Israeli airstrikes and shootings near aid hubs run by the Gaza Humanitarian Foundation (GHF), a controversial US and Israel-backed initiative, have seen a dramatic increase in deaths and injuries leading to amputations, compounding the suffering of Palestinians struggling to stave off malnutrition and starvation as the conflict continues.
At the Al-Shifa Hospital in Gaza City, a small child, Maryam Abu Alba, is crying in pain. "The neighbour's house was bombed, and their home was hit," says her grandmother.
"One of her legs had to be amputated, and metal plates had to be inserted into the other one, which was fractured. She is in severe pain."
Nowhere to run
At the same hospital, young Mohammad Hassan looks down at his heavily bandaged left leg, and the stump where his foot used to be. "I was going to buy falafel," he says. "On the way home, I looked up and saw a rocket heading towards me. I tried to run, but it was too fast. I found myself pinned to the wall, and my foot had been blown off. Then someone picked me up and took me to this hospital."
Gaza now has the highest number of child amputees per capita of anywhere in the world.
Shot in search of food
In May, GHF took over aid delivery in Gaza, bypassing established routes and dramatically scaling back the number of distribution points to a handful of fortified hubs, a policy that has been criticised by the UN and NGO partners.
We were told the Gaza Humanitarian Foundation had opened its doors to distribute aid. When I arrived...I was hit by an explosive bullet
On Monday, the UN human rights office described attempts to access these sites as "a deadly pursuit". Thousands of Palestinians have been killed or injured since May while seeking food.
When GHF began operations, Ibrahim Abdel Nabi was one of the many Palestinians who headed to the hubs in the hope of finding desperately needed provisions for their families.
In his tent at a displacement site in the coastal Al-Mawasi area of Khan Younis, Mr. Nabi, surrounded by his wife and children, explains how the journey ended in disaster and life-changing injuries.
"We were told that the Gaza Humanitarian Foundation had opened its doors to distribute aid. When I arrived at the Al-Alam area, west of Rafah, I was hit by an explosive bullet in my leg. I was bleeding for about an hour and a half, and no one came to help me. They were all trying to find food for their children."
Eventually, a group of people came to his rescue and took him to the nearby Red Cross hospital.
"I stayed there for about a month and a half, undergoing about 12 operations. I became malnourished and lost a lot of blood. Infection spread, and more of my leg had to be amputated."
'I made my prosthetic leg'
As Mr. Nabi was trying to recover, he was aware that his family were still in need of food. Despite the pain, he decided to make a simple prosthesis from materials he could find to allow him to get back on his feet and make fresh attempts to find food and water.
"The prosthesis injures my leg," he said. "It causes inflammation and increases the pain. We don't have medical care or supplies, but I will use it no matter how much it hurts."
As he speaks, Mr. Nabi's wife begins to cry. "God willing, we will live through this experience," she says.
Mr. Nabi gets up on crutches and heads to a nearby tent, where his wife helps him to put on the crude prosthesis.
"Don't strain yourself," she repeats, over and over. "Take your time. Walk slowly."
