The medical professionals treating terrorists who participated in the October 7 attack face daily dilemmas, to what kind of medical treatment are these terrorists, some of whom were severely wounded, are worth? To what extent are the physicians, nurses and other medical professionals emotionally equipped to deal with the mission they took on? Are they able to disconnect themselves from the knowledge that they are treating people who committed and participated in atrocities and go about their jobs as normal?

Very little information has emerged thus far about what is happening at the field hospital set up at the Sde Teiman army base in the Negev desert, where Israel is holding terrorists from Hamas’ Nukhba Force and other Gazans who participated in the attack. 

For the first time, Shomrim can bring testimonies from inside the detention facility and highlight the issues that volunteers there are facing. Our conversations with the medical professionals and soldiers who served there provide the first insight into the difficulties that arise when treating terrorists.

Although the Sde Teiman field hospital is located on the grounds of an army base, it was actually set up by a private firm. The move was decided on by the Health Ministry, around one week after the start of the war, in part because members of the far-right La Familia organization had rioted at hospitals in central Israel, when it became obvious that these terrorists could not be treated in public hospitals.

“If you ask me, the first problem with this story is that the facility was set up by a private contractor,” says Prof. Yehiel Bar Ilan, an expert in medical ethics and a member of the Faculty of Medicine at Tel Aviv University, who has collected testimony from staff at Sde Teiman for a study – the most extensive conducted into the issue thus far.

The contractor that Bar Ilan is referring to is KLP, a company that exports defense systems and which has, in the past, operated field hospitals in Ukraine. It was selected without a tender by the Health Ministry.

“The fact that public medicine is not involved – that is, the IDF’s chief medical officer – is a problem,” Bar Ilan adds. “This is a civilian hospital. The physicians there are civilian volunteers. It is inconceivable that the chief medical officer, who is supposed to be responsible for running this kind of hospital, simply says that he won’t treat the enemy. There are orders. Once the war is over, a thorough investigation into this abrogation will be required.”

Bar Ilan, a doctor of internal medicine by profession, has been dealing with medical-military ethics for many years. He has intimate knowledge of the issue of medical care for detainees and prisoners and began to take an interest in what was happening at Sde Teiman when a colleague called him to consult. “A doctor who is a former student of mine called me after he was offered a position there treating wounded Palestinians,” he says. “I told him that it is important to volunteer and work there and from there I had more conversations with other physicians and medical professionals who served there and some of whom are still there. I quickly realized that something totally abnormal was happening there.”

The Sde Teiman field hospital is, in fact, a compound of five tents, each with 10 to 12 beds. One of the tents is fenced off and sterilized for surgeries. Another is where injured Palestinians are interrogated and only Shin Bet and Unit 504 officers are allowed to enter. The rest of the tents are used for hospitalized patients. Bar Ilan was not given permission to enter the Sde Teiman facility himself but has managed to speak to most of the medical team who worked there or who still work there. They agreed to cooperate with him anonymously and the article he wrote as a result of these testimonies is due to be published soon in an overseas journal.

When the field hospital was set up, just a few days after the outbreak of the war, the obvious question was: Where would the doctors come from? Since Sde Teiman was not a military hospital, it was not supposed to employ physicians who had been called up for reserve duty. On the other hand, this was nothing like the humanitarian missions that Israel often sends to overseas disaster areas and for which it asks doctors to volunteer. After all, Sde Teiman is where Israel treats terrorists who committed atrocities.

“Approaches were made to hospital directors and to senior figures in the medical world, asking if anyone is willing to volunteer,” Bar Ilan explains. “One senior physician told me that the director of the hospital he works in told him ‘We’ve been asked to send doctors to Sde Teiman. Who do you recommend?’ He told me that he thought about it for a minute, recognized that it would be an extremely difficult mission and how difficult it would be to convince other doctors – and said that he himself would go. For me, that reflects one of the positive things that happened there. The result was that the physicians who started working there are at the top of the Israeli medical world. These doctors brought their colleagues. When they needed to consult with someone, they could do so by sending a WhatsApp message.”

We only talk among ourselves

Shomrim approached many of the physicians who were part of the team providing treatment at Sde Teiman. All of them asked to be interviewed anonymously – and their answers are almost identical. Some of them were harshly criticized by colleagues and personal acquaintances when they found out where they were volunteering. Others are worried about groups like La Familia.

“Look, the atmosphere toward volunteers there is not positive,” says one of the physicians. “Most of my colleagues have fought in Gaza. It’s not easy when they find out that I have treated terrorists at Sde Teiman. Some of my colleagues also volunteered there and we only talked amongst ourselves about what happened there – including our frustrations over the way things were handled. Hospitals, including the one I work in, refused to treat the terrorists. Even though I saw injuries at Sde Teiman that justified taking the patient to a proper hospital, I understood that it would be wrong for me to make my opinion known to the management. It was implied that there was no point.”

During the first two or three weeks of operations, the Sde Teiman facility took in mainly terrorists from Hamas’ Nukhba Force. Some of them were in critical condition. Even though the facility was designed to house patients in stable condition and was not equipped to provide complex medical treatment, such procedures were carried out there since there were no other options. In the weeks that followed, more and more injured Palestinians, whom the IDF had brought back from Gaza, were taken to the facility. In all of these cases, the medical team did not know whether the person they were treating was a wounded terrorist or a noncombatant who had been arrested by Israel after being wounded.

As reported by CNN, the patients in Sde Teiman were strapped down by the hands and feet, their eyes were covered with flannel cloth and they were put into diapers so they could relieve themselves without having to be moved. Arguments soon broke out between the defense officials who managed the facility and doctors who were unused to treating patients in handcuffs.

“At first, all the detainees who were brought in for treatment were forced to wait on their knees. The doctors said that this was not acceptable and demanded that chairs be provided – something that the Military Police objected to. Even when the officers finally agreed to the demand, there were bureaucratic problems, like finding someone to physically bring the chairs to the facility,” Bar Ilan says. “There were also major arguments over whether detainees should be strapped down by all four limbs during treatment and whether they should be blindfolded during treatment or whether we should permit eye contact.” Bar Ilan adds that the decision to put the detainees in diapers and to feed them liquids was based on the need to avoid moving them as much as possible – but this necessarily meant that the nurses were forced to change diapers.

“Defecating in a diaper means that you need a team to clean. As does feeding someone with a spoon. We call this the infantilization of the patient and it became a complex issue at Sde Teiman,” he says. “Feeding, changing diapers and treating wounds – including removing maggots – were part of the team’s daily work. Some of them told me that the fact that the detainees were blindfolded made it easier as they did not have to make eye contact. There were some cases in the first few weeks that medical staff knew for certain that the patients who has maggots in their wounds were from the Nukhba Force [wounded terrorists whose wounds become infected while they hid in open spaces in southern Israel – RS]. It was extremely hard for the staff but they treated them anyway.”

“When a patient was covered in diarrhea, I had to wash him from head to toe. You can’t do that without intimacy and empathy – and it was extremely hard for me. The fact that he was blindfolded helped me keep an emotional distance. That way, I did not have to look into the eyes of someone who raped and murdered babies,” one nurse who volunteered at Sde Teiman told Bar Ilan in obvious emotional distresses.

Another problem was the lack of information about the patients and their medical history. “Everything was done haphazardly,” one of the sources told Shomrim. “The doctors wrote everything down in WhatsApp messages so that there would be documentation of what treatment they had given or to relay information to other doctors.” Among the other issues that were not addressed were how patients were to be given blood and what kinds of drugs to give them – but the very identity of the patients was the most disturbing part for the medical teams.

Arguing over pudding

“There is an innate dual loyalty when it comes to treating prisoners and detainees. You have to take care of the wellbeing of the patient but you also have to be loyal to the prison,” Bar Ilan explains. In the first few weeks after the Sde Teiman field hospital started operating, the medical teams’ problems were huge. In the news, the number of Israeli fatalities was still climbing and people were terrified about what could happen next – but in the tents at Sde Teiman, medical teams were forced to feed and treat people they knew for certain had taken part in the atrocities. According to Bar Ilan, “one nurse declared on arrival at Sde Teiman that he would not serve food to Hamas terrorists but when he stood there in front of patients in agony, he went above and beyond his ethical duty to ease their suffering.”

“The medical staff are torn every second: on the one hand are their professional ethics and their natural empathy they feel; on the other hand, there is a strong desire to differentiate Hamas patients from others,” Bar Ilan says. He adds that the nurses were responsible for feeding patients who were strapped down in their beds. “One of the nurses made scrambled eggs for the patients and peeled vegetables for them,” according to one of the testimonies that Bar Ilan collated. This led to an argument among medical staff over whether they should provide this “service” to terrorists or whether they should only be given the most basic sustenance.

In his article, Bar Ilan wrote that, since many of the patients were suffering from malnutrition, the medical staff considered adding to their menu a pudding that is rich in calories. This led to a heated argument between them and, in the end, a dietician was brought in to come up with a solution that “people found less unpleasant.”

“Two of the physicians I interviewed shared with me a case where they treated a patient who had been involved in the massacre. They discovered that, like them, he was a medic and that he spoke fluent English. Although he was given limb-saving treatment of the highest quality, he complained to the staff about behavior that he argued violated their ethical code as physicians,” Bar Ilan says.

The doctors in question, according to Bar Ilan’s account, were deeply disturbed by that conversation. In another case, one nurse related how a patient tried to kiss her hand – a common gesture of gratitude in Arab culture. The nurse pulled her hand back, slapped the patient and was subsequently summoned to a disciplinary hearing. She later left the facility. “Not everyone can stand this place,” was something that many of Bar Ilan’s interviewees told him.

Focus on biology

In order to function properly, medical teams reported that they employed a technique which, under normal circumstances, is something that the medical world is trying to put an end to: they tried to create a barrier between themselves and the patient and only deal with the injured organ or limb. In other words, to focus on human biology and not human beings.

One of the instances that the medical staff described as “an encouraging moment” came when a Shin Bet officer came to the facility and told them that “you are carrying the Hippocratic Oath on your shoulders.” In his article, Bar Ilan writes that “they were told that dead terrorists don’t help and do not advance Israel’s interest when it comes to finding the hostages. It was clear that the Shin Bet needed those patients for interrogation and that they had to be healthy enough to sit. One female physician told me that, one day, a member of the security forces came to her and showed her a newspaper article about a successful operation that had been carried out in Gaza. He said: ‘That came from here.’ In other words, from information from one of the patients. That really boosted our morale.”

This is what Bar Ilan wrote about that: “That created a paradox whereby, if the physician believes that a certain patient is evil, they will give them the best clinical treatment to help get information that could lead to the release of hostages and victory in the war.”

‘The problem is not the physicians who were there. It’s the system that created a place like that’

The Sde Teiman field hospital hit the headlines in Israel in April, when Haaretz newspaper revealed that a volunteer doctor at the facility had written a letter to the ministers of defense and health, as well as the attorney general, warning that Israel was breaking the law. “From the first days that the medical facility began operating until today, I have faced serious ethical dilemmas. More than that, I am writing [this letter] to warn you that the nature of operations at the facility does not comply with a single clause of dealing with health in the Incarceration of Unlawful Combatants Law,” the doctor wrote. He went on to describe a severe lack of equipment, patients being shackled for hours and harsh conditions throughout the facility – despite the fact that it was being used as a field hospital. The doctor went on to describe many cases of patients having limbs amputated because they had been shackled for so long.

On this issue, opinions are divided among those physicians who spoke with Shomrim. While one doctor argues that the adaptations carried out there were not proportionate, Bar Ilan believes that amputation can be a “cheap and live-saving operation. In normal hospitals, doctors fight to save a leg. But in military field hospitals, most of the operations are amputations. At Sde Teiman,” he adds, “some of the best orthopedists in Israel were working and they certainly saved the limbs of many patients or performed life-saving surgeries.” At the same time, Bar Ilan agrees that “there is no training in IDF in the use of zip ties. If you place them tighter and tighter on detainees’ wrists or ankles and leave them like that for many hours, there will be damage. It should never have happened.”

One senior physician who worked at Sde Teiman told Shomrim that he went to the facility “after a colleague asked to consult with me about a certain patient and I offered to come and look for myself. I found the patients bound to their beds in a star shape. Some of them were naked and it was winter at the time. The patient I came to see was also strapped down, even though he had gunshot wounds to the chest and there was no chance he would attack anybody. He had very complicated injuries, especially for a field hospital to deal with. He was treated at a regular hospital and then sent back to Sde Teiman, as had happened with many other patients. The doctors wanted to provide treatment and they asked for my help and the help of other colleagues in order to give the best possible treatment. The problem is not the physicians who were there. It’s the system that created a place like that.”

Due to the problematic nature of the situation, physicians at Sde Teiman asked the Health Ministry to send an ethics team to discuss their concerns. The ministry, however, made do with issuing a report on legal procedures that was published in December – and nothing beyond this. Since the government did not act, the Israeli Medicine Association sent its own ethics team to the facility some two months ago. The identities of members of the team were kept secret and it was careful not to include anyone who volunteers in their spare time for organizations like Doctors Without Borders. Officials involved in the issue told Shomrim that the Health Ministry was displeased with the visit and viewed it as “akin to kashrut inspectors” visiting facilities over which they have no authority.

At the end of the visit by the IMA’s ethics delegation, no report was written and no recommendations were published. In late April, however, the Chairperson of the IMA Ethics Board, Dr. Yossi Walfisch , published an article on the Israeli website Doctors Only, in which he gave a general description of the events that led to the establishment of the Sde Teiman field hospital and the medical dilemmas at play. Walfisch wrote that the physicians there were among the most moral and that the treatment they were providing was appropriate. “There is, in fact, no ethical supervision or clear ethical codes at this time for the medical teams treating the Sde Teiman detainees,” he wrote.

Bedside politics

Most of the physicians who worked at Sde Teiman went there voluntarily, although some of them were eventually issued emergency draft notices. Some knew in advance that they had the mental fortitude to treat injured enemy fighters and some had previously volunteered for humanitarian projects across the world. At the same time, one senior doctor who spoke to Shomrim said that there were those who went there with a very different agenda. “I can tell you that, while there were certainly doctors working at Sde Teiman who are close to organizations like Physicians for Human Rights, there were also some who openly declared that they were there to ensure that they were not treated compassionately and that we did not do more than the bare minimum. They didn’t hide this. In the end, a patient is treated by a team of physicians and nurses, not one individual, and when you have an agenda of this kind, everyone hears about it.”

In early June, after the harsh conditions at the Sde Teiman detention facility were made public, several human rights organizations petitioned the High Court, demanding the facility's closure. The petition stated, "Over the past few months, evidence has mounted revealing an unimaginable reality at the facility: surgeries performed without anesthesia, detainees held in painful positions for days, handcuffing leading to amputations, prolonged blindfolding even during medical treatment, and abuse."

In response to the petition, the state told the High Court that, of the 700 detainees currently being held at the facility, 500 would be relocated to the Ofer detention facility in the West Bank and 200 would remain at Sde Teiman but that conditions there would be improved.

On Monday, July 15th, the High Court issued a conditional order instructing the state to explain “why the Sde Teiman detention facility is not operated in accordance with the conditions set forth in the law governing internment of unlawful combatants.” Acting Supreme Court President Uzi Vogelman and Justices Daphne Barak-Erez and Ofer Grosskopf told the government to respond within 10 days.

The IDF response: Committed to treating every human

The Health Ministry submitted the following response: “In light of the considerable number of terrorists being held in Israel, the various security needs and the complexity of treatment in ‘regular’ frameworks, the army established a dedicated framework within the Sde Teiman military base. The medical teams operate in accordance with their legal obligations, medical ethics and international law. The medical staff have the medical equipment and drugs they need to provide appropriate treatment. To the extent necessary, and in accordance with medical needs, the terrorists are transferred to hospitals for treatment that cannot be given in the framework of the Sde Teiman field hospital.”

The IDF Spokesperson's Unit issued the following response: “The IDF, the Medical Corps and the medical teams are committed to treating every person, even when facing complex challenges. The IDF has set up clinics in the detention centers to provide a basic medical response, as an alternative to transferring detainees to hospitals, in situations where it was necessary.  At the same time, the Health Ministry chose to establish a designated medical facility adjacent to the detention facility to provide an advanced medical response.”