Hospitals in Gaza are ceasing to function because they are running out of water and fuel for generators, while being overwhelmed by huge numbers of casualties and civilians seeking shelter from Israeli bombing.
Doctors, health administrators and international aid organisations describe nightmarish conditions, including doctors forced to operate with little or no anaesthesia, or by the light of mobile phones, and using vinegar in some cases in place of antiseptic.
Not only are Gaza’s hospitals overwhelmed by thousands of patients with traumatic wounds from constant aerial bombardment, they are also filled with tens of thousands of people seeking shelter, making it even harder to attend to the wounded.
Meanwhile, more than 20 hospitals in north and central Gaza, representing the bulk of the Gaza health service, have been told to evacuate by the Israeli army – an order doctors say is impossible to carry out.
“We have no fuel to run the standby generators, and those who are affected first are the operation rooms, the intensive care units and emergency rooms,” Dr Medhat Abbass, the director general of the Gaza health ministry, said.
“We have mass casualties in the hospitals dealing with surgical cases. The problem is that the staff are exhausted and we have no medical supplies. We are consuming in a day what we used to consume in a month.”
“We are operating on some patients in the corridors of the hospitals,” Abbass said. “We are operating on them on the ground by the light of the mobile phones, and some of them were operated on without anaesthesia.”
Limited quantities of medical supplies have been allowed over the Egypt-Gaza border in recent days, but Israel refuses to allow them to be distributed in the north, where most of the hospitals are, as the Israeli government wants the whole northern half of the Gaza Strip evacuated before a planned ground offensive.
The World Health Organization (WHO) says it has not been possible to distribute fuel or medical materials in the north for lack of security guarantees. No new fuel has been allowed into Gaza since the 7 October Hamas attack on Israel, starving hospital generators as well as the desalination and pumping plant essential to the water system.
Over the past few days, aid officials had been optimistic that fuel would eventually be included in the aid convoys crossing from Egypt, but on Tuesday evening the Israeli military spokesperson, R Adm Daniel Hagari, was adamant.
“Fuel will not enter Gaza as Hamas uses it for its operational needs,” Hagari said. “If necessary, Hamas can return the fuel it stole from UNRWA [the United Nations Relief and Works Agency for Palestinian refugees] and give it to the hospitals.”
Video posted on Tuesday showed the Indonesian hospital in north Gaza in total blackout after the generators failed, with the sole illumination from mobile phones.
Abbass said patients from the hospital, built with funds from the Indonesian government in 2016, had been transferred to al-Shifa hospital, which was already severely overcrowded.
A professor of nursing there said: “Shifa hospital is not a hospital any more. Everywhere people lie on the floor on mattresses, or cardboard, to find shelter and safety. Only the entrance for the ambulances is left free.
“The departments and wards are full everywhere with children running around. The nurses are exhausted. A colleague has been working 24 hours. We cannot discharge patients as they are scared to be bombed again and do not know where to go.”
The professor, like many Gaza doctors, did not want their name to be used, as many believe that health workers have been targeted in airstrikes. So far 55 doctors are reported to have been killed.
“Some of the facilities waiting for WHO supplies and fuel in northern Gaza include al-Shifa hospital, where bed occupancy is already close to 150%,” the WHO said on Tuesday. “Last night, the Indonesian hospital was forced to shut down some critical services due to lack of fuel, and is now running with limited functionality. The Turkish Friendship hospital, the only oncology hospital in the Gaza Strip, remains partly functional due to lack of fuel, putting around 2,000 cancer patients at risk.”
“The WHO gave us training in mass casualty management,” said Mohammed Ghuneim, an emergency medicine doctor at al-Shifa hospital. “But there is no protocol in the world, WHO or any other, that can handle this scale of casualties.”
Salaam, a consultant surgeon, said she had been faced with the dilemma of two patients who needed space in an intensive care unit.
“We had to prioritise between the two of them to see which one of them we would take to the ICU,” Salaam said. “In these situations, we don’t take the most critical first, we take the one with a higher chance of survival.”
Tanya Haj-Hassan, a Canadian-based paediatric intensive care and humanitarian doctor who helps run a western support network for Gaza health workers, said a third of hospitals in the territory had ceased to function.
“They’ve either been directly hit by Israeli airstrikes, or they are in areas that have been threatened with bombing and therefore thousands of people are currently seeking refuge inside hospitals, blocking the corridors, blocking the entrance ways or sharing a limited number of toilets,” Haj-Hassan said. “So you’re talking about hundreds of people sharing one toilet and living in the corridors and that obviously has significant concerns for hygiene, sanitation and the functioning of the hospitals.”
“The remainder of the hospitals are functioning at less than a bare minimum capacity as a consequence of the large burden of injuries and rupture of supply of many of the medications and of course the supply of fuel,” she said.
Some Gaza doctors have told Haj-Hassan that they had resorted to using vinegar as a stand-in antiseptic.
Another member of the western support group, Omar Abdel-Mannan, a senior paediatric neurology resident based in London, said: “Doctors on the ground are using minimal anaesthesia so they can economise on it.”
“They are reusing surgical gloves and equipment as they are not able to sterilise properly due to the lack of water,” Abdel-Mannan said. “Infectious diseases like chickenpox are starting to spread. It is only a matter of time before we see cholera and typhoid.”
Medical experts from the International Committee of the Red Cross (ICRC) visited hospitals in Gaza on Tuesday and confirmed the dire reports from doctors on the ground.
“What they describe seeing are death, destruction and displacement on a staggering level,” Matt Morris, an ICRC spokesperson said. “People are sleeping in the stairwells of hospitals. Thousands of people have nowhere else to go and are seeking shelter in the hospitals. Our teams felt the building walls shake from explosions in the vicinity.”
“International humanitarian law is very clear that hospitals are specially protected facilities,” Morris added. “Put plainly: no patient should ever be killed while lying in a hospital bed. No doctors, nurses or any medical professionals should ever die in a fiery explosion while working to save lives.”
