The rows of hospital beds with adjacent oxygen units line the underground parking lot.

Four operating rooms, a maternity ward and a dialysis center are among the facilities that Haifa’s Rambam Health Care Campus has set up three levels down in its parking garage.

The largest hospital in northern Israel has created the biggest underground hospital in the world, and is gearing up for what could be an all-out war against Hezbollah in Lebanon.

The three-floor, $140 million Fortified Underground Emergency Hospital was constructed following the Second Lebanon War with the terrorist organisation in 2006, when the Iranian proxy fired about 70 missiles on this northern port city over a month, shaking the hospital in an era before the Iron Dome aerial-defense system was in place.

“We made a commitment that this scenario cannot happen again,” recalled hospital director Professor Michael Halberthal during a tour of the facility on Sunday.

The 2,000-plus bed subterranean emergency hospital, which has been ready if unused over the last decade, is essentially a 1,500-car garage that has been seamlessly converted into a fortified hospital for warfare, and which can be put in full use within eight hours.

Nearly two decades after the last major war with Hezbollah, the security threats have only grown, with the Shi'ite terrorist group, which has been raining down missiles on Israel almost daily since the Oct. 7 Hamas massacre that triggered the war in Gaza, better trained and more heavily armed, with a missile stockpile experts estimate at 150,000 projectiles capable of striking virtually the entire country.

Halberthal said that the Israeli military assessment for an all-out war is that Hezbollah would fire a missile at Haifa every four minutes for 60 days, leading to thousands of casualties.

“We wanted peace of mind so we can continue to work, and to reduce exposure time if there is a sudden missile attack on northern Israel,” he said.

The facility, which was based on a model in Singapore, received 30% funding from the state, with the remainder financed by Jewish and Christian philanthropists -- including the late Israeli shipping magnate Sammy Ofer who the hospital is named after -- and charities.

During the coronavirus pandemic, it was converted into the largest COVID-19 facility in Israel.

With tensions with Hezbollah running high—Israel killed a top Hezbollah leader in Beirut last month after a Hezbollah rocket killed 12 Israeli children playing soccer in the Golan Heights—the underground hospital is again primed for use.

One of its three 20,000-square meter (5-acre) floors has been cleared of cars these last 10 months and put on standby, even as above ground the hospital has treated hundreds of casualties from the war, including the Druze children wounded in the Golan Heights attack.

Restrooms, showers, and even a daycare area in the underground facility can fit 8,000 people at full capacity, with electricity, water, oxygen, food and gas to make the facility self-sufficient for several days of warfare, the hospital director said.

A fortified hospital underground command centre replete with smart-screen TVs and a state-of-the-art hospital data computer system was donated by the International Fellowship of Christians and Jews for a medical centre where nearly one-third of its staff are non-Jews.

Beds stand ready to be put in position for the underground dialysis centre in Haifa. Courtesy of Rambam Health Care Campus.

No panic

“There is no panic but citizens are concerned,” said Tal Siboni, head of the Haifa Municipality’s emergency call centre, which since Oct. 7 has been operating in an underground bunker. “The phones are not ringing off the hook but we are prepared.”

This city of 300,000 residents, 12% of whom are Arabs, is, like many other Israeli communities these last 10 months, on edge.

About 60,000 Israelis have been evacuated from their homes in northern Israel following the attacks from Lebanon, with some relocating to Haifa.

Veteran Haifa Mayor Yona Yahav has said that in a full-scale war, Hezbollah could fire as many as 4,000 projectiles a day at northern Israel.

“I am being accused of being too pessimistic but it’s better to be too pessimistic,” he said on Monday, confirming his remarks, which raised eyebrows and were reported in the Arab world, even as he voiced the hope that an agreement could be reached to avert all-out war.

“We are the target,” the mayor said. “[Hezbollah leader Hassan] Nasrallah says it openly.”

In the meantime, the city has reduced the levels of hazardous materials at its petrochemical industries over the last two weeks as a safety measure in keeping with a military instruction, said Yair Zilberman, the city’s director of emergency preparedness and security.

“There are diplomatic efforts to de-escalate the conflict but we are readying for anything and everything,” said IDF foreign press spokesman Maj. David Avraham at a briefing in Haifa overlooking the city’s ports.

Back at the hospital, a steady stream of patients comes and goes through the main entrance on a warm and sun-swept summer day, seemingly oblivious to the preparations underway three levels down.

“We have to be optimistic,” Halberthal said. “Somewhere along the line there has to be an end to this.”