Doctors at one of Gaza City’s last functioning hospitals say they are overwhelmed with casualties from Israeli strikes and are having to carry out operations in filthy conditions with few or no anaesthetics.
One Australian medic volunteering at al-Shifa hospital told the BBC that every day was a mass casualty event, while another described how a baby had been saved from the body of a pregnant woman who had been decapitated.
Israeli forces are now just 500m (1,640ft) away from the hospital as they expand their ground offensive to fully occupy Gaza City, which Israel’s military calls Hamas’s “main stronghold”.
Witnesses say tanks are advancing into the city centre from the south and north-west.
Israeli air and artillery strikes, attacks by quadcopter drones and detonations of remotely driven vehicles laden with explosives continue to drive tens of thousands of Palestinians from their homes each day.
Al-Shifa hospital was once the biggest medical complex in the Gaza Strip. After 23 months of war, it now lies in ruins, pockmarked by craters, with burned-out wards and bullet holes.
But inside medics are working beyond full stretch. Many of the beds do not even have mattresses, medicines are in short supply and the casualties are endless.
“It’s just a mass murder, a killing, a torture, a nightmare,” Dr Nada Abu Alrub, an emergency specialist from Australia volunteering at the hospital, told the BBC in a video call on Tuesday.
She said they were operating on severely wounded patients with “minimal to hardly no anaesthesia”.
“No painkillers as well, with their limbs hanging with a piece of skin and the tendon. Brain matter out. Organs are out. It’s horrific,” she added.
Last week, she said, doctors had to conduct an emergency Caesarean on a nine-month pregnant woman whose head had been blown off. They managed to save her daughter.
“The baby was a bit bradycardic, so her heart rate was low,” she recalled. “She was transferred to another hospital.”
Dr Saya Aziz, an Australian anaesthetist, described how a six-year-old boy with a fractured arm and leg had been waiting for three days for an operation to place external fixators on them because the hospital’s only orthopaedic surgeon had to prioritise more serious cases.
“Every couple of hours there are multiple amputation cases with massive resuscitation. It’s life or limb, literally,” she told the BBC.
“And you go in and you’re trying to anaesthetise them [while] they’re swatting flies in theatre.
“There’s blood over the beds. There’s no equipment. There’s no replacements. And you can see the sorrow and the sadness of the healthcare workers.”
Outside the hospital, Israel’s tanks are advancing, as the ground offensive against Hamas in Gaza City continues.
One video posted on social media showed a tank at Hamid junction in the Rimal neighbourhood, which is less than 500m from al-Shifa.
Another video showed troops to the south, only 700m from the city centre.
Palestinian journalist Fathi Sabah, who lives in southern Gaza but owns an apartment in the city’s southern Tal al-Hawa neighbourhood, said members of his family had narrowly escaped an Israeli incursion.
“My wife and son went to our flat to collect some belongings. They suddenly found themselves trapped as tanks surrounded the area,” he said.
“They lived through the hardest night of their lives before escaping through a back door. It’s unbelievable how quickly the tanks reached the heart of the city.”
Around one million Palestinians were estimated to be living in Gaza City before Israel announced its plans for the offensive last month.
The UN says more than 320,000 have fled southwards since then, while the Israeli military puts the figure at 640,000.
The Israeli military has told people to head south for their safety to a designated “humanitarian area” in al-Mawasi, where it has said medical care, water and food will be provided.
However, witnesses say the coastal al-Rashid road is severely congested and that families are struggling for hours to complete the journey.
The cost of evacuation has also reportedly soared to more than $3,000 (£2,200) per family – far beyond the reach of most residents.
The UN has also said the tent camps in al-Mawasi are overcrowded and unsafe, and that southern hospitals are operating at several times their capacity.
“The tanks are only a few metres from my house but I cannot afford the cost of fleeing,” Sultan Nassar, a 62-year-old father of five from the Sabra neighbourhood, told the BBC. “Death is everywhere, in the north and in the south.”
The Palestine Red Crescent Society said the oxygen station at al-Quds hospital in Tal al-Hawa had ceased operating after being struck by gunfire from Israeli forces, and that it only had enough pre-filled oxygen cylinders to last three days.
Israeli military vehicles were currently positioned at the southern gate of the hospital, preventing anyone from entering or leaving, it added.
On Monday, Gaza’s Hamas-run health ministry said the Israeli advance and bombardment had forced al-Rantisi children’s hospital and the nearby St John Eye hospital in the northern Nasr neighbourhood to evacuate patients and shut down.
The Jordanian armed forces also decided to close their field hospital in Tal al-Hawa and relocate it to southern Gaza, with Jordan’s state news agency reporting that shelling and other intense explosions in the vicinity had damaged the facility and some medical equipment.
The Palestinian Medical Relief Society’s primary healthcare centre in Gaza City was destroyed in an Israeli air strike which reportedly injured two health workers, the World Health Organization said. The centre was providing blood services, trauma care, cancer medications, and chronic disease treatment.
