NAHARIYA, Israel — When you visit the Galilee Medical Center in northern Israel, you can hardly tell you're underground. There are nursing stations, hospital beds and a separate neonatal intensive care unit, or NICU.
There are familiar hospital scenes: a father caressing the feet of his newborn, family members crowded around the bed of an ailing loved one, and a nurse drawing blood.
The community hospital in Nahariya is just 6 miles from the border with Lebanon — where tensions and fighting between Israel and Lebanese militants are intensifying. The Israeli military says about 125,000 people have been evacuated from the border region to points south.
"We are underground with the patients because we are preparing ourselves to continue taking care of our patients, even under fire," explains Dr. Masad Barhoum, the director of the hospital. He's wearing a protective vest over his dress shirt.
It took only a few hours to move the first patients underground on Oct. 7, when Hamas-backed militants crossed from the Gaza Strip into southern Israel, killing more than 1,400 people and taking over 240 hostages, according to Israeli officials.
In the month since, Israel has bombarded Gaza, run by Hamas, killing more than 10,000 Palestinians and damaging overcrowded hospitals there, according to Gaza's Health Ministry.
The war has also ignited what experts are so far calling a "limited spillover" of conflict between Israeli forces and militants in neighboring Lebanon.
In northern Israel, the exchange of rocket fire and artillery with Iran-backed Hezbollah and other armed factions in Lebanon comes daily. In recent days, civilians on both sides of the border have died amid dozens of airstrikes. Just outside the hospital in Nahariya, it's common to hear drones and air raid sirens.
"Almost all the hospitals in Israel are preparing for the big war with Hezbollah," Barhoum says, "but we, specifically, are preparing this moment for many years."
Galilee's wartime protections were used in Israel's 2006 war with Lebanon. During that conflict, a missile from Lebanon hit the fourth floor of the hospital. Staff had already moved their medical care underground, so no one was injured in the attack.
All across Israel, but especially in the north, hospitals are moving underground or into fortified areas, or are preparing to do so.
Parking garage turned hospital
In the northwestern city of Haifa, Rambam Health Care Campus, has converted a three-floor underground parking garage into a hospital.
Where there used to be parking spots, there are now hospital beds, oxygen hookups, monitors and a respirator. Rambam, Israel's largest trauma hospital, has 1,400 beds underground.
"I'm not familiar with another facility like this in the whole world," says Dr. Netanel Horowitz, who is part of the team setting up the garage-turned-hospital in Haifa. "If we need tomorrow to go down, it's ready."
Each day, Horowitz says, he and his team are alert to elevated border action that could drive them underground.
Hassan Nasrallah, the leader of the Lebanese militant group Hezbollah, has said he's ready to escalate the war further at any moment, depending on the course of Israel's offensive in Gaza and its behavior toward Lebanon. "All scenarios are open on our Lebanese southern front," he said on Friday in his first speech since the conflict began.
Israeli Prime Minister Benjamin Netanyahu had his own threats for Hezbollah, saying an attack from Lebanon "will come at a price."
A model miles from the border
At Nahariya's Galilee Medical Center, the first unit to go underground was the NICU, where vulnerable babies get medical care. It took staff several hours to move all the equipment and patients down.
"I'm not afraid myself," says Dr. Vered Fleisher Sheffer, who runs the unit, "but the safety is so important to our parents and our most vulnerable babies." When NPR visited late last month, there were babies being treated who were delivered as early as 24 weeks, their treatment just as seamless as if there wasn't a war.
It's a stark difference from what's happening with the health care system in the Gaza Strip, which was already struggling before Israel launched its latest military response to the Hamas attacks. Eighteen hospitals and most of the primary care centers have stopped functioning due to attacks or lack of fuel since Oct. 7, according to Gaza's Health Ministry.
Galilee isn't just going underground for safety. The hospital's first floor is fortified to withstand a missile attack, protecting the trauma department, ambulance bay and other surgical rooms from an attack out of Lebanon.
Heavy steel doors guard the opening to the first floor trauma center and emergency room. Nearby there's a shower ready in case Lebanon uses chemical weapons.
For the last few weeks, the hospital has been receiving Israeli soldiers wounded from fighting in Gaza, as well as more than 200 northern residents who have been injured in rocket attacks from Lebanon.
Dr. Bahir Sirhan, who works in the Galilee hospital's emergency department, says there's no need to wait for future escalation. "The threat is real," he says. "The war is already here. It's here."
A few weeks ago, Sirhan was working when a call came in that an ambulance was on its way in with four people injured in a rocket attack near the border. Some of the patients, it turned out, were his relatives.
"We have drills to receive such trauma cases, but no one prepared me for receiving family members," he says. "I went from being a doctor to being a family member and it was a bit confusing. It took me several moments to cool down my nerves and start after receiving them."
He says when the patients recognized him, they called his name, and his presence calmed them down. Their injuries weren't critical and they have since recovered. But the experience still haunts him. "I don't wish to treat my family again," he says. "That's a nightmare."
Getting the staff ready for the migration underground
At Rambam Hospital in Haifa, the underground facilities sit mostly empty, but ready. Many parking spots have hospital beds already, other sections have numbers to signify a patient area with hookups, waiting for the beds that are currently in use upstairs to be rolled down. On a recent visit, hospital leaders were running a drill to help nurses and doctors get used to working in the facility.
Though the hospital had previously used the underground garage during the COVID-19 pandemic, only a set number of staff had worked in that space, so for many, the practice exercise was the first time they'd been down there.
"I cannot lie and say it's not a terrifying and frightening situation because it is," says Alina Maister, an internal medicine nurse who is part of the training exercise and describes the last month in Israel as "one long day."
"It's better to know what to do, how to do it, and be prepared for the worst so we can manage it in the best way possible," she says.
While touring the facility, she says she exchanged questioning glances with her fellow nurses. "It's hard to imagine how our jobs would look down here," she says. "Where is everything? Where will people be? What is the plan?"
During the drill, dozens of staff members begin to practice triage and treatment of pretend-patients played by their coworkers and members of the Israeli military. Challenges become obvious: The acoustics make it difficult to hear the patients, and hospital sections — the ICU, the operating rooms — are in new locations, so the staff need to practice rolling the beds in the right direction.
But Maister says she's confident they'll figure out what to do in time. "We know how to handle most situations. I think it's one of the strengths of nurses."
At Rambam, the pediatric dialysis is already fully functional in the garage. That section of parking spots is buzzing with the hum of nurses, children playing video games and a father listening to a pop song with his daughter.
Tal Romano's 4-year-old son Hadar is getting dialysis treatment. "It makes me feel more comfortable," Romano says, sitting next to his son. "It feels very safe down here."
While Romano speaks to NPR, a nurse draws a flower in pen on Hadar's leg to make him laugh. Romano says his only critique of getting treatment underground is that Hadar misses the colorful kid-friendly decor of the upstairs unit.
"For the kids, it's a little bit difficult, you know, he doesn't see the outside world," says Romano. "He doesn't get used to it so easily."