The tragedy at al-Ahli Arab hospital in the north of the Gaza Strip provoked bitter recriminations that reverberated across the Middle East and beyond.
Palestinian officials blamed an Israeli airstrike for the explosion that Gaza’s health ministry said on Wednesday had killed 471 Palestinians and wounded 314 others.
Israel has said the blast was caused by a failed rocket launch by the Palestinian Islamic Jihad militant group, which has denied blame.
Forensic reviewing of open source videos and news broadcasts have given a clearer picture of what happened on Tuesday night.
They show the impact on the hospital occurring at 6.59pm local time, with a massive orange plume visible in the dark horizon, engulfing the building.
A video, broadcast by Al Jazeera and verified by the Guardian, appears to show an airborne weapon following a rising trajectory over Gaza and bursting into flames in mid air. Moments later an explosion is seen at the hospital.
The first local reports of the blast started to come in between 7pm and 7.20pm.
Throughout the day the Telegram channels of Hamas’s armed wing, al-Qassam brigades, had been posting updates of attempted strikes into Israel.
Updates at 7pm described “bombardment by rockets” on Ashdod. Another, three minutes later, described an attack on Tel Aviv.
At 8.14pm, Hamas gave a further update, describing how al-Qassam brigades had targeted the northern Israeli city of Haifa with a R160 missile.
This was followed immediately by a press statement blaming Israel for the blast at the hospital which they called “an horrific massacre”.
The exact location of the impact on the ground where the blast occurred shows a crater in the compound of the hospital that experts describe as “fairly shallow”.
Marc Garlasco, a former Pentagon chief of high value targeting during the Iraq war in 2003, told the Guardian: “The number [of casualties] is astronomically high, an absolute high range of all time if true.
“The crater is not consistent with an airstrike, it is more likely to be a weapon that failed and released its payload over a wide area.
“The crater and surrounding damage is also not consistent with a JDAM aerial bomb. The hole on the ground occurred from kinetic energy.”
The JDAM, or joint direct attack munition, is a precision-guided air-to-surface weapon system that is part of the Israeli arsenal provided by the US.
Israel has said it used 6,000 bombs in the first six days of the conflict, more than the US used in a year during its operations in Afghanistan and double what the US-led coalition used against Islamic State in Iraq and Syria in a month.
Justin Bronk, the senior research fellow for airpower and military technology at RUSI in London, said that while the results were not conclusive, no crater or obvious shrapnel pattern consistent with standard JDAM bombs was visible in images of the aftermath.
“If this is the extent of the damage then I’d say an airstrike looks less likely than a rocket failure causing an explosion and fuel fire,” he added.
In a press conference, the Israeli military said Islamic Jihad militants had fired a barrage of rockets near the hospital and that “intelligence from multiple sources” indicated the group was responsible.
The chief spokesperson of the Israeli army, Rear Adm Daniel Hagari, said the army determined there were no air force, ground or naval attacks in the area at the time of the blast.
He said radar detected outgoing rocket fire at the same moment and intercepted communications between militants discussing the attack, suggesting that Islamic Jihad fired the rockets.
Hamas called for Israel to be held “accountable for the genocide it has been committing for the eleventh day in a row in an already blockaded area”.
The blast came as the hospital was being used as a safe shelter for civilians amid heavy Israeli bombardment.
Evidence indicates there were cars and hundreds of people gathered or being treated in the hospital compound.
Hosam Naoum, the Anglican bishop of Jerusalem, said: “The hospital has at least seven big buildings, and there’s a courtyard in the middle, with the church also in the middle of the compound. Between the library, the administration and the church, the missile hit the parking lot … inside the hospital.”
In the hours after the blast, doctors held a bleak press conference surrounded by dead bodies lying on the floor in heaps.
“This morning, when I drove into the hospital, I noted how full the hospital courtyard was with families who had sought refuge, inside the hospital [compound], thinking it would be a safe haven,” Ghassan Abu Sitta, a British-Palestinian doctor, told the Guardian.
The hospital had also been targeted last week, sustaining damage to the top floor of the new diagnostic centre and the ultrasound in the mammography room on the second floor.
Hospital administrators had warned people about the Israeli order to evacuate the area. “We had a moral obligation,” Naoum said. “We told them it is important you know what is taking place, but they have nowhere to go.”
About 5,000 people left after the first warning, he said. But many returned when airstrikes pummelled the neighbourhood, hoping the hospital compound might be a relative haven amid Israel’s blanket evacuation order that effectively turned the whole city into a target.
“At that point in time [of the blast], we know there were thousands of people there,” he said. “They received a warning, there were some bombing and airstrikes around the hospital and they fled in, and this has been happening all the time, back and forth, people coming in and out.”
The Israeli military said in a statement that roughly 450 rockets fired at Israel by militant groups had landed in Gaza.
Islamic Jihad dismissed those claims, accusing Israel of “trying hard to evade responsibility for the brutal massacre it committed”.
Under international humanitarian law, any combatant has a duty to take all precautions possible to avoid any acts that might risk harm to medical facilities or staff.
• This article was amended on 20 October 2023 to remove an incorrect reference, introduced during editing, to there being “hundreds” of cars in the hospital compound. A reference to “imagery from before the blast” showing that there were hundreds of people in the compound was also amended, to instead refer to “evidence”.
