Gaza's collapsing health sector
Hospitals crammed, bombed and doctors performing surgery without anesthesia
TEHRAN- Since the beginning of the war on Gaza, the Israeli military has shocked international bodies and organizations with its regular attacks on hospitals and health centers.
Adding to the revulsion, the world is watching on as Gaza's health sector faces different threats from the regime.
While the Israeli attack on al Ahli Hospital on October 17, that killed and injured hundreds of civilians, made global headlines, the reality of the health situation on the ground is much more dangerous for Gaza's 2.3 million population.
Experts believe that by destroying the health sector amid a merciless bombing campaign, such as the October 30 Israeli bombing of al-Quds Hospital, Israeli leaders are trying to pressure the local Gaza population to turn against Hamas and other defenders of the land. It is a tactic that has proven to be a failure.
Israel is not only bombing hospitals and health centers but also the roads leading to them.
The World Health Organization (WHO) says it has documented 102 attacks on health care centers in Gaza since October 7.
It is important to note that these attacks have occurred in very a small piece of land and have only been documented by WHO. The UN body says it has limited access to move around and make contact in the besieged territory, with the Israeli regime regularly cutting off internet and phone connections.
WHO said the attacks have resulted in the death of hundreds of patients with hundreds of others injured as well as damage to 39 facilities and 31 ambulances.
The casualties are a direct result of Israeli airstrikes. But other experts on the ground believe the casualty figure is much higher, especially when taking into account the regime's decision to block the entry of fuel into the Gaza Strip.
Fuel is essential for hospitals to operate. Without fuel, patients are left to die.
WHO's office in the Gaza Strip also stated that more than half the hospitals in Gaza City have come under fire and ten are not functioning.
"Health care is not a target. WHO calls for the active protection of civilians and health care," it added.
The flow of vitally needed medical supplies and other aid into Gaza has been severely disrupted by the Israeli closure of the Rafah border crossing, which connects the territory with Egypt. Fuel has been literally prohibited by the Israeli leadership from entering the enclave.
As hospital generators stop working because of a lack of fuel, doctors in Gaza explain this means the lights will go out, ventilators will stop working, premature babies will die and those having dialysis on a daily basis will die.
"This is frankly a humanitarian catastrophe beyond anything we have witnessed in recent history," one pediatrician at a Gaza hospital said in a TV interview.
He said he has seen photos of children with "dismembered limbs, mutilated bodies, burns to their faces," and there are "no drugs available to give them".
"They are almost better off dead, that's the reality," he said. "They are in absolute pain and agony."
The regime claims Hamas would take advantage of the aid that has been slowly dripping into the Gaza Strip, but even its staunchest ally, the United States, says it has seen no such evidence to back up the claim.
Asked on the tiny amount of aid deliveries that have entered Gaza, U.S. special envoy David Satterfield said the U.S. has seen no "interdiction or interference" by Hamas since supplies started flowing into the region again some two weeks ago.
The head of the UN's World Food Program (WFP), Cindy McCain, says the amount of aid entering Gaza is "nowhere near enough" to meet the "exponentially growing needs" of Palestinians.
McCain issued an urgent plea from the Rafah crossing for more aid to enter the region as supplies reach "dangerously low levels".
Such is the scale and devastation of the Israeli bombing; medical staff are requiring mental health services as they perform surgery without routine anesthesia.
Psychological first aid is being provided to medical teams in Gaza by the Palestinian Red Crescent Society.
The organization said recreational activities were being provided at the al-Quds Hospital to medics to "ease their psychological strain amid constant threats of being targeted".
Israeli evacuation orders for Palestinians to head south of the Gaza Strip are adding to the woes of the health sector. The Israeli orders are difficult in peacetime let alone during war.
It is "impossible" to carry out orders to move the thousands of patients as well as people sheltering at al-Quds hospital in Gaza to the south, an aid worker in the region said.
Muhammad Abu Musabih, the director of ambulance and emergency services and a spokesperson for the Palestine Red Crescent Society, said that trying to transfer ICU patients on ventilators along with children and pregnant women posed a challenge.
Describing the conditions at the hospital as "miserable", he also said the bombings in the surrounding area meant the infrastructure was "totally devastated along with the roads".
"The situation in Gaza now is very complex in terms of reaching the injured and delivering them to the hospitals," he added.
Gaza's biggest hospital was forced to switch off one of its generators as its fuel supplies ran out, a doctor has said.
Dr Ghassan Abu-Sitta said staff at al Shifa Hospital were told they would need to shut down a generator.
"We had to stop operating five hours before we usually stop because the wards where we bought in our patients and took them back were dark," he said
"Basically, there was no way to maneuver the patients safely in and out of these wards."
With fuel in dire need, hospitals have already been forced to cease operations.
But even reaching a hospital has become a nightmare.
As Israeli warplanes bomb the Gaza Strip indiscriminately, transferring the injured survivors has proven to be another challenge with Palestinians forced to seek alternative ways.
A survivor of an Israeli strike on southern Gaza, where the regime said it was safe for Palestinians to travel, was carried to an ambulance by a bulldozer.
With the rubble piled high, it appeared the quickest way to bring her to safety.
Rescue workers dug through bricks and concrete to retrieve casualties after the strike destroyed a family home.
A humanitarian worker says Gaza is "in the last second of the eleventh hour".
In a TV interview, Deepmala Mahla, the vice president of humanitarian affairs at CARE, said every single minute in the region "is a matter of life and death".
Mahla also branded the level of aid that has so far been allowed into the enclave as "absolutely insufficient".
She echoed calls made by many humanitarian groups for an urgent ceasefire, warning there was "very little" time left.
"People are literally dying as we are talking."
Asked what is needed to happen right now, Mahla said water and electricity supplies needed to be fully reinstated, with families thirsty and hospitals "pretty much non-functioning".
The Palestinian Red Crescent (PRCS) strongly condemned the targeting of an ambulance convoy transporting the injured in Gaza last Thursday, saying it constitutes a “war crime”.
It released a statement saying the leading ambulance belonging to the Gaza health ministry was first struck by a missile one kilometer from al Shifa Hospital.
One of its own ambulances was then hit two meters from the hospital gate as it went to unload the injured, the PRCS said, with that strike killing a number of civilians and injuring scores more.
It added that eight Red Crescent ambulances have been "rendered inoperable" since the start of the conflict, while four PRCS medics have been killed and 21 injured.
"PRCS emphasizes that the deliberate targeting of medical teams constitutes a grave violation of the Geneva Conventions, a war crime, and that the parties to the four Geneva Conventions are legally bound to ensure the protection of medical teams and civilians under all circumstances," it said.
The Israeli military acknowledged that it had identified and bombed the ambulances.
Gaza's health ministry also said that scores were killed and injured in the attack.
Footage showed the devastating aftermath of the air strike on the ambulance convoy near a hospital in Gaza City.
The International Committee of the Red Cross (ICRC) has acknowledged receiving a request from the Gaza health ministry to accompany ambulances.
This is while the United Nations relief agency UNRWA said the situation in Gaza is now so dire that the average person there is living on two pieces of bread made from UN stockpiles.
The agency supports around 90 bakeries across the region, which aim to supply 1.7m people with food.
But Thomas White, UNRWA's Gaza director, said in a video briefing that "now people are beyond looking for bread. It's looking for water".
He described Gaza as a "scene of death and destruction" where no place is safe.
UN deputy Mideast coordinator Lynn Hastings said just one of three water supply lines from Israel is now operational.
"Many people are relying on brackish or saline groundwater, if at all," she said.
She also added that dwindling fuel supplies mean backup generators, which keep hospitals, water desalination and food production facilities running, are "one by one grinding to a halt".
Some people in Gaza have resorted to using seawater to drink due to the lack of fresh water in the enclave.
This humanitarian crisis means already overcrowded hospitals are totally incapable of coping with the outbreak of unpreventable diseases.
"The population in Gaza is at breaking point, untreated water is leading to a rise in cholera and diarrhoea which both have huge implications for child mortality," the charity group spokesperson for Action Against Hunger said.
The WHO chief has said Israel's forced evacuation of hospitals in the Gaza Strip would put the lives of thousands of patients at risk - as he called the situation on the ground "indescribable".
"Twenty-three hospitals have been ordered to evacuate in Gaza City and north Gaza, and forced evacuation in these circumstances would put the lives of patients in a life-threatening situation," Tedros Adhanom Ghebreyesus told a news conference in Geneva.
"We're running out of words to describe the horror unfolding in Gaza," Tedros added.
By late October, the only cancer treatment hospital in Gaza went out of service.
The Turkish-Palestinian Friendship Hospital was forced to cease all services after using up its fuel supplies, its director said.
"We tell the world don't leave cancer patients to a certain death due to the hospital being out of service," Subhi Skaik said.
Palestinian Health Minister Mai al-Kaila confirmed the director's remarks in a statement.
At the time, the total number of hospitals not operating stood at 16 out of 35 in the region. This has now risen.
She added that "the number of cancer patients in the Gaza Strip is about 2,000 living in catastrophic health conditions as a result of the ongoing Israeli aggression on the strip and the displacement of a large number."
On Monday Israeli forces targeted a solar panel system at a building in the al-Shifa hospital complex in Gaza City.
The latest regime atrocities against hospitals led UN agency leaders to declare that “enough is enough”
"An entire population is besieged and under attack, denied access to the essentials for survival, bombed in their homes, shelters, hospitals and places of worship. This is unacceptable" the 18 signatories of top UN agency leaders added in a joint statement.
Hospitals in the Gaza Strip were already under strain with everyday issues, even before the Israeli war on Gaza began.
For example, 50,000 pregnant women will be giving birth over the next month or so, in what the WHO has called a "public health catastrophe".