No communications, no medicine and little hope. That's what operating a hospital in a war zone has become in Gaza, according to a team of doctors trapped for weeks inside the besieged Al Amal Hospital in Khan Younis.
"Life is very difficult here," hospital manager Dr. Haidar Al-Qudra told UN News.
Currently, only 12 of Gaza's 36 hospitals are "partially functioning", according to the World Health Organization (WHO), with the rest destroyed by Israel's near constant bombardment of the enclave.
As the war in Gaza enters its fifth month, Israeli forces continue to raid healthcare facilities, with Al Amal Hospital among the latest to endure a weeks-long deadly siege. Israel claims Hamas is operating in hospitals, but Palestinian authorities and medical professionals have refuted those allegations.
Al Amal Hospital took 40 direct hits that killed at least 25 people and incapacitated the health facility, according to a report from the UN Humanitarian Country Team in Palestine.
Buildings continue to be peppered by Israeli sniper fire, communications blackouts and the detention of health workers alongside drastic shortages of essential goods and restrictions on what lifesaving supplies can enter the complex, according to UN agencies and news reports.
'We are surrounded now'
Since the start of the siege on Al Amal in January, more than 8,000 displaced people have been evacuated from the complex, many having used the premises as shelter from Israeli attacks in the area.
Nearby fighting and multiple bombings found health workers "were afraid for their lives" and, for more than a month, they have been unable to leave the hospital buildings, Dr. Al-Qudra said.
"We are surrounded now, and patients cannot reach the hospital because they are not allowed to walk in the streets near the hospital," he said. "Our ambulances now cannot move outside the hospital."
'Most patients have either died or are suffering'
Many surgical cases had been postponed, he warned, noting that five months had passed without many operations being performed, from mastectomies and thyroidectomies.
"All of these normal operations were not performed in any hospital, therefore, most of these patients either died or they are suffering more and more," Dr. Al-Qudra said.
Extensive damage has also forced management to try to transfer patients to get the care they need. After the ceiling on the third floor collapsed, he said they would now refer around 35 patients to other nearby hospitals.
But, the remaining hospitals across Gaza are badly overcrowded. In Rafah, 77 newborns were sharing 20 incubators, according to UNFPA.
'First time we see the sun'
Dr. Waheed Qudih, a surgical consultant at Al Amal Hospital, was among the medical staff trapped inside during the siege.
"This is the first time we see the sun," he said, referring to the arrival of a joint UN mission to the battered premises this week. "We have not been allowed to leave the hospital door since 21 January."
He, like others, he stayed inside on site "to help injured patients".
"We perform a lot of surgeries for injured patients, such as general surgery and orthopaedics," he explained. "We have saved the lives of many patients, and we did what we could with limited facilities."
Joint UN relief mission
Following reports of the besieged medical centre, the UN deployed a joint mission, with WHO alongside agencies for humanitarian affairs office OCHA, the mine action service (UNMAS), reproductive health agency UNFPA, the safety and security department (UNDSS) and UNRWA, the Palestine refugee relief agency.
Meeting with health workers in the besieged hospital and checking on the condition of the patients and companions inside, the mission's goal was to evacuate 24 patients and deliver lifesaving food, water and fuel as well as emergency surgical supplies and antibiotics to treat an estimated 50 infections.
The mission had to leave 31 non-critical patients behind, an OCHA spokesperson said on Tuesday, highlighting that the Israeli military had not given "any information or any communication" about why the mission ambulances were detained for at least seven hours nor why the paramedics "had been taken out, forced to undress".
'There are still patients here'
Dr. Athanasios Gargavannis, a trauma surgeon and WHO emergency staff member, said the level of devastation he witnessed is "beyond imaginable".
"However, there are still patients here," he said. "Our top priority is to identify and refer a number of them so they can continue to receive care."
As chronic delays at Israel's Kerem Shalom crossing continues, with news reports showing Israeli protesters blocking the entry of aid into Gaza, some nations have resorted to emergency aid airdrops this week.
But that represents only a tiny portion of what is needed at Al Amal and other Gaza health centres.
'No respect for any humanitarian law'
At Al Amal Hospital, Dr. Al-Qudra said that before the war, it had 100 beds, focused on maternal and child health and was able to meet basic surgical and internal medicine needs while providing specialized rehabilitation services.
The destruction caused by the bombing of the third floor reduced the capacity to an estimated 60 beds. Supplies are scarce. Communications blackouts continue.
On Wednesday, the Palestinian Red Crescent Society said Israeli forces continued to detain seven team members for nearly three weeks, including a doctor, anesthesia technician and ambulance staff, who were taken into custody during Israel's raid on Al Amal Hospital, according to media reports.
These days in Gaza, Dr. Al-Qudra stressed, there is "no respect for any rule or any humanitarian law related to the medical staff".
