, with two explosions visible near the hospital within two minutes of it being struck. Israeli forces told The Times that they had not been striking "within a range that endangered the hospital," but gave no indication of how close the nearest strike had been.[53]

BBC Verify spoke to a number of experts to establish whether publicly available evidence could establish the cause of the explosion. Some experts said they could not form a view on what occurred, while three experts[lower-alpha 3] said that the evidence was inconsistent with an Israeli airstrike or warhead damage, and that evidence was consistent with an explosion caused by rocket fuel.[2] Security experts said that the preliminary evidence suggests that a Palestinian rocket fired inside Gaza caused the explosion.[54][55]

Justin Bronk at Royal United Services Institute said that, while not conclusive, "an airstrike looks less likely than a rocket failure causing an explosion and fuel fire" was a more likely explanation than an Israeli airstrike.[56][54] Independent open-source intelligence (OSINT) groups and analysts interviewed by The Telegraph, including Evan Hill, an OSINT investigator for The Washington Post,[55] as well as The Independent, agreed.[57] [58] The Wall Street Journal reported that analysts who examined publicly available images said the explosion site did not "bear the hallmarks of a strike with a bomb or missile of the types used by Israel" and that the "damage appeared more consistent with a fireball from a rocket."[54]

The Guardian quoted Marc Garlasco as saying that the crater at the blast site required kinetic energy inconsistent with a Joint Direct Attack Munition (JDAM) aerial bomb, and was also inconsistent with an airstrike, concluding that it was "more likely to be a weapon that failed and released its payload over a wide area."[5] In an interview with PBS, Garlasco also referred to an unusual amount of fire damage, pointing to a long period of burn which, according to him, is also inconsistent with the way standard military munitions work.[59] Bellingcat noted that one of the images the IDF spokesman used to demonstrate there was no crater did in fact show what appeared to be a crater, and also quoted Garlasco's analysis. They requested comments[27] and the next day IDF spokesman Jonathan Conricus stated that the size of the crater and the damage caused were too small for the munitions used by the IDF, as previously stated: "Scroll through pictures of rockets that impacted in Sderot, Ashkelon, in Be'er-Sheva, you'll see very similar sites," he said. "A small crater, lots of soot and fire remarks and you can see that all of the buildings around are generally intact."[60]

Two researchers from the Australian Strategic Policy Institute noted that the blast radius and lack of structural damage on the surrounding cars were inconsistent with a typical Israeli airstrike.[61][62]

The Associated Press noted the absence of any large crater of the sort that would be expected if the explosion were caused by an Israeli airstrike. Although Israel does have smaller munitions in its arsenal, the AP noted that "there has been no public evidence of such missile strikes in the area around the al-Ahli Arab Hospital on Tuesday night." AP reported that David Shank, a retired U.S. Army colonel with expertise in military rockets and missiles, explained that the large explosion and subsequent fire was likely caused by the fact that the rocket was still full of propellant.[21] A later analysis by the AP, including video evidence and satellite imagery, as well as expert opinion, assessed that a rocket was fired from Gaza, and that "the hospital explosion was most likely caused when part of that rocket crashed to the ground", though the lack of physical evidence makes definitive proof unlikely if not impossible.[21]

Der Spiegel reported that the opinion of Fabian Hoffman, a weapons researcher at the University of Oslo, is that the most likely explanation regarding the cause of the explosion is that a rocket fell apart in several phases and hit the hospital. According to Der Spiegel, Hoffman could not say for sure what caused the rocket's failure, but he suspected that the engine overheated, causing the rocket to fall to the ground.[58]

Agence France-Presse (AFP) published an article on 20 October 2023, reporting on interviews of several analysts, who "remained cautious, preferring not to rule out any scenario." Heloise Fayet, a researcher at the French Institute of International Relations, said that it was difficult to link the minor damage observed at the hospital with the large explosion seen on video. Based on the nature and extent of the damages, Fayet concluded that the most likely scenario was that a rocket hit the gas tanks of several cars. The same AFP article quoted Joseph Henrotin, editor-in-chief of the journal Defense and International Security (DSI), as saying that the visible damage was "consistent with the hypothesis of engine pieces, for example, of a rocket, which fall in a ballistic alignment, projecting debris, flaming materials, and creating a blast effect," at the same time noting that the absence of any structural damage to the building, the impact site being in the parking lot, and the size of the craters were all inconsistent with "the ammunition and targeting capabilities available to the Israelis". Similarly, Xavier Tytelman, an air defense consultant who also works for the magazine Air & Cosmos, said that the grade of munitions used by Israel, which frequently destroy entire buildings with a single strike, "would have done infinitely more damage" than that seen in the hospital parking lot, noting that the images of the scene were not comparable to the effects of laser-equipped JDAM bombs.[30] Tytelman was also quoted as suggesting the rocket in question was likely an Iranian-designed Badr-3 and that its trajectory change was caused by faulty detachment of the first stage.[63] The analysts interviewed by AFP stated that they could not completely rule out the scenario of a micro munition fired from an Israeli drone, at the same time observing that they were not aware of any evidence to support it.[30]

CNN's investigative report from 21 October 2023, suggests that a rocket launched from Gaza malfunctioned mid-air, causing the explosion at a hospital complex. Experts consulted found the damage inconsistent with an Israeli airstrike. Missile expert Markus Schiller hypothesized that the rocket broke apart mid-air and ignited fuel at the hospital's car park, causing the explosion. Both Cedric Leighton, former National Security Agency of US deputy director, and Chad Ohlandt, a senior engineer at Rand Corporation, concurred. Analysis of mobile phone-captured audio also did not align with a high-grade military explosion. The experts noted a smaller impact crater and lack of wide destruction, undermining the possibility of an aircraft bomb. Patrick Senft from ARES and an unnamed explosives specialist emphasized that the damage was more likely caused by the rocket's fuel and shrapnel, rather than an artillery shell. All cautioned that definitive conclusions couldn't be made due to various limitations.[28]

The Wall Street Journal published a report on 21 October 2023 containing an analysis of four geolocated and verified videos of the incident, concluding that the explosion was caused by a misfired rocket.[23]

Channel 4 News noted that the explosion site contained only small craters, that buildings surrounding the explosion site were only superficially damaged (and did not structurally collapse), and some of the windows of a nearby church were undamaged–all facts that made it unlikely that the cause of the explosion was a ground-detonating Israeli missile strike, without ruling out the possibility of an air-burst explosion. Channel 4 also observed that although Palestinian Islamic Jihad had indicated they had recovered a warhead, they have not produced it.[25]

India Today's OSINT Team analyzed the footage and images of the explosion and the aftermath as well as comparing the explosion site to previous aerial bombings by Israel. India Today reported that the visual evidence does not match previous aerial bombings by Israel but that a more detailed investigation would be needed for a conclusive verdict.[64]

Numerous other news outlets reported on similar opinions from experts they spoke with–all agreeing that the cause of the explosion was more likely a misfired rocket than an Israeli airstrike.[65][66]

After the explosion, there was speculation on social media that Israel's Iron Dome air defense system could have played a role in causing the event.[21] Der Spiegel relayed the analysis of weapons expert Fabian Hoffman, of the University of Oslo, who noted that the Iron Dome is not designed to intercept rockets during their ascent.[58] Similarly, the Associated Press cited to the opinion of John Erath, senior policy director at the Center for Arms Control and an expert on missile defense, who also relayed that the Iron Dome is designed to intercept rockets during their downward path into Israeli territory—not while they are in an upward trajectory—though Erath conceded that it is not technically impossible for Iron Dome to destroy a rocket during its ascent.[21] Retired U.S. Army colonel David Shank, an expert in missiles, concurred with this view, telling the Associated Press that the air defense system is generally not engaged unless a rocket has a high probability of causing casualties or damage within Israel, and would not likely be used to destroy a rocket flying over Gaza.[21] Experts consulted by CNN found no evidence that the Iron Dome intercepted the projectile that caused the explosion[28]

Al Jazeera published its analysis of the hospital explosion.[67][68] Al Jazeera said they had constructed a second-by-second timeline by analyzing video footage of the event. According to Al Jazeera, a rocket launched from Gaza was intercepted by an Iron Dome interceptor and "completely destroyed" in mid-air five seconds prior to the hospital explosion. As no more rocket launches could be seen in video footage from Gaza from this time until the hospital explosion, Al Jazeera said that they found "no grounds" for the IDF assertion that the hospital explosion was caused by a failed rocket launch from Gaza. The investigation also identified "four Israeli air strikes on Gaza, targeting the area near the hospital" in the minutes before the explosion.[68][69][70]

The death toll asserted by the Gazan Health Ministry was not independently verified as of 18 October.[71] The Wall Street Journal reported that open-source intelligence analyst Blake Spendley estimated the death toll at 50, based on his review of videos and photos of the scene.[54] Several analysts cast doubt on the death toll figure from the Gazan Health Ministry, citing the limited shock-wave damage and the small size of the open area.[54] On 19 October, Agence France-Presse cited an unnamed senior European intelligence official who said he believed the death toll was no more than 50.[72] A video geolocated by Bellingcat showed "[a]t least two dozen bodies" in a grassy area near the explosion.[27]

The New York Times, after reviewing video footage and witness accounts, said on 18 October that there were "scores" of bodies in the hospital's courtyard and the number of casualties was "high".[71]

Shortly after the explosion, IDF released an audio recording purportedly containing an intercepted conversation between two Hamas operatives saying that a misfired rocket launched by PIJ caused the explosion.[40] BBC Verify and CNN said they could not verify the recording.[2][28] Channel 4 News reported on a forensic analysis of the alleged Hamas operative audio released by the IDF, concluding that it was digitally manipulated.[52] Channel 4 News spoke to two Arab journalists who said that the recording did not appear authentic, because the "language, accent, dialect, syntax and tone" were not credible.[25] Channel 4 News also reported on a preliminary audio assessment performed by a sonic analysis company called Earshot, which concluded that the audio recording had been edited to fuse two channels that were recorded separately, one for each speaker.[73]

The Israeli Defense Forces said the cause of the blast was a misfired rocket targeting the Israeli city of Haifa and launched by Palestinian Islamic Jihad (PIJ), a Palestinian militant group allied with Hamas.[74][19] Rear Admiral Daniel Hagari of the IDF Spokesperson's Unit said that intelligence indicated that PIJ had launched a barrage of rockets near the hospital, and shared drone-collected aerial photography that he said was inconsistent with Israeli munitions.[38]

The IDF also published audio that it says contains intercepted discussions among militants saying that their misfired rocket caused the explosion.[40] BBC Verify said that it could not verify the recording.[2]

On 18 October, the IDF released drone footage, which it said showed the hospital before and after the explosion. The annotated video showed burned vehicles in the hospital parking lot, and noted the apparent lack of a crater or significant structural damage to surrounding buildings. The IDF said these attributes were inconsistent with the aftermath of Israeli munition strikes.[75]

Following the explosion, the official Israel Twitter account published a statement saying that the attack was the result of an enemy rocket.[76][77][78] Attached to the tweet was footage, purported to be proof of the rocket coming from Gaza.[76][79][77] Aric Toler, a journalist on the visual investigations team of the The New York Times, noted that the timestamps on the video were at least 40 minutes after the explosion was known to have occurred. Shortly after, the Israeli government Twitter account edited the tweet, removing the video from it.[76][41][80] The IDF said it was not involved with the video, and attributed it to the Israeli Ministry of Foreign Affairs.[77]

According to the The New York Times, Israel has declined its requests to share logs of its military activity in the area at the time of the explosion or say what video it was basing its assessment that a failed Palestinian rocket launch was responsible for the blast on.[24]

The Gaza Health Ministry said the explosion was caused by an Israeli airstrike. Palestinian Islamic Jihad has denied responsibility,[35] blaming Israel for the explosion and drawing attention to the fact that Israel had also hit the hospital on 14 October and previously ordered its evacuation.[38] Hamas stated that Israel struck the hospital as punishment for the failure to evacuate.[21]

David Leonhardt of The New York Times wrote on 20 October that "Gaza officials and their supporters have three main arguments, all circumstantial":[81]

• First, Palestinians have noted that the al-Ahli Arab Hospital was hit by rocket fire three days earlier, although according to The New York Times, the source of the rocket fire remains unclear, and staff had received text messages and phone calls demanding that the hospital be evacuated.[81] Anglican Archbishop Hosam Naoum said the Israeli military had telephoned and texted the hospital at least three times since 14 October, asking patients and staff to leave.[39] He said these warnings were specific to the hospital, and not part of Israel's general push to have civilians leave northern Gaza: "There were specific warnings to get out of the building."[39]
• Second, Israel dissembled about civilian casualties before, such as in the death of Palestinian-American journalist Shireen Abu Akleh.[81]
• Third, Israeli government officials have put out inconsistent information regarding the hospital explosion, including a video of a rocket barrage showing a time stamp well after the time of the explosion.[81] Hananya Naftali is frequently cited on this point. Naftali, an Israeli social media influencer and a social media advisor to Netanyahu, initially posted a statement on X[lower-alpha 4], stating the Israeli Air Force had struck a Hamas terrorist base inside a hospital. Naftali promptly deleted this, later stating that his previous post was a false assumption he had made based on a Reuters report.[82][83] PolitiFact found no evidence of Naftali being "an official spokesperson for Israel or its military". PolitiFact also noted, "He said in an Oct. 14 Facebook video that Netanyahu assigned him to a task force to defend Israel in the media."[84]

Hamas failed to produce or describe any evidence linking Israel to the explosion.[24] Islamic Jihad claimed to have a missile fragment, but have not produced it."[85] Ghazi Hamad, a Hamas spokesperson, told the Associated Press that Hamas would welcome a United Nations investigation of the cause of the explosion.[21] He told the New York Times on 22 October that the munition was not available for inspection because it had "dissolved like salt in the water. It’s vaporized. Nothing is left". N.R. Jenzen-Jones, director of the Australia-based Armament Research Services, said that "[o]ne would expect remnants to be recoverable in all but the most extreme circumstances, and the available imagery of the hospital site suggests something ought to be identifiable on the ground[.]"[24]

U.S. President Joe Biden supported the Israeli account of events, and referred to Pentagon intelligence sources that indicate the explosion was caused by a Palestinian Islamic Jihad (PIJ) rocket misfire.[54]

U.S. officials said that the U.S. had collected "high confidence" signals intelligence indicating that PIJ was responsible.[54] Adrienne Watson, a spokesperson for the United States National Security Council, said, "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." Other U.S. intelligence officials concurred, adding the analysis was still preliminary and investigations would continue.[86]

Blake Spendley of CNA[lower-alpha 5] said that "At the moment, the preponderance of evidence does point to it being a Hamas or PIJ rocket hitting the area."[54]

U.S. intelligence officials who spoke with The New York Times on condition of anonymity on 24 October 2023, said that Palestinian communications intercepted by Israel and publicly available video gave them high confidence that a rocket launched from Gaza experienced a "catastrophic motor failure," causing the warhead to fall near the hospital. The officials said their analysis focused primarily on the Al Jazeera video that captured the moment of the explosion during a live broadcast, though they also considered signals intelligence and images of the aftermath of the explosion. The officials told the Times that their assessment was also based on the absence of any Israeli weapon presented by Palestinians at the site of the explosion. According to the U.S. officials, the videos showing the fireball and fire-damaged vehicles in the hospital parking lot are consistent with a malfunctioning missile. The officials also told the Times that they had authenticated communications intercepts provided by Israeli intelligence, all of which consisted of Hamas members "discussing their belief that the explosion was caused by an errant or malfunctioning rocket fired by Palestinian Islamic Jihad." The officials also told the Times that they had low confidence in their assessment of a death toll between 100 and 300, noting that an accurate figure was impossible to confirm because of the absence of independent sources.[89]

France's Directorate of Military Intelligence stated that a misfired rocket from within Gaza was the "most probable cause".[90] A French military official who spoke with Associated Press on condition of anonymity stated that French intelligence drew this conclusion from classified information, satellite imagery, intelligence shared by other countries, and open-source information.[91] The official stated that the blast crater was indicative of an explosive charge of approximately 5 kilograms, which is consistent with several types of rockets used by Palestinian militant groups.[91] With regard to the origin of the rocket, the French official said that the impact hole suggested the projectile was on a south-to-north trajectory.[91] In addition, the French military intelligence official indicated that, while he could not say for certain, the reported death toll of 471 did not seem possible based on the apparent size of the rocket. [91]

As of 19 October 2023, Canada had refrained from taking a position regarding the cause of the explosion. Prime Minister Justin Trudeau said that Canadian officials "saw some preliminary evidence," but would continue to work with allies "before reaching any firm and final conclusion."[92] On 21 October, Canada's Department of National Defence announced that an independent analysis conducted by Canadian Forces Intelligence Command had determined "with a high degree of confidence that Israel did not strike the hospital on October 17, 2023," and that the more likely cause was an errant rocket fired from inside Gaza. The assessment was based on open source intelligence and classified reporting.[93]

Rishi Sunak, the UK Prime Minister, told the House of Commons that, relying on British intelligence agencies, the government had concluded that the blast was likely the result of a Palestinian rocket fired towards Israel. He also criticized the initial reporting, saying it had a negative impact on the region.[94]

Antonio Tajani, Italy's Foreign Minister, said on 24 October 2023 that the cause of the explosion was not an Israeli missile and that the death toll was around 50. He did not indicate what evidence formed the basis of his comments.[95]

Biden subsequently said at a meeting with Israeli Prime Minister Benjamin Netanyahu that, "Based on what I've seen, it appears as though it was done by the other team, not you",[108][109] later adding "I'm not suggesting that Hamas deliberately did it, either – it's that old thing: You've got to learn how to shoot straight".[110]

Saudi Arabia, Jordan, Qatar, UAE, Bahrain, Oman, Egypt, Algeria, Lebanon, Egypt, Algeria and Libya condemned the explosions as attacks, and accused Israeli forces of bombing the hospital.[111][112][113][114] The UAE and Bahrain condemned the explosions as Israeli attacks, and demanded an "immediate cessation of hostilities". The Turkish President Recep Tayyip Erdogan denounced the bombing as "the latest example of Israeli attacks devoid of the most basic human values." Moussa Faki, Chairperson of the African Union Commission, denounced the IDF attack as a "war crime" and demanded that other countries stop what they said was Israeli aggression.[111][112][113]

Caretaker Prime Minister Anwaar-ul-Haq Kakar and the Ministry of Foreign Affairs of Pakistan condemned the IDF as the perpetrators of the attack. They described the attack as "inhumane and indefensible" and asserted that IDF targeting of civilians and medical personnel were "war crimes". Kakar denounced IDF military operations as a "campaign of terror"; and the Foreign Ministry demanded global action to swiftly stop "Israeli bombardment and siege of Gaza".[115][116][117]