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As their supplies dwindle, hospitals are also becoming more crowded with an influx of patients as well as other civilians seeking shelter after they’ve been displaced from their homes. “There’s no space in the hospital,” Abu-Sittah added in his SBS News interview. “We have over 2,000 wounded patients in a hospital that had a bed capacity of around 600.”

“In terms of the patient load of hospitals, it’s indescribable,” says Tanya Haj-Hassan, a physician with Doctors Without Borders who is based in Jordan, but in regular communication with doctors in Gaza. “They’re having to resuscitate patients on the floor, to do surgical procedures on the floor because there’s no room anywhere else.”

Hospitals have been the targets of or near repeated airstrikes and bombings as well. According to the WHO and the Palestinian Health Ministry, there have been 218 attacks on health care-related facilities in the Palestinian territories, and at least 135 health care personnel are among the casualties of the overall Israeli offensive. That includes airstrikes that were near the al-Shifa hospital, the al-Quds hospital, and the Indonesian hospital, as well as a bombing that hit an ambulance convoy. Many hospitals have been told to evacuate due to bombings in the region, but physicians have said this is impossible and an effective death sentence for patients who rely on ventilators and life support.

“Moving a baby on life support would be hazardous in a high-income country. Doing so in Gaza would gravely endanger a child whose life has only just begun,” said Ghebreyesus.

At least 81 wounded people are expected to be able to evacuate to Egypt for further treatment, and both Turkey and the United Arab Emirates have offered to provide medical care for those in need. But not every evacuation attempt works: Friday, for instance, a convoy attempting to leave al-Shifa was hit by an Israeli bomb, killing at least 13 and injuring many more, including people taking shelter in the facility. Additionally, the number of patients who are evacuated pales in comparison to the degree of need and the scope of people who’ve been injured.

The Israeli government claimed it was targeting — and killed — Hamas combatants in the al-Shifa ambulance strike, and has often sought to justify some of its airstrikes on healthcare by claiming that Hamas has a presence. Al-Shifa hospital, for example, has been cited as the location of a Hamas command center by Israeli leaders, an accusation Hamas has denied.

The WHO has raised concerns that attacks on health facilities are a violation of international humanitarian law. As experts told Al Jazeera, attacks on hospitals are a breach of the Geneva Conventions, which state, “Directing an attack against a zone established to shelter the wounded, the sick and civilians from the effects of hostilities is prohibited.” There are exceptions if there’s evidence that medical facilities are being weaponized to harm an opposing force, however. But Israel’s claims aside, it’s not clear Hamas is weaponizing hospitals. Thursday, WHO officials said they had not independently verified whether the al-Shifa hospital was being used as a base by Hamas.

“We have no information about what may be happening elsewhere underneath these facilities, that’s not information we would have, that’s not information we could verify,” Michael Ryan, executive director of the WHO’s Health Emergencies Program, said on Thursday. “The difficulty here is separating the needs of 50,000 people at al-Shifa hospital, civilians, doctors, patients, and others.”

There’s immense fallout for patients and providers

The fallout for patients from these hospital closures and shortages has been enormous — and is poised to increase.

For patients with chronic illnesses, hospitals are increasingly unable to provide the vital medication and care they need to survive. “If you don’t have electricity, you can’t give dialysis [to patients with kidney illnesses],” says Haj-Hassan. “If you cannot do those things, you will ultimately become very unwell and die. [If] you can’t get cancer therapy, you will also die.”

For people with acute conditions, like a heart attack or stroke, there are limited medical resources — both when it comes to staffing and supplies — to be as responsive to these needs as before. “For acute problems, there’s just no capacity to care for anything that’s not a war injury at this point,” says Haj-Hassan. Care International told CNN roughly 160 people are expected to give birth in Gaza each day over the next month. Those pregnant people — including those who need C-sections — are among those who may be unable to secure the care they need.

Data from Al Jazeera and the WHO also notes that there are 130 infants relying on incubators, 1,000 kidney dialysis patients, and 350,000 patients with noncommunicable diseases such as diabetes, cancer, and heart disease who have to bear these effects.

And for patients with traumatic injuries — including thousands who’ve been injured during the airstrikes — it has meant incomplete treatments and little pain management. “How can you care for patients [when a] large part of their body is burned if you don’t have pain relief? It is completely inhumane,” says Haj-Hassan.

On top of the existing patient needs, many experts worry about the spread of infectious disease as clean water supplies continue to run low and people continue to shelter in cramped spaces. Roughly 50,000 people were believed to be taking shelter in al-Shifa as of late October, while the UN said 670,000 people were packed into its shelters. Asi pointed to a cholera outbreak that occurred during the war in Yemen and said a similar scenario could take place in Gaza.

“[Water-borne illness] is one of the number one killers of children in Gaza even before this, and the potable water situation there has always been poor since the siege started in 2006,” she says.

Infrastructure projects and general pollution limited the availability and quality of water before the war. Now, water is available, but it is untreated — full of salt from the Mediterranean and contaminated by wastewater and other pollutants.

Doctors, too, are completely overwhelmed by the degree of need they are seeing as well as having to make impossible decisions about who is able to receive care and use supplies. “What I’m hearing from speaking with them is just desperation that they can’t do anything,” says Asi. “The hospitals are to the point where they’re so full that when patients arrive, sometimes doctors have to choose between who we bring into the hospital, who may have a chance of survival, and who we can’t.”

“Doctors are distressed. They are calling us crying…by the horror they are seeing…This has to stop.
We’re operating on children without anesthetics.
We don’t have morphine for them.”

MSF’s Leo Cans discussing Gaza on @cnni pic.twitter.com/az2ozu97SR

— Doctors w/o Borders (@MSF_USA) October 31, 2023

The WHO and Doctors Without Borders are calling for a ceasefire, the ability to provide humanitarian aid to hospitals, and security for health care providers in light of these conditions.

In her description of doctors’ experiences in Gaza, Haj-Hassan read a text message she received on Friday from a pediatric intensive care physician based there.

“Unfortunately, we are on our way to collapsing from the horror of the scenes we see despite our strength,” it reads. “And the world is watching as if we were in a movie theater showing a horror movie and the viewers are silent.”

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