The entrance hall of Galilee Medical Center in northern Israel is mostly empty and quiet. At this major hospital, closest to the Lebanese border, the roar of fighter jets and intermittent artillery fire gave way to the voices of doctors, paramedics and patients.

Almost all hospital staff and patients went underground.

These days, getting to the hospital’s nerve center requires passing through 15-foot-tall concrete barricades, multiple blast doors, and descending several stories into a labyrinthine underground complex.

Thousands of patients and hospital staff have stayed there for the past six months as strikes rage between Lebanon’s Israeli army and the powerful Iranian-backed militia Hezbollah, just nine miles north. That’s where I was.

The underground operation at the Galilee Medical Center in Nahariya marks the complete transformation of life in northern Israel since Hezbollah launched near-daily attacks against Israeli forces in October in solidarity with the Iranian-backed group Hamas. This is one of the most notable examples. That same month, he led an attack on southern Israel.

The cross-border fires have forced tens of thousands of Israelis to evacuate their towns, villages and schools, and factories and businesses to close. Tens of thousands more have fled their homes on the Lebanese side of the border.

The hospital has been preparing for this scenario for years, given its proximity to one of the region’s most volatile borders.

“We knew this moment would come, but we didn’t know when,” the hospital’s director, Dr. Massad Barhoum, said in an interview last week.

Hours after the October 7 Hamas-led attack, staff at the Galilee Medical Center feared that Hezbollah would launch a similar attack. Even before the government issued the evacuation order, hospital executives had decided to move much of the vast facility to a spare basement annex. They reduced the 775-bed hospital’s capacity to 30 percent in case it suddenly had to admit a new wave of trauma patients.

“It’s our duty to protect the people here,” Dr. Barhoum said. “This is something I’ve been preparing for my whole life.”

The hospital’s towering medical ward now stands empty, its wide neon-lit hallways silent. In the current basement location of the ward, the hum of hospital machinery mixes with the beeping of golf carts hauling supplies through a narrow tunnel that leads to the hospital parking lot, providing the only daylight.

Patients lie in beds separated by movable curtain racks in a maze of halls. Visitors sit on plastic chairs in a makeshift waiting room because it’s too crowded to visit everyone at the bedside. The ceiling is lined with tubes and wires, creating the atmosphere of an engine room.

In the neonatal intensive care unit, new parents huddled in protective gowns in a dimly lit room feeding their babies with bottles. Doctors treat another small patient a few feet away.

The neonatal unit moved underground for the first time on October 7, said Dr. Bered Fleischer-Schaefer, the unit’s director.

“Everyone feels safe here, but it’s difficult because we’re humans and now we have to stay underground,” she said.

Her unit also went underground in 2006 during Israel’s last all-out war with Hezbollah. Dr. Fleischer Schaefer recalls walking to the hospital along a barren road as air raid sirens wailed. One day, a rocket landed in the ophthalmology ward, but the patients had already been transferred, hospital officials said.

That war lasted just over a month, and over the next few years Hezbollah became less of a threat. October 7th changed the situation.

The day before New York Times reporters visited the hospital, a Hezbollah attack hit a nearby Bedouin village, wounding 17 soldiers and two civilians. The wounded were taken to the hospital’s intensive care unit, where one of the soldiers died on Sunday.

“They are our neighbors,” Dr. Fleischer Schaeffer said, referring to Hezbollah militants. “They’re not going anywhere, and neither are we.”