Much of the enclave is a battlefield, with more than 2 million civilians and combatants intermixed
Within minutes of the Oct. 31 Israeli attack on the Jabalia refugee camp in Gaza, the victims began flooding the Indonesian Hospital a mile away. Dr. Marwan Sultan, the hospital’s medical director, says that most of the injured and dead were women and children. Some had deep burns, serious head injuries, or missing limbs, Sultan told TIME four hours after the attack. There are only 16 intensive-care beds in the hospital, which was running dangerously low on fuel, threatening the lives of his patients. If the electricity goes, says Sultan, “they will die. They will die.”
The conditions for medical care in Gaza are deteriorating across the besieged 140-sq.-mi. coastal strip. Surgeons are operating by flashlight and rationing water, anesthesia, and the generator fuel needed to perform surgeries, provide electricity for incubators, and care for kidney-dialysis patients, doctors and health organizations tell TIME. The roughly two dozen hospitals still operating in Gaza are absorbing the patients of the 12 that have closed because of a lack of supplies and the ongoing bombing, says the World Health Organization (WHO). “Medical teams are on their knees,” says Hisham Mhanna, spokesperson for the International Committee of the Red Cross in Gaza.
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All war zones are awful, but Gaza presents a unique hell. Much of the enclave of 2 million is now a battlefield, with civilians and combatants intermixed, and homes and businesses sitting side by side with military infrastructure. Nowhere is that reality felt more keenly than at the territory’s hospitals, which have simultaneously become safe havens and potential targets, and where the impact of Israel’s offensive is measured every day in lives—more than 9,000 killed as of Nov. 2, including 135 medical personnel, according to the Palestinian Ministry of Health.
After the Oct. 7 Hamas attacks that killed more than 1,400 people in Israel and started the war, the Israeli military began a massive bombing campaign. On Oct. 13, it ordered civilians to depart the northern part of the strip for the south, and on Oct. 27 it sent in ground troops and armored vehicles. Hamas has fought back above and below ground, from a network of concrete tunnels extending hundreds of miles.
For the estimated 1 million people displaced by fighting, the search for shelter has brought many to makeshift tent cities. More than 50,000 are packed into the Al-Shifa hospital complex in northern Gaza, says Dr. Ghassan Abu-Sittah, a surgeon. Mattresses line the floor, kids run around, and a stench hangs in the air. So many people in such a small space, with inadequate access to hygiene and sanitation, will lead to an outbreak of infectious diseases, Abu-Sittah worries. Hospitals are struggling to dispose of dead bodies, which pose their own health hazards. Abu-Sittah has been going to a corner store to buy bottles of vinegar and laundry detergent to clean wounds. “Every day you make more and more compromises,” he says.
Some two dozen hospitals have been asked to evacuate to the south, according to the WHO, which says doing so would risk patients’ lives. When Israeli government officials called Al-Awda hospital and told its manager, Dr. Ahmed Mhanna, to evacuate staff and patients, “I refused, of course,” he says. “Where can I deal with my patients?”
Doctors worry that their facilities will be hit in the bombardment. On Oct. 30, an Israeli airstrike damaged part of Gaza’s only cancer hospital, the Turkish-Palestinian Friendship Hospital, says its director, Dr. Sobhi Skeik. “My message is please don’t kill cancer patients,” Skeik says. On Nov. 1, the WHO said that the hospital had shut down.
Days before that, the Israel Defense Forces presented evidence it said showed Hamas had established a command center in and beneath Al-Shifa hospital. A Hamas official denied the allegation. Targeting a hospital would be a war crime, whether or not Hamas is using it to hide in, says Susan Akram, a law professor who directs Boston University’s International Human Rights Clinic. “Israel has an obligation to protect the entire population in Gaza,” she says. For its part, Israel notes that using a hospital to hide military equipment or facilities is itself a war crime.
Read more: Stories of Loss and Grief From Gaza
Even without a direct attack, the hospitals lack key supplies, which are coming in at a painfully slow pace amid the Israeli siege. On Oct. 31, the U.S. said that 66 trucks of humanitarian aid were entering Gaza daily, a fraction of the hundreds per day before the war. Fuel remains a critical issue. The Israeli military reportedly believes Hamas holds more than 500,000 liters that it could provide to hospitals. The U.S. says it is pressuring Israel to break its blockade and allow aid in. President Biden called Nov. 1 for a humanitarian “pause” in the war, but faces criticism for providing military aid to Israel.
Everyone in Gaza has been affected. “We often focus on the victims of airstrikes,” says Dr. Brenda Kelly, a consultant obstetrician in Oxford, U.K., “but ordinary lives don’t stop. Women still go into labor. They still have miscarriages, ectopic pregnancies, preterm births.” Dr. Hatem Edhair, the head of the neonatal intensive-care unit at Nasser Medical Complex in Khan Younis, fears that electricity shutting off will mean the deaths of five babies in his care who are dependent on ventilators. “If there is no electricity,” he says, “it means the end of their life.”
Al-Awda hospital’s Mhanna, speaking by phone Oct. 23 in southern Gaza, seemed unfazed by the sound of a blast during the interview. “We are afraid; we are human beings,” Mhanna says. “But we cannot do anything except continue our mission with our patients.”
—With reporting by Leslie Dickstein