Dr Fozia Alvi was making her rounds of the intensive care unit on her final day at the battered European public hospital in southern Gaza when she stopped next to two young arrivals with facial injuries and breathing tubes in their windpipes.
âI asked the nurse, whatâs the history? She said that they were brought in a couple of hours ago. They had sniper shots to the brain. They were seven or eight years old,â she said.
The Canadian doctorâs heart sank. These were not the first children treated by Alvi who she was told were targeted by Israeli soldiers, and she knew the damage a single high-calibre bullet could do to a fragile young body.
âThey were not able to talk, paraplegic. They were literally lying down as vegetables on those beds. They were not the only ones. I saw even small children with direct sniper shot wounds to the head as well as in the chest. They were not combatants, they were small children,â said Alvi.
Children account for more than one in three of the more than 32,000 people killed in Israelâs months-long assault on Gaza, according to the Palestinian health ministry. Tens of thousands more young people have suffered severe injuries, including amputations.
![A doctor looks at a wounded child in a hospital bed](https://i.guim.co.uk/img/media/9933e600eb2560194d3f1b2fb66bbbc3336de89f/314_0_2887_1900/master/2887.jpg?width=445&dpr=1&s=none&crop=none)
Nine doctors gave the Guardian accounts of working in Gaza hospitals this year, all but one of them foreign volunteers. Their common assessment was that most of the dead and wounded children they treated were hit by shrapnel or burned during Israelâs extensive bombardment of residential neighbourhoods, in some cases wiping out entire families. Others were killed or injured by collapsing buildings with still more missing under the rubble.
But doctors also reported treating a steady stream of children, elderly people and others who were clearly not combatants with single bullet wounds to the head or chest.
Some of the physicians said that the types and locations of the wounds, and accounts of Palestinians who brought children to the hospital, led them to believe the victims were directly targeted by Israeli troops.
Other doctors said they did not know the circumstances of the shootings but that they were deeply troubled by the number of children who were severely wounded or killed by single gunshots, sometimes by high-calibre bullets causing extensive damage to young bodies.
In mid-February, a group of UN experts accused the Israeli military of targeting Palestinian civilians who are evidently not combatants, including children, as they sought shelter.
âWe are shocked by reports of the deliberate targeting and extrajudicial killing of Palestinian women and children in places where they sought refuge, or while fleeing. Some of them were reportedly holding white pieces of cloth when they were killed by the Israeli army or affiliated forces,â the group said.
The Guardian shared descriptions and images of gunshot wounds suffered by eight children with military experts and forensic pathologists. They said it was difficult to conclusively determine the circumstances of the shootings based on the descriptions and photos alone, although in some of the cases they were able to identify ammunition used by the Israeli military.
Eyewitness accounts and video recordings appear to back up claims that Israeli soldiers have fired on civilians, including children, outside of combat with Hamas or other armed groups. In some cases, witnesses describe coming under fire while waving white flags. Haaretz reported on Saturday that Israel routinely fires on civilians in areas its military has declared a âcombat zoneâ.
The Israel Defense Forces (IDF) deploy snipers â or sharpshooters, as the military calls them â during combat operations, often as part of elite units. They are trained to âtarget and eliminate particularly difficult terrorist threatsâ, according to the militaryâs own definition.
Israeli and foreign human rights groups have documented a long history of snipers firing on unarmed Palestinians, including children, in Gaza and the West Bank.
Palestinians in Gaza also report a terrifying new development in the latest Gaza war â armed drones able to hover over streets and pick off individuals. Called quadcopters, some of these drones are used as remote-control snipers that Palestinians say have been used to shoot civilians.
![Doctors care for a patient among bloodstained bandages](https://i.guim.co.uk/img/media/bd841434430d75e4ad890f9181cf56e87275765f/0_0_1200_1600/master/1200.jpg?width=445&dpr=1&s=none&crop=none)
The IDF said it âcompletely rejectsâ allegations that its snipers deliberately fire on civilians. It said it cannot address individual shootings âwithout coordinates of the incidentsâ.
âThe IDF only targets terrorists and military targets. In stark contrast to Hamasâs deliberate attacks on Israeli civilians, including men, women and children, the IDF follows international law and takes feasible precautions to mitigate civilian harm,â it said.
Doctors say otherwise.
Dr Vanita Gupta, an intensive care doctor at a New York City hospital, volunteered at Gazaâs European hospital in January. One morning, three badly wounded children arrived in quick succession. Their families told Gupta that the children had been together in the street when they came under fire and that there had been no other shooting in the area. She said no wounded adults were brought in to the hospital at the same time and from the same place.
âOne child, I could see there was a shot to the head. They were doing CPR on this five- or six-year-old girl who obviously died,â said Gupta.
![Medical staff perform CPR on a child who was shot in the head.](https://i.guim.co.uk/img/media/1c74ee2a94632d496678897892cb7f5bc4c9bac5/0_0_1600_1200/master/1600.jpg?width=445&dpr=1&s=none&crop=none)
âThere was another little girl about the same age. I saw a bullet entry wound on her head. Her father was there, crying and asking me, âCan you save her? Sheâs my only child.ââ
Gupta said that a third young child also had a shot to the head and was sent for a CT scan.
âThe neurosurgeon looked and said, âThereâs no hope.â You could see the bullet had gone through the head. I donât know how old he was, but young,â she said.
Family members told Gupta that the Israeli army had withdrawn from the area about four kilometres from the hospital.
âThey said people started returning to their homes because the army was gone. But the snipers stayed on. The families said they opened fire at the children,â she said.
Doctors who worked at the Nasser hospital in southern Gaza said what appeared to be targeted Israeli fire killed more than two dozen people, including children, as they entered or left the hospital in the first weeks of this year.
Among the casualties was 14-year-old Ruwa Qdeih. Doctors say she was shot dead outside the hospital in Khan Younis as she went to collect water. They said there was no fighting in the area at the time and that she was killed by a single shot and then men who went to recover her body were also shot at.
In Gaza City, three-year-old Emad Abu al-Qura was shot outside his home as he went to buy fruit with his cousin, Hadeel, a 20-year-old medical student, who was also killed. The family said they were targeted by an Israeli sniper.
A video of the pair lying together in the street shows Emad still alive after he is first hit and trying to lift his head. More shots hit the ground close by including one that strikes a plank next to Emad. The boyâs mother said he was then hit again and this time killed.
Hadeelâs father, Haroon, saw the shooting.
âThe targeting of civilians is very clear. It is a deliberate direct targeting aimed at killing civilians without reason, without there being any events, without there being any resistance. They deliberately killed Hadeel and Emad,â he told Al Jazeera.
Other young victims include 14-year-old Nahedh Barbakh, who was hit by sniper fire alongside his 20-year-old brother, Ramez, as they followed Israeli military orders to evacuate an area west of Khan Younis in late January, according to the Geneva-based Euro-Med Human Rights Monitor.
![People walk in a group along a road](https://i.guim.co.uk/img/media/e1ffe97ad9b5acf78a727c7fa1813f02d948973e/0_0_4000_2625/master/4000.jpg?width=445&dpr=1&s=none&crop=none)
According to a witness interviewed by Euro-Med Monitor, Nahedh was carrying a white flag to lead the way for his family, but after walking just a few steps from the house he was hit in the leg by a bullet. As the teenager attempted to turn back home he was shot in the back and head, the witness said.
Ramez was shot through the heart when he tried to rescue his brother.
The family decided it was too dangerous to recover the bodies and eventually fled the area, leaving the brothers still lying in the street. A last photograph shows Ramez stretched across Nahedhâs body with the white flag tangled between them.
Witnesses said the shots came from the rooftop of a nearby building taken over by Israeli soldiers.
A new threat
In December, the Palestine Red Crescent Society said that 13-year-old Amir Odeh was killed by an Israeli drone at its headquarters in the Al-Amal hospital in Khan Younis. The family told Euro-Med Monitor he was shot through a window as he played with his cousins on the eighth floor of building where they had sought shelter from the fighting. The killing was especially notable because the single shot to the chest came from a type of drone not seen in combat in Gaza before â a quadcopter, fitted with a gun, camera and speaker. Unlike some other drones, quadcopters are able to hover over their targets.
Dr Thaer Ahmad, a Chicago doctor who volunteered in Nasser hospitalâs emergency room, said quadcopters sometimes appeared in swarms, giving orders to Palestinians to clear an area.
âWe heard an incredible amount of stories from people recovering from injuries from these quadcopters firing bullets from the sky,â he said.
Ahmad said that on one occasion a drone shot one of the hospitalâs doctors in the head, although he survived.
Dr Ahmed Moghrabi described on Instagram âhundredsâ of quadcopters descending on the Nasser hospital in the third week of February and ordering people to evacuate the compound before killing a number of them. On another occasion, he filmed quadcopters giving instructions to Palestinians to leave the area.
Although the Israeli military has previously deployed quadcopters for intelligence gathering, this appears to be the first time that versions of the drone able to fire guns have been used against the Palestinians.
Prof Ghassan Abu-Sittah, a British-Palestinian surgeon and who was recently elected rector of the University of Glasgow, told Mondoweiss, a leftwing Israel-Palestine news site, that working at the Al-Ahli hospital in Gaza City âwe were getting a lot of people shot by these quadcopters, these drones that have sniper guns attached to themâ.
Abu-Sittah, who has operated on Palestinians wounded by Israeli sharpshooters during visits to Gaza in earlier years, described the quadcopters as firing âsingle high-velocityâ shots.
âWe have received over 20 chest and neck gunshot wounds fired from Israeli Quadcopter drones. This is a low flying sniper drone,â he wrote on X.
![A drone drops teargas canisters](https://i.guim.co.uk/img/media/711036d250b6dc9d2688a390de9a37e3983bb7c3/0_0_3072_2116/master/3072.jpg?width=445&dpr=1&s=none&crop=none)
Quadcopter killings documented by Euro-Med Monitor include two children shot dead on 21 January when drones opened fire at al-Aqsa University near Khan Younis, where thousands of displaced Palestinians were sheltering. The following month, a drone shot dead Elyas Abu Jama, a 17-year-old whose family said had mental and physical disabilities, outside his tent in a Rafah displaced persons camp. Euro-Med Monitor said that on the same day, a quadcopter killed 16-year-old Mahmoud al-Assar and his 21-year-old sister, Asmaa.
Thaer Ahmad spent three weeks at the Nasser hospital in January as a volunteer with the medical charity MedGlobal. Normally he works at a trauma centre on Chicagoâs south side, where he regularly deals with gunshot wounds.
âI did more trauma procedures on paediatric patients in the three weeks that I was at Nasser than I did in the 10 years that Iâve been practising in the US,â he said.
The doctor said he treated five children he believes were shot by snipers because the placing of the bullets suggested they were not hit randomly but targeted.
âThey were mostly shot in the thorax, the chest area, some in the abdomen. There was one boy shot in the face. As a result he had a shattered jaw. There were two children who had been shot in the chest, young, under the age of 10, who did not survive. Two others, one shot in the abdomen, did survive. They were still recovering in the hospital when I left,â he said.
Ahmad noted the children were often shot by âone large-calibre bulletâ which could produce devastating wounds.
![A doctor cares for a child](https://i.guim.co.uk/img/media/59d62a5ce136076d7e3992a7172150ee3de483ce/0_0_3024_4032/master/3024.jpg?width=445&dpr=1&s=none&crop=none)
Dr Irfan Galaria, a surgeon based in Virginia, slept on the operating room floor of the European hospital between shifts as a volunteer in January. He too saw children badly wounded by high-calibre bullets.
Galaria said that a 14-year-old boy arrived at the hospital who had been shot once through the back. When surgeons operated they found a bullet in the boyâs stomach.
âHe was very lucky because it missed a lot of the vital organs but it was just sitting in his abdomen,â he said.
The surgeon took a photo of the bullet, which former IDF soldiers who spoke with the Guardian identified as a powerful .50 calibre round typically fired from a machine gun mounted on an armoured vehicle, although it has also been used in sniper rifles. They said that vehicle-mounted guns often have advanced sighting systems that allow them to target shots but that large numbers of .50 rounds could be fired without precision targeting, making it difficult to establish whether the child was targeted.
Other bullets recovered from young Palestinians include 5.56mm rounds that are standard issue for all IDF infantry rifles but also used by marksmen attached to all infantry units.
Gupta provided the Guardian with CT scans of children with head wounds. These included one of an eight-year-old girl that a pathologist described as showing a âgunshot wound to the head entering right side with bullet in brain (medial right temporal lobe)â.
![A brain scan shows a bullet lodged in the skull of an 8-year-old Palestinian girl.](https://i.guim.co.uk/img/media/e2fc158f13061224329ba3f06aef6a2e4571da39/0_0_1280_943/master/1280.jpg?width=445&dpr=1&s=none&crop=none)
Although doctors were shocked at the number of child victims, they said they believed the shootings were part of a broader pattern of targeting Palestinian civilians, including elderly people.
âThe vast majority of people we saw were not combatants,â said Ahmad. âThere was an elderly woman who was on the back of a donkey cart when she was shot. The bullet lodged in her spine and she was paralysed from the waist down and also her lung collapsed. She was somewhere between 60 and 70 years old.â
âSniper wounds were commonâ
Dr Osaid Alser helped organise a group of doctors outside Gaza to give long-distance guidance to the only Palestinian general surgeon remaining at Nasser hospital, who only had limited experience.
âSniper wounds were common, and quadcopter gunshots as well,â said Alser, who grew up in Gaza City and now lives in Texas.
Doctors said that apparent sniper shots also account for numerous amputations and long-term disabilities, made all the worse in children because a bullet often causes more damage to small bodies.
Alser argued that it was often possible to distinguish sniper shots.
âWhen itâs a sniper, usually itâs a bigger bullet, which causes significantly more damage and has more shock-wave energy as compared to a smaller rifle or a pistol. If itâs a sniper, it may cause amputation of the limb because it will cause damage to the vascular structure â nerves, bone, soft tissue, everything,â he said.
âAnother pattern is injury to the spinal cord when people are shot in the middle of the abdomen or in the middle of the back. Spinal cord injury is not necessarily fatal, unless itâs the neck, but it can be disabling.â
![Patients lie on the floor of a hospital](https://i.guim.co.uk/img/media/1d08d38610962b8c1204a9186731c96eb1949aaf/0_0_1200_1600/master/1200.jpg?width=445&dpr=1&s=none&crop=none)
Alser said that one of his elderly relatives, a pioneer of dentistry in Gaza, was among the apparent victims of a sniper.
Dr Mohammed Al Madhoun went missing after seeking medical treatment for a chronic condition at a charity hospital west of Gaza City in December. The 73-year-oldâs body was found near the hospital a week later alongside that of his great-nephew. They had both been shot.
âThe pattern of injury, and the amount of damage from the bullet, was significant, and thatâs mainly caused by a sniper,â said Alser, who reviewed CT scans of the injury. âHe was obviously old. You wouldnât expect a 73-year-old to be a target, right?â
The doctor said the cases he reviewed remotely included other elderly people, among them a woman in her 70s.
âShe was shot by a sniper and she had a massive head bleed. That is non-survivable. She died a day or two after,â he said.
In October, Israelâs prime minister, Benjamin Netanyahu, described the IDF as âthe most moral army in the worldâ. The Israeli military claims to be guided by a âpurity of armsâ doctrine that precludes soldiers from harming âuninvolved civiliansâ.
But Israeli and international human rights groups have long said that the militaryâs failure to enforce its own standards â and its willingness to cover up breaches â has contributed to a climate of impunity for soldiers who target civilians.
The groups say it is extremely difficult at this stage to quantify the scale of such shootings in Gaza, not least because their own staff are often displaced and under attack. But Miranda Cleland of Defense for Children International Palestine said that over the years there had been a âclear pattern of Israeli forces targeting Palestinian children with deadly force in situations where the children posed no threat to soldiersâ.
âIn the occupied West Bank, Israeli soldiers routinely shoot children in the head, chest or abdomen, all areas from which a child will quickly bleed out if they arenât killed instantly. Many of these children are shot by Israeli forces from great distances, sometimes upwards of 500ft, which is something only a trained military sniper would be capable of,â she said.
An Israeli group, Breaking the Silence, collected testimonies from IDF soldiers in earlier conflicts who said they shot Palestinian civilians merely because they were where they were not supposed to be even though it was evident they were not combatants.
IDF snipers boasted about shooting unarmed Palestinian protesters, including young people, in the knees during nearly two years of demonstrations at the Gaza border fence from the spring of 2018.
![A combination photo showing 10 Palestinians who were shot in the legs](https://i.guim.co.uk/img/media/8793e6becabfad94f9e276acb4f9515d5141805c/0_0_4000_2667/master/4000.jpg?width=445&dpr=1&s=none&crop=none)
One former Israeli army sniper, who did not want to be named, told the Guardian that the IDFâs open-fire regulations were so broad that a soldier has extensive leeway to shoot at anyone once an area is declared a combat zone.
âThe problem is the regulations that enable soldiers who just want to shoot Palestinians. In my experience, most soldiers who pull a trigger only want to kill those who should be killed but there are those who regard all the Arabs as the enemy and find any reason to shoot or no reason at all,â he said, adding that a system of impunity protects such soldiers.
âEven if they are outside the regulations, the system will protect them. The army will cover up. The other soldiers in the unit will not object or they will celebrate another dead Arab. Thereâs no accountability so even the loosest regulations have no real meaning.â
The Israeli human rights group BâTselem has described the IDFâs open-fire regulations as âno more than a semblance of legalityâ in part because they are ârepeatedly violatedâ.
âOther than a handful of cases, usually involving low-ranking soldiers, no one has been put on trial for harming Palestinians,â the group said.
In one of the most notorious cases of soldiers shooting young children in the occupied territories, an army captain fired the entire magazine of his automatic rifle into a 13-year-old Palestinian girl, Iman al-Hams, in 2004 after she crossed into a security zone even though she posed no immediate threat and his own soldiers told him she was âa little girlâ who was âscared to deathâ. The captain was cleared of wrongdoing by a military court.
![A man prays over a shrouded body](https://i.guim.co.uk/img/media/5e0e3bf9cf79455913eb644a6d619cd1e7b987ed/0_0_2200_1462/master/2200.jpg?width=445&dpr=1&s=none&crop=none)
The Israeli military also has a long history of covering up the killing of children.
After 11-year-old Khalil al-Mughrabi was shot dead as he played football in Rafah in 2001, the Israeli human rights organisation BâTselem wrote to the IDF demanding an inquiry.
![A mother hugs her dead child](https://i.guim.co.uk/img/media/39543a9c6f380cb1ba4e0d5fb29b57f0d0cd4d36/0_0_2048_1438/master/2048.jpg?width=445&dpr=1&s=none&crop=none)
Months later, the judge advocate generalâs office told BâTselem that Khalil was shot by soldiers who acted with ârestraint and controlâ to disperse a riot in the area. However, the IDF made the mistake of attaching a copy of its secret internal investigation, which said the riot had been much earlier in the day and that soldiers who opened fire on the child were guilty of a âserious deviation from obligatory norms of behaviourâ.
The chief military prosecutor, Col Einat Ron, then spelled out alternative false scenarios that should be offered to BâTselem to cover up the crime.
More recently, the IDF was accused of lying to cover up the shooting of the Palestinian American journalist Shireen Abu Akleh, almost certainly by an Israeli sniper. The military at first blamed the Palestinians and then falsely claimed that Abu Akleh was caught in crossfire during a gun battle. Her employer, Al Jazeera, presented video evidence that there was no firefight and that at least one Israeli soldier was targeting the journalist.
![A child lies in a hospital bed](https://i.guim.co.uk/img/media/f3da64678c3a0c1e785c4ff58fd7b2ecdc502340/0_0_4032_3024/master/4032.jpg?width=445&dpr=1&s=none&crop=none)
Alvi, the Canadian physician, left Gaza in the third week of February as Israeli forces were threatening a ground assault against Rafah. Alvi founded the US-based charity Humanity Auxilium, which has worked with Rohingya refugees in Bangladesh, displaced Syrians and earthquake survivors in Turkey.
âThis is not a normal war. The war in Ukraine has killed 500 kids in two years and the war in Gaza has killed over 10,000 in less than five months. We have seen wars before but this is something that is a dark stain on our shared humanity.â