Dr Fadel Naim, head of the orthopaedic department in Al-Ahli Arab hospital in Gaza, had just finished a surgery on the evening of October 17 when he heard the “sound of two rockets” closing in. The false ceiling in the operation theatre collapsed. Though he sustained an injury on his head, Naim managed to run out.

“When I came out in the courtyard, it was full of body parts,” Naim told Scroll on a phone call from Gaza city. “…Dead people, injured people. We tried to help as many as we could.”

The explosion at the 41-year-old hospital in south of Gaza city killed between 300 and 500 people –patients, medical staff and displaced people who had taken shelther there.

“This was a big massacre,” Naim said. “Hundreds of people were thrown away.”

The source of attack on Al-Ahli Arab hospital remains contested. Authorities in Gaza have blamed Israel but Tel Aviv claims it was the result of a misfired rocket by Hamas.

Though hospitals and schools are counted as protected civilian establishments under international humanitarian law, data from the World Health Organisation shows that at least 51 health facilities have been attacked since Israel began its war on Gaza on October 7.

According to the Gaza health ministry, 49 medical staff have died in the conflict, 70 have injured and 23 ambulances have been damaged.

Since the beginning of the conflict, 4,137 people have died in Gaza and over 13,612 have been injured.

As the war on Gaza enters its third week, international agencies are calling attention to the precarious situation in territory’s hospitals. They are vulnerable to attack from Israeli forces, who claim that hospitals in Gaza are being used as shelters by Hamas militants. They are also running very low on supplies, putting the lives of thousands of civilians at risk.

Dr Fadel Naim, orthopaedic surgeon in Al-Ahli Arab hospital in Gaza. Photo by Special Arrangement

Over the last week, international humanitarian law has been repeatedly breached in Gaza, said Dr Mike Ryan, executive director of the World Health Organisation’s Health Emergencies Programme during a press briefing. “And it has to stop,” he said. “It must stop. Any attack on health workers in this situation is a violation of international law.”

On Saturday, the Palestine Red Crescent Society that runs the Al-Quds hospital in Tel al-Hawa area, said it had received a warning from Israeli forces to evacuate the establishment. The hospital has 400 patients and said it is providing shelter to 12,000 people who have been displaced. “My anaesthetist friend in Al-Quds said they have over 100 wounded patients,” said Dr Mads Gilbert, a Norwegian anaesthesiologist who has visited Gaza four times since 2006 to treat people during conflict situations. “They have refused to evacuate.”

In 2015, Israel barred him for life from entering Gaza. Gilbert has been waiting in the Egyptian capital of Cairo for 10 days for the Rafah border passage to open so that his team can treat those wounded in Gaza. The Rafah crossing connects the Gaza Strip with Egypt.

Ryan of the WHO said those undergoing treatment in Gaza’s hospitals were in an extremely vulnerable state. Some were on incubators. Others were undergoing complicated operations and amputations. Some had head injuries or multiple fractures. “We cannot move these patients from hospital,” Ryan said. “Moving hundreds and thousands of these patients is a death sentence to those patients as well.”

Al-Ahli Arab hospital, the site of the explosion, was one of the 22 hospitals in the north of Gaza Strip that was given an evacuation order by the Israeli military on October 12, said Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean.

“The order for evacuation has been impossible to carry out given the current insecurity, critical condition of many patients and lack of ambulances, staff, health system bed capacity,” Al-Mandhari said during a WHO press briefing.

The WHO has urged Israel to reverse its evacuation orders. The United Nations has made a similar appeal. “Hospitals are sacrosanct, and they must be protected at all cost,” said Volker Türk, the UN High Commissioner.

Though the Al-Ahli hospital has been evacuated since the explosion, efforts to resume operations are underway. Naim said he hoped patients would be admitted again by Saturday. “If we leave the hospital, we could be killed anywhere,” he said. “So we will continue to treat patients till the end of the war.”

But to restart, Al-Ahli hospital needs medical supplies. “We are out of fuel, water, food and medical supplies,” Naim told Scroll. He has operated on at least 100 patients since the conflict started.

The facility is in dire need of antibiotics and surgical equipment. “Our’s is a small hospital,” he said. “We are getting many cases of fractures, specially open fractures with soft tissue defect. We need to transfer some patients to Egypt. We cannot deal with such load.”

In Al-Shifa hospital, the largest medical facility in Gaza city, doctors need surgical disposable material to dress the wounds of the injured. Patients from Al-Ahli hospital were transferred here after the explosion.

Gilbert told Scroll from Cairo that the Gaza health authorities said that they need disposable material, bandages, essential drugs, medication, external fixators to fix fracture, sutures for children, anaesthesia drug, antibiotics, IV fluid, in particular for children.

“When doctors don’t have the tools, how can they operate?” Gilbert said. “This blockade is not only suffocating 2.2 million civilians, among them one million children, it is also completely stopping the functioning of health care system.”

At a webinar on Friday, Dr Amber Allayan, the deputy cell manager in the Middle East of Médecins Sans Frontières said that the organisation has emptied its stocks to help the Gaza health ministry. MSF has 300 staffers in several hospitals in the Gaza Strip. “We can’t refill our stock,” she said. “We can’t get” supplies in.

Farhat Mantoo, Executive Director for MSF South Asia, told Scroll by an e-mail that their team has exhausted three weeks’ worth of medicine stock in three days. “In Al-Shifa Hospital, the very few remaining members of our team reported a shortage in painkillers,” Mantoo said. “They heard wounded patients screaming in pain.”

Naim said seven hospitals in Gaza city are currently not functioning, while about 15 are working only partially.

Dr Richard Peeperkorn, the WHO Representative in the Occupied Territories, said 34 hospitals across the Gaza Strip are not operating because of severe damage. About 60% of primary health centres are shut. “Blood banks have only one week of supply,” Peeperkorn said. “Those that are functional are fast running out of supplies too,” he said during a press brief.

He added that patients with diabetes, cancer, cardiovascular diseases, and those who need obstetrics care are unable to access treatment. Water and sanitation remain a major concern. The Gaza Strip has about 10,000 pregnant women, of them nearly 3,000 are in their last trimester and in need of delivery care, Dr Gilbert said.

Dr Richard Brennan, the regional emergency director in WHO’s Eastern Mediterranean regional office, said during a press brief that medical supplies and equipment have been held up for days as the Rafah border crossing remains closed.

“We’re ready to go as soon as there is an opening,” Brennan said. “But it is extremely frustrating.”

A group of doctors from Jordon wait in Cairo to enter Gaza. Photo by Special Arrangement

Over-burdened health facilities

Dr Mohammed Ghuneim, an emergency medicine doctor in Al-Shifa hospital, told Scroll about the challenges he and his colleagues were facing. “We have been trained in mass casualty,” he said. “But no guidelines in the world can prepare us for this.”

As the largest hospital in north Gaza, Al-Shifa hospital is receiving patients from nearby areas and hospitals. “We have received more than 700 casualties at the same time in over 25 minutes,” Ghuneim said. “There is no space. We are dealing with patients on the floor, there are no beds.”

The war is taking a toll on the health workers. Ghuneim has not gone home for 14 days. “We are sleeping for short periods,” he said. “There is not a lot of food available, we are eating sparingly.”

There are also fears of Israeli attacks. “I don’t think our hospital is safe either, not after bombardment in Al-Ahli,” he said.

He has lost several loved ones over the last fortnight. His medical school teacher, Dr Omar Ferwana, arrived in a gunny bag for him to identify. “His entire family has been wiped out,” Ghuneim said. “There was no one to identify him.”

Next to Dr Ferwana’s body, Ghuneim had to also identify his daughter Dr Aya Ferwana, who worked in the family medicine department. “These are the tragic stories we all witnessing,” he said. “We can never forget them.”

The Al-Shifa hospital. Photo by Dr Mohammed Ghuneim

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.