GAZA CITY -- In the grimy, overcrowded and rodent-infested wards of Shifa Hospital, the Gaza Strip's largest medical facility, the results of the Israeli Army's "break their bones" policy are still trickling in.
In one bed in the men's surgical ward lay Yusef Jamil Ali Hammada, 40. He had two broken arms, two broken legs, a broken left hand and 12 scalp lacerations. When ambulance workers carried him in last Monday from the Ansar II detention center, he had no blood pressure whatsoever. He is slowly recovering.
Hammada says Israeli soldiers attacked him with lead pipes. The Army says he tried to take a gun from a soldier and was injured in the ensuing struggle.
In the next room lay Khaled Akal, 19, nursing a broken left arm and deep bruises on his legs and arms. His 17-year-old cousin, Iyad, died in the bed next to him last Sunday night. Akal says he and his cousin were seized by soldiers, dragged from their home in the Bureij refugee camp and beaten in a vacant lot near the camp cemetery.
The Army denies Iyad Akal was beaten by soldiers. But he was one of three Gazans to die under mysterious circumstances last week.
Downstairs in the women's ward, Fatma Hashisha, 34, was brought in Tuesday with a fractured leg. She said soldiers came to arrest her 17-year-old son for stone-throwing and she stalled them while he fled. The soldiers got angry, smashed furniture in her house and then broke her leg, she said.
Israel says it is gradually restoring order here and in the occupied West Bank, after two months of civil unrest in which at least 54 Palestinians have died. But here in the hospital where some of the most seriously injured beating victims come for treatment, the struggle for control of Gaza looks more like a war of attrition than a return to normalcy.
Between a dozen and two dozen beating victims arrive here every day, hospital officials say, and they contend many others are either too afraid to seek care or are prevented from leaving their homes by military curfews in their areas.
Those who come are received at a hospital that, according to H. Jack Geiger, an American physician who visited here last week, "is at best of medium Third World standards.
"The wards and the floors are filthy, the bathrooms are filthy, the kitchens are filthy, cats are running around the corridors," said Geiger, who is on the faculty of the City University of New York Medical School. "It's a miracle there aren't serious infections. The physicians are doing a phenomenal job in miserable circumstances."
Shifa is a collection of ramshackle buildings and makeshift annexes first opened in the early 1950s during the days of Egyptian rule. It has 360 beds and about 90 doctors. Although it serves as the major medical emergency center for a population exceeding 600,000, it has no intensive care unit or CAT scan equipment. Many patients with serious injuries must be transferred to better-equipped Israeli hospitals in nearby Ashkelon or Beersheba.
But Shifa is not just a hospital. In the past two months it has become a kind of collective thermometer where journalists and other observers measure the fever of Gaza's uprising and the anger of the Army's reaction. When things get hot in the refugee camps, Shifa's wards begin to overflow.
The Army, too, sees Shifa as something more than a hospital. There is a 24-hour military checkpoint at its entrance and Palestinians seeking to go inside are often required to leave their identity cards at the gate. The Army says this is done to keep the area tranquil, but doctors contend the guardpost discourages many patients from seeking treatment inside.
During the first three weeks of the violence, Shifa was also a battleground. Soldiers entered its grounds on 10 occasions, according to hospital records. Two Palestinians were shot dead on hospital property, more than 40 were injured by gunshot wounds or beatings and more than 100 were arrested.
Soldiers pursuing alleged rioters entered virtually every ward, even the operating theater. One surgeon recalls being in the middle of an emergency operation when a bullet whizzed through the room. Last week a group of plainclothes security agents entered the main building at night and took three persons to detention, a staff member said.
Anxious relatives and friends of patients cram the wards and the hallways, leaning nervously against the walls of peeling yellow paint and ignoring the "No Smoking" signs. The steady din of chatter is occasionally pierced by hysterical screams. Doctors regularly work 100 hours or more a week to deal with the overload of emergency cases.
"You can see -- it's a market, not a hospital," said a surgeon, taking a break during a busy morning last week. Like other staff members here, he insisted on anonymity because he says he fears retaliation by the Israeli Army. "A lot of cases are treated and sent home immediately because we simply do not have room for them, and a lot of others never come at all."
The Army says the beatings policy, first enunciated publicly by Defense Minister Yitzhak Rabin in mid-January, is designed to suppress riots while causing fewer fatalities and serious injuries than live bullets. Physical force is only supposed to be used to subdue rioters and those resisting arrest, the Army contends.
Geiger's team of four American medical experts who toured the territories last week under the auspices of Physicians for Human Rights, a Boston-based monitoring group, confirmed that most of the beatings appear designed to injure, not kill. But they told a press conference in Jerusalem that the nature of many injuries indicates the beatings are inflicted methodically and not in the heat of combat.
They also said that injuries in Gaza appeared far more severe than those in the West Bank and were more likely to result in fatalities.
An Army spokesman conceded that injuries in Gaza were generally more severe, but said the reason was that demonstrations there often involve larger groups of people who are more eager for confrontation than their West Bank brethren. Brig. Gen. Yitzhak Mordechai, the Gaza military commander, told reporters last week that unjustified beatings by soldiers there had occurred only in "isolated instances."
The first of three Gazans to die last week was Rami Akluk, 15, transferred from a local hospital to the Makassed Hospital in Arab East Jerusalem because Shifa did not have the facilities to give him neurosurgical treatment. He died of brain damage on the afternoon of Feb. 7.
Akluk had had a brain hemorrhage a year ago and the Army contends he died from natural causes, not a beating. But the boy's father said Akluk was hit by soldiers, and Hani Abdeen, a doctor at Makassed who examined the boy, said Akluk had bruise marks on his head. Geiger says it is possible that since the boy had a history of hemorrhages, even a light blow to the head could have caused death.
The second victim was Iyad Akal, 17. His cousin, Khaled, said the soldiers left him lying unconscious in the vacant lot. Akal was brought to Shifa in a private car in a state of severe shock on Feb. 7.
A doctor who examined Akal that night said the boy woke up eventually and felt well enough to get out of bed to urinate. But on the way back he collapsed and died suddenly. The doctor believes an embolism such as a massive blood clot caused by the beating was pushed loose and killed the boy when he stood up.
Israeli authorities usually claim for autopsy the corpses of victims hurt in the unrest, returning the bodies for carefully restricted nighttime funerals. But within minutes after his death, Akal's family rushed the corpse from Shifa. He was buried at Bureij the next morning in a ceremony that set off a new round of violence at the camp.
Because of the quick burial, the Army said it could not determine the cause of death. But a military spokesman said soldiers denied being in Bureij at the time of Akal's beating. "We think the family is trying to hitch a ride on the unrest," he said.
The third victim was Khader Tarazi, 19, a resident of a Gaza City neighborhood just a few blocks from the hospital. His father, Elias, interviewed at his home, said Khader had left the house on his bicycle Monday afternoon to go to the market.
On the way there Khader came across a confrontation between soldiers and stone-throwers and ducked into a house to wait it out, his father said. But soldiers followed Khader into the house, beat him with clubs, and when he tried to flee, four or five soldiers put him against the hood of their jeep and beat him again. Neighbors at the scene told the father that the soldiers then threw Khader's lifeless body into the vehicle and drove off.
Elias Tarazi and his wife, members of a prominent Gaza Christian family, then began a fruitless search at military headquarters and Ansar II prison for their son.
The next day a deputy military governor called one of Tarazi's cousins, a city engineer, and informed him that Khaled had been taken unconscious to Soroka Hospital in Beersheba where he died. The hospital says he had multiple bruises and suffered a blow to his skull. The Army says Khaled died of "heart failure" but added it is still investigating the incident.
Elias Tarazi says he does not care what the Army finally rules. "He was just starting to build his life," said the father. "I will never forget my son and I will never forgive Israel. I will be an enemy of Israel forever."