Subterranean parking garages are designed to save space. In Israeli hospitals, they’re also designed to save lives.

Over the past decade, while terrorist organization Hamas has spent millions digging tunnels under Gaza hospitals to harbor militants and their weapons, Israeli hospitals have spent millions creating underground medical facilities to complement aboveground fortified spaces for continuous patient care in case of attack. 

It’s not a theoretical threat: Since October 7, myriad rockets have fallen close to northern and southern hospitals. Barzilai Medical Center in Ashkelon has taken three direct hits from Hamas missiles, and a Hezbollah attack severely damaged a northern rehab hospital in the Upper Galilee on August 10. 

In case of an all-out war with Hezbollah in Lebanon, or additional attacks from Gaza, Yemen or Iran, hospitals throughout Israel are further fortifying aboveground units and preparing – or already providing – underground care facilities.

Among others, these include Galilee Medical Center in Nahariya; Rambam Health Care Campus in Haifa; Emek Medical Center in Afula; Baruch Padeh Medical Center in Tiberias; Sheba Medical Center in Ramat Gan; Tel Aviv Sourasky Medical Center; Beilinson Hospital in Petah Tikva; Hadassah University Medical Center and Herzog Medical Center in Jerusalem; and Barzilai in Ashkelon.  

Healthcare under fire

The three-level Sammy Ofer Fortified Underground Hospital at Rambam opened in 2014. Reportedly the world’s largest underground hospital, it can withstand conventional, chemical and biological attacks. 

Hospital spokesman David Ratner tells ISRAEL21c it was constructed in the wake of the 2006 Second Lebanon War.

“We were under attack from Hezbollah and [about 60] rockets fell really close to Rambam. We had no shelter at that time and the directors decided to fortify so we could provide healthcare even under fire,” he says.

“We dug deep, building a large parking garage that can convert within 72 hours into a fully operational hospital.”

As the largest medical center in northern Israel and the fifth largest in Israel, Rambam regularly holds drills preparing its medical staff to transfer all patients calmly and quickly, within six to eight hours, once the underground hybrid hospital is ready.

“It’s not just a parking lot that you push hospital beds into,” says Ratner. 

“All the vacuum lines, all the oxygen lines, medical gases, computer data, electricity –it’s all embedded in the concrete walls, which makes this unique. We just have to take out the cars, clean up, and put in special panels that connect to the embedded lines and turn every parking space into an area where you can put a few hospital beds.”

Two days after the October 7 terror attacks from Gaza, which triggered attacks from Lebanon, Rambam Director General Dr. Michael Halberthal ordered staff to begin the preliminary transition. 

“We cleaned floor minus-3 and put in 1,200 beds. Right now it’s standing empty and ready,” Ratner said on August 9. 

“We have another 700 beds on minus-2, which makes 1,900 altogether. We also have 90 dialysis stations. Every medical and surgical department that we have aboveground, we have a mirror department underground,” says Ratner. 

“We have another 200 beds aboveground in fortified departments such as intensive care units for kids and adults,” he continues. “Altogether, that’s about 2,200 beds; this number makes us the largest fortified facility in Israel and possibly in the world.” 

There’s also underground space to accommodate 400 kids – both inpatients from Rambam’s children’s hospital and children of employees. 

Ratner says that Rambam stands ready as well to take in patients from Haifa’s Fliman Geriatric Hospital and Carmel Hospital. 

The underground hospital can function for at least 72 hours independently of the electricity and water grid, anticipating the possibility of interruptions in service during war or natural disaster.

The underground facility cost more than $120 million to build (more than half coming from donors, most prominently the Ofer family). 

“Every year we must raise money for its maintenance, because it is very expensive to make it chemical and biological warfare resistant,” says Ratner. 

Not just for wartime

Israel’s underground emergency hospital spaces are useful not only in wartime. Several of them answered a need for keeping Covid-19 patients isolated from other patients during the pandemic.

One example is the 350-bed fortified underground complex at Beilinson, a 1,300-bed hospital in central Israel. This underground facility opened in September 2020 in response to Covid.

The 5,000-square-meter complex on two floors of a subterranean parking lot was expanded to include intensive-care units, surgery departments, orthopedics, internal medicine departments, and a 20-station dialysis unit.

“As part of Israel’s emergency operations planning and management system, Beilinson Hospital opened its underground hospital in the first days of the war, in October 2023, to ensure uninterrupted care for Israel’s most vulnerable,” said a hospital spokesman.

“Since the beginning of the war, Beilinson Hospital has operated without interruption, serving its ongoing role in the healthcare system in Israel while treating victims of terrorist attacks and more than 1,000 wounded heroes of the IDF and the security services who were wounded on the battlefield,” he said. 

“In addition to the underground hospital, all the aboveground hospital buildings have secure spaces and floors to continue to treat patients without the need to move the most critical patients and equipment during an attack. The emergency department of the hospital is fully protected and includes a trauma center and more than 100 stations for the treatment of ambulatory and non-ambulatory patients.”