(WASHINGTON) — President Joe Biden said on Monday he had told Israel he had concerns about conditions at and around the Al-Shifa Hospital in Gaza where its forces are fighting with Hamas.

“I have not been reluctant in expressing my concerns about what’s going on and it’s my hope and expectation that it will be less intrusive action relative to the hospital,” Biden said.

“So, I remain somewhat hopeful but the hospital must be protected,” he said.

On Monday morning, a Doctors Without Borders surgeon working at Gaza’s largest hospital said when an ambulance was sent outside the hospital gate to bring in patients, the ambulance was attacked.

The U.S. and Israel have said Hamas is using Gaza hospitals as command posts.

Expanding on Biden’s comments at the daily White House press briefing, national security adviser Jake Sullivan said, despite the growing concerns in Gaza, the U.S. is confident from conversations with Israel that they “hold similar positions.”

He specifically said both countries agree that there should be no “firefights” in hospitals.

“What the president has just said, and what I’ve said, is that we do not want to see firefights in hospitals. We want to see patients protected, we want to see hospitals protected. We have spoken with Israeli government about this, and they have said they share that view, that they do not want to see firefights in hospitals, and you’ve heard, from IDF (Israel Defense Forces) spokespeople stating things along those lines,” Sullivan said.

He also said the U.S. is continuing to work on getting fuel to hospitals and allowing evacuations from hospitals, if patients are in danger. All of those positions have been echoed by Israel, Sullivan said.

“So, these are positions that, for us, are straightforward, they are clear. We have a constructive discussion with the Israeli government on this and I believe that they have indicated they hold similar positions on these issues,” he said.

But he allowed for the possibility that what plays out on the ground is different.

“Now, as for what happens on the ground, you know, in a given hour, on a given day, we can’t react to every individual report, we can simply continue to state our position and continue to consult with the Israeli government to ensure that they are doing their best to fulfill their stated position on this,” he said.

While the White House is emphasizing the need to protect civilians in and around Gaza’s hospitals, two administration officials said the U.S. has intelligence supporting Israel’s assessment that Hamas is using Al-Shifa to shelter a command center under the medical complex — further complicating the situation on the ground.

Like other administration officials, State Department spokesperson Matthew Miller declined to weigh in on Hamas’ operations surrounding Al-Shifa specifically and underscored that regardless of the terror groups’ activities, these centers were still serving vital civilian needs and must be safeguarded.

“We don’t want to see hospitals be the subject of crossfire. We want to see the civilians who are sheltering in hospitals, the civilians who are being treated in hospitals, including babies in hospitals, be protected. Hospitals are legitimate civilian infrastructure; they should be protected. At the same time, I would say Hamas continues to use hospitals as locations for its command posts,” Miller said. “This is a very difficult issue.”

Miller also stressed that Hamas bore responsibility for the suffering at hospitals.

“We would love to see Hamas vacate the hospitals it’s using [as] command posts immediately. We would love to see all the people that are calling for Israel to take steps to protect hospitals call for Hamas to vacate the hospitals and stop using civilians as human shields. We would love to see Hamas take some of the fuel reserves it’s sitting on and use that to supply hospitals in northern Gaza. We would love to see Hamas have taken the fuel that Israel offered it yesterday that they declined for use at Al Shifa Hospital,” he said.

Since Hamas launched a surprise attack on Oct. 7, more than 1,200 have been killed in Israel, according to the Israeli prime minister’s office. And more than 11,000 people have been killed in Gaza, according to the Hamas-run Gaza Health Ministry.

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