In a proactive response to escalating tensions and fighting between Israel and Lebanese militants near the border, the Galilee Medical Center in Nahariya, northern Israel, has moved critical hospital facilities underground. The hospital, situated merely 6 miles from the Lebanese border, has shifted essential units, including the neonatal intensive care unit (NICU), to subterranean spaces. Dr. Masad Barhoum, the hospital's director, emphasized that this move is aimed at ensuring the continuity of patient care, even under the threat of conflict.

The decision to relocate portions of the hospital underground was prompted by recent events, particularly the incursion of Hamas-backed militants from the Gaza Strip into southern Israel on October 7. The ensuing conflict has seen significant casualties and damage in Gaza, with over 10,000 Palestinians killed and hospitals facing strain.

In Nahariya, the hospital's preparedness for potential conflict has been a long-standing effort, given the ongoing tensions with Iran-backed Hezbollah and other armed factions in Lebanon. The region witnesses daily exchanges of rocket fire and artillery, heightening the risk to civilians on both sides of the border. As the specter of a broader conflict looms, Galilee Medical Center's proactive measures underscore the gravity of the situation and the dedication to ensuring healthcare continuity in the face of potential hostilities.

Galilee Medical Center's strategic move to utilize underground facilities as wartime protections dates back to Israel's 2006 war with Lebanon. During that conflict, the hospital's foresight proved crucial when a missile from Lebanon struck the fourth floor. Fortunately, the medical care had already been relocated underground, sparing staff and patients from harm. This experience underscores the efficacy of such measures in ensuring the safety of medical personnel and those in need of care during times of heightened conflict.

This proactive approach is not unique to Galilee Medical Center. Throughout Israel, especially in the northern regions, hospitals are adopting similar strategies—either moving critical operations underground, into fortified areas, or actively preparing to do so. Rambam Health Care Campus in the northwestern city of Haifa, Israel's largest trauma hospital, exemplifies this trend by converting a three-floor underground parking garage into a fully functional hospital. The transformation includes hospital beds, oxygen hookups, monitors, and respirators, totaling 1,400 beds underground.

Dr. Netanel Horowitz, part of the team establishing the underground hospital in Haifa, highlights the unique global significance of such facilities. With heightened border tensions, the hospital is on high alert, ready to move operations underground at a moment's notice.

The regional context adds urgency to these preparations, with Hezbollah's leader, Hassan Nasrallah, expressing readiness to escalate the conflict further. Israeli Prime Minister Benjamin Netanyahu, in response, issues warnings of consequences for any attacks from Lebanon.

In Nahariya's Galilee Medical Center, the NICU was the first unit to transition underground, reflecting a commitment to safeguarding vulnerable infants and ensuring continuous medical care. As geopolitical tensions persist, these measures underscore the resilience of Israel's healthcare system in the face of potential threats, aligning with a broader trend of hospitals fortifying their infrastructure to prioritize the safety and well-being of both patients and medical staff.

In Nahariya's Galilee Medical Center, the commitment to safety extends beyond moving critical units underground. Dr. Vered Fleisher Sheffer, who oversees the neonatal intensive care unit (NICU), emphasizes the paramount importance of safety for parents and the most vulnerable babies. The unit continues to provide seamless care for infants delivered as early as 24 weeks, even amid the ongoing conflict.

This dedication stands in stark contrast to the challenges faced by the healthcare system in the Gaza Strip. Struggling before Israel's recent military response to Hamas attacks, the Gaza health system has seen 18 hospitals and most primary care centers cease functioning due to attacks or fuel shortages since October 7, according to Gaza's Health Ministry.

Galilee Medical Center's preparedness goes beyond moving underground. The hospital's first floor is fortified to withstand missile attacks, safeguarding crucial departments such as trauma, the ambulance bay, and surgical rooms from potential attacks from Lebanon. Heavy steel doors protect the opening to the first-floor trauma center and emergency room, with provisions like a shower ready in case of chemical weapon use.

The hospital, in recent weeks, has been receiving Israeli soldiers wounded in Gaza fighting and over 200 northern residents injured in rocket attacks from Lebanon. Dr. Bahir Sirhan, working in the emergency department, underscores the immediacy of the threat, stating, "The war is already here. It's here." Dr. Sirhan shares a personal experience of receiving relatives injured in a rocket attack, highlighting the emotional challenges faced by medical professionals in times of conflict.

Navigating the dual roles of healthcare provider and family member, Dr. Sirhan reflects on the intense moments when professional duties intersect with personal connections, illustrating the profound impact of the ongoing conflict on both the healthcare system and the individuals directly involved.

In the midst of escalating tensions and ongoing conflict, the underground facilities at Galilee Medical Center in Nahariya serve as a crucial refuge for medical professionals like Dr. Bahir Sirhan, who faced the emotionally challenging experience of treating his injured relatives. Despite the patients' non-critical injuries and subsequent recovery, the haunting nature of the encounter emphasizes the personal toll that the conflict exacts on healthcare providers.

Meanwhile, at Rambam Hospital in Haifa, preparedness takes the form of mostly empty, yet fully equipped, underground facilities. Hospital beds occupy parking spots, sections are marked for patient areas with hookups, and hospital leaders conduct drills to familiarize nurses and doctors with working in this subterranean space. Alina Maister, an internal medicine nurse participating in the training exercise, acknowledges the terrifying and frightening nature of the situation but emphasizes the importance of preparedness. For healthcare professionals like Maister, understanding the procedures and being ready for the worst ensures effective management during challenging times.

During the drill, staff members engage in practicing triage and treatment on pretend-patients, played by their coworkers and members of the Israeli military. Challenges emerge, such as difficulties in hearing patients due to acoustics and the need to navigate new locations for hospital sections like the ICU and operating rooms. The drill serves not only as a practical exercise but also highlights the complex logistics and coordination required for effective medical response in underground facilities during times of heightened conflict.

Alina Maister, an internal medicine nurse at Rambam Hospital in Haifa, expresses confidence in the adaptability of medical professionals to navigate the challenges of working in underground facilities during drills. Despite the complexities of the new environment, Maister underscores the strength of nurses in handling diverse situations, emphasizing their resilience and ability to adapt.

At Rambam Hospital, the pediatric dialysis unit is already fully operational in the converted underground garage. Amid the hum of activity, children play video games, and a father shares a moment with his daughter while listening to a pop song. Tal Romano, whose 4-year-old son Hadar is undergoing dialysis, finds comfort in the underground setting, describing it as a safe environment. However, he notes that, for children like Hadar, adjusting to the absence of the colorful and kid-friendly decor from the upstairs unit poses a challenge. Despite the necessary adjustments, Romano emphasizes the paramount importance of safety and acknowledges the efforts of the medical staff in maintaining a positive and supportive atmosphere for young patients like Hadar.

In conclusion, the transformation of Israeli hospitals, such as Galilee Medical Center in Nahariya and Rambam Hospital in Haifa, to incorporate underground facilities reflects a proactive response to the escalating conflict with Lebanon and the ongoing regional tensions. This shift ensures the continuity of medical care and safety for both patients and healthcare professionals in the face of potential missile attacks and other security threats.

The commitment of medical personnel, like Dr. Bahir Sirhan and nurse Alina Maister, to adapt and navigate the challenges of working in subterranean environments is evident. Their confidence in handling diverse situations and the resilience of nurses as a strength underscore the healthcare system's preparedness in these uncertain times.

The conversion of underground spaces not only serves practical purposes but also highlights the emotional and logistical complexities involved in treating patients, especially children, in these subterranean settings. While safety remains paramount, the challenge lies in providing a supportive and reassuring environment for patients who may miss the vibrant decor of traditional medical units.

As the conflict unfolds, the dedication of healthcare professionals, coupled with ongoing drills and preparedness measures, exemplifies the resilience and adaptability of the Israeli healthcare system in ensuring medical care continuity and safety in the face of adversity.