• The WHO has documented 72 attacks on healthcare facilities in Gaza since the start of Israel's offensive.
• The total siege has forced 12 out of 35 hospitals to close their doors due to a lack of energy and water.
• The remaining hospitals are unable to treat the more than 14,000 wounded. Those in desperate condition lose priority of care.
• "Healthcare staff are working in dramatic conditions," Monica Minardi, president of MSF, explains to LifeGate.

The hospitals of the Gaza Strip are ceasing to function, one after another. Already a third of hospitals have closed their doors. The Israeli offensive on Palestinian territory following the Hamas attack of 7 October is making no distinction between military and civilian targets, and hospitals are suffering the consequences. On one side, there are the bombardments by the Israeli army, which have struck dozens of medical facilities. On the other, there is the total siege, which is depriving Gaza of basic necessities such as water and energy, making the work of doctors impossible in many cases.

A situation of this kind has already translated into a serious humanitarian emergency, given that the provisional toll of the Israeli offensive on Gaza is tragic: more than 5,000 dead, of whom 40 per cent are children. And at least 14,000 wounded. For the latter, doctors are forced to make a cynical but necessary triage, because guaranteeing care for everyone is not possible. Those who are now in a desperate condition are left to die, so that focus can be concentrated on those who might still survive. And doctors find themselves working in extreme conditions.

"Without a ceasefire and if humanitarian corridors are not permitted that would allow sufficient medicines, medical equipment, food and essential goods to be brought into Gaza, the situation can only get worse," Monica Minardi, president of Médecins sans frontières, explains to LifeGate.

Bombs on hospitals in Gaza

On 7 October the Israeli army launched a heavy military offensive on the Gaza Strip, after an attack by the Palestinian extremist organisation Hamas on Israeli soil had caused approximately 1,400 deaths, with more than 200 people taken hostage. The Israeli government said it wanted to destroy Hamas and was targeting military objectives, but within a matter of hours the offensive took on the characteristics of mass punishment, prompting statements of condemnation from the UN and several international leaders.

PRCS ✓ @PalestineRCS

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🚨 A short while ago, heavy shelling near Al-Amal Hospital, which is affiliated with the Red Crescent Society, in Khan Yunis City.
#Gaza_Genocide

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So far, Israeli raids on Gaza have struck more than 50,000 homes, causing the displacement of one million people — half the population of the Strip. The bombs have struck escape routes such as the Rafah crossing, refugee camps, mosques and churches. The United Nations Office for the Coordination of Humanitarian Affairs has recorded 206 attacks on schools. And then there are the hospitals.

Media and political attention in this regard has focused on the explosion that occurred on 17 October in the courtyard in front of Al-Ahli Arab hospital, attributed by the Palestinian Health Ministry, controlled by Hamas, to an Israeli bomb, with almost 500 dead. In reality, many doubts have emerged about this version of events, both regarding the number of victims — which is said to have been a few dozen — and regarding responsibility, which remains not fully clarified. Israeli and American intelligence, as well as some independent analyses such as that of the Royal United Services Institute, have said that the explosion was caused by a Palestinian rocket. Other independent analyses, such as that of the award-winning team Forensic Architecture, have instead expressed strong doubts about Palestinian responsibility.

Al-Ahli Arab had already been struck by an explosion a few days earlier, which had injured four healthcare workers and damaged several wards, including the obstetrics unit. On that occasion it had been an Israeli raid. Since the start of the offensive on 7 October, the WHO has recorded 72 cases of attacks on healthcare facilities. The hospitals damaged by Israeli raids so far have numbered 19, and 24 ambulances have been destroyed. Many facilities are ceasing to function, while the toll in the Gaza Strip stands at more than 5,000 dead, including more than 2,000 children. And at least 14,000 wounded.

Water and energy running out

Israeli raids on healthcare facilities explain only part of the medical emergency being experienced by the Gaza Strip. While the explosions have put some facilities out of action, just as others in the northern part of the territory have been evacuated due to evacuation ultimatums from the Israeli army, for the remaining hospitals the problem is related to the total siege.

TRT World @trtworld

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Gaza’s Indonesian Hospital went dark due to lack of fuel on October 23. Health authorities say more than 100 incubator babies in Gaza are at serious risk and all hospitals are expected to be dark in the next 48 hours

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Within hours of the start of the offensive on Gaza, Israel cut supplies of water, electricity, food and fuel to the Strip's territories. While some food is now arriving with humanitarian trucks through the Rafah crossing, the energy and water problem remains. Without electricity, many hospitals have had to close their doors because it has become impossible to operate the machinery. According to the latest WHO data, around two thirds of Gaza's healthcare facilities have ceased to function. As for hospitals, 12 out of 35 — around a third — are no longer operational.

UNRWA ✓ @UNRWA

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We are lost for words.

We pay tribute to our 35 colleagues who have been killed in📍#Gaza since 7 October.

We grieve and we remember.

These are not just numbers. These are our friends and colleagues.

Many were teachers in our schools. @UNRWA mourns this huge loss.

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In the hospitals still in operation the situation is critical. In addition to entire wards put out of action by the bombardments, the energy problem forces the rationing of what little electricity remains, and hospitals still open have declared they have only a few hours of room to manoeuvre. Medical supplies are running short and the total siege in which Gaza finds itself prevents new imports, while UN staff have said that the security conditions needed to personally deliver them to hospitals in the north of the Strip are not in place — since the start of the offensive, Israeli raids have already killed 35 UN members. Finally, there is the problem that the closure of many hospitals, combined with the ever more dramatic toll of the Israeli offensive, is pouring into the still-operational healthcare centres a number of wounded that cannot be accommodated.

Healthcare system on the verge of collapse

In recent hours, Ashraf al-Qudra, spokesperson for Gaza's Ministry of Health, said that the healthcare system in the Gaza Strip has "totally collapsed". And this is forcing doctors to work in extreme conditions, in an effort to somehow continue providing care to the population.

MediciSenzaFrontiere @MSF_ITALIA

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🔴#Gaza
"È solo questione di tempo prima che scorte mediche e carburante finiscano del tutto e gli ospedali smettano di funzionare."
Nedal Abed, chirurgo ortopedico MSF a Gaza

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To save on electricity, doctors are operating in the dark, lit only by small head torches. The power has been cut to entire high-energy wards, such as mortuary refrigerators: hospitals are therefore unable to keep the bodies of victims. Other wards, such as dialysis units, cannot function for the same reason. The situation is so dire that doctors have been instructed not to admit patients in critical condition with very low chances of survival. A form of forced medical Darwinism. "At this stage we are not treating the most critical cases first, but those most likely to survive," says a surgeon. Among those no longer being treated to make room for other patients: a 10-year-old child in a state of brain death.

Accounts from healthcare workers in Gaza speak of extremely difficult working conditions. "We sleep very little, there isn't much food available, we eat sporadically," says an emergency doctor. "We treat the wounded on the floor, there are no more beds," reports another doctor. Someone else explains that nursing shifts "can last up to 24 hours", given the need to assist as many people as possible. Healthcare staff have now been living in hospitals for days, alternating between giving care and snatching a few hours' rest on makeshift beds laid out on the floor.

According to data from Gaza's Ministry of Health, as many as 65 healthcare workers have already been killed by the Israeli offensive. An enormous human cost, despite international law considering attacks on hospitals a war crime.

The looming risk of epidemic

"Healthcare staff in Gaza are working in appalling conditions, unthinkable for those of us — doctors and nurses — who are here in Italy or in other countries not involved in this kind of conflict. The motivation, dedication to their work and medical ethics of these Palestinian colleagues is extraordinary," Monica Minardi, president of Medici Senza Frontiere, tells LifeGate. "In recent days we have received testimony from one of our surgeons working at Al-Shifa hospital in conditions beyond the limit: they have no medicines, they don't have enough medical equipment to carry out emergency surgery. He told us about the case of a 13-year-old boy whose foot had t