Multiple hospitals have closed due to airstrikes and lack of fuel. Others are struggling to stay open.
A wounded girl waits for treatment at al-Shifa hospital on November 5, 2023. Bashar Taleb/AFP/Getty Images Li Zhou is a politics reporter at Vox, where she covers Congress and elections. Previously, she was a tech policy reporter at Politico and an editorial fellow at the Atlantic.
As Israel steps up its air raids and ground assault in its ongoing war against Hamas, the medical situation in Gaza is growing more and more dire, with the north’s major remaining hospitals warning they’ll soon run out of fuel and supplies. Once they do, a humanitarian crisis that’s already untenable is only expected to get worse.
“If the airstrikes continue, there’ll be these dual forces of bombing, all of the trauma injuries that come from that. And then just as the health system deteriorates … [an] inability to deal with infectious disease, people who need other types of care,” says Yara Asi, a professor of global health management at the University of Central Florida who has studied health care systems in the Occupied Palestinian Territories. “It is a disaster from the top to the bottom.”
The need for quality medical care in Gaza has only deepened following weeks of devastating airstrikes by the Israeli government, which have killed more than 10,000 people and injured more than 25,000, according to the Gaza Health Ministry. These airstrikes are in response to a brutal attack by Hamas on Israel on October 7, during which the Palestinian militant group killed 1,400 people and took roughly 240 people hostage.
As a result of the Israeli government’s airstrikes and full siege on Gaza, hospitals are not just running out of fuel, food, and water, they’re also suffering damage from ongoing bombardment. Solar panels keeping one of Gaza’s largest hospitals going have reportedly been destroyed in the fighting, while other hospitals have suffered extensive structural damage.
That means existing patients, including pregnant people, babies, and people with chronic illnesses, can’t get treatment and are more likely to die as a result. As a doctor in southern Gaza told the New York Times, “The hospital doors are open, but the care we are able to give — it is negligible.”
Additionally, the airstrikes have overwhelmed hospitals with a surge of new trauma patients who’ve been grievously wounded and burned, and who have increasingly limited options for treatment as doctors run low on antiseptic supplies, antibiotics, and anesthesia. In their absence, doctors describe cleaning wounds with vinegar and laundry detergent, and performing operations with patients who are wide awake.
Additionally, hospitals have become refuges for displaced people, making facilities already full of the ill and wounded even more packed. Medical experts worry that infectious diseases — such as cholera — will increase as people in Gaza are exposed to contaminated water and forced to shelter in cramped, crowded spaces.
“We’re running out of words to describe the horrors unfolding in Gaza,” World Health Organization Director-General Tedros Adhanom Ghebreyesus said in a news briefing on Thursday. “Hospitals crammed with the injured lying in corridors. Morgues overflowing. Doctors performing surgery without anesthesia. Thousands of people seeking shelter from the bombardment. Families crammed into overcrowded schools desperate for food and water. Toilets overflowing and the risk of disease outbreak spreading. And everywhere, fear, death, destruction, loss.”
Hospitals are suffering from supply shortages and airstrikes
Of Gaza’s 35 hospitals, 16 have already been shuttered, and a number of those that remain — particularly in the north, which has borne the brunt of Israel’s attacks — say they can last days more at best. Smaller practices are in dire shape as well, with about 70 percent of primary care clinics reportedly forced to shut their doors.
Due to both dwindling fuel and damage from airstrikes, Gaza’s only cancer hospital, the Turkish-Palestinian Friendship Hospital, ceased operations last week, according to Palestinian health officials. The Indonesian Hospital, a major provider of medical care in northern Gaza, also saw its main generator go out last week, severely limiting its ability to provide key services, including oxygen and ventilators. And on Friday, al-Shifa hospital, the largest hospital in Gaza, said it was running so short on fuel that it only had enough energy to power the neonatal intensive care unit. The UN has been able to keep some services at hospitals in the south afloat by sharing its fuel reserves, but the organization hasn’t been able to get any fuel to the north, where all three of the aforementioned hospitals are.
Without fuel, these hospitals aren’t able to ensure that they can keep their power or life-saving machines on. Beyond these struggles, Gaza’s hospitals are also short key medical supplies including everything from gauze to IV bags to antiseptic. These shortages have forced physicians to ration their existing supplies, and to perform procedures — including surgeries — with little or no anesthesia.
“Even the most basic of supplies we’ve run out,” Ghassan Abu-Sittah, a surgeon in Gaza, told Australia’s SBS News. “We’ve run out of dressings, we’ve run out of intravenous fluids, we’ve run out of blade sutures. Anything that we require is finished or in the last few boxes left in the department.”
MSF’s Dr. Tanya Haj-Hassan, talking about what hospitals in Gaza need:
Fuel for generators.
When fuel runs out, every person on a ventilator, premature baby in an incubator will die.
We need an immediate ceasefire.https://t.co/Ev866wFFSF
— Doctors w/o Borders (@MSF_USA) October 29, 2023
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.”