Intensified Israeli ground operations and new evacuation orders are stretching Gaza’s health system beyond breaking point, the head of the World Health Organization (WHO) has warned.
Dr Tedros Adhanom Ghebreyesus said the Indonesian, Kamal Adwan and al-Awda hospitals in the northern towns of Beit Lahia and Jabalia were inside an evacuation zone announced on Tuesday. Another two hospitals are within 1km (0.6 miles) of it.
Kamal Adwan was out of service due to hostilities nearby and the Indonesian hospital was inaccessible because of the presence of Israeli forces around it, he added.
Al-Awda hospital is still functioning, but its director told the BBC on Wednesday that it was “totally under siege”.
“Nobody can move out and we can’t receive any cases from outside the hospital,” Dr Mohammed Salha said.
He added that there was a quadcopter drone “shooting in the surroundings of the hospital and the outdoor area of the hospital”.
“We also hear shooting from the tanks… maybe 400 or 500 metres [away].”
Israel Defense Forces (IDF) told the BBC that it was “operating in the area against terror targets”, but that it was “not aware of any siege on the hospital itself”.
Dr Tedros said: “Even if health facilities are not attacked or forced to evacuate, hostilities and military presence obstruct patients and staff from accessing care, and WHO from resupplying hospitals, which can quickly make them non-functional.”
“We’ve seen this too many times – it must not be allowed to happen again.”
Médecins Sans Frontières (MSF) also said that at least 20 medical facilities across Gaza had been damaged, or forced partially or completely out of service, in the past week by Israeli ground operations, air strikes and evacuation orders.
The charity demanded that Israeli authorities stop what it called the “deliberate asphyxiation of Gaza and the annihilation of its healthcare system”.
Israel imposed a total blockade on Gaza on 2 March and resumed its military offensive against Hamas two weeks later, ending a two-month ceasefire. It said it wanted to put pressure on Hamas to release its remaining 58 hostages, up to 23 of whom are believed to be alive.
After several days of intense bombardment, the IDF launched an expanded offensive on Sunday that Prime Minister Benjamin Netanyahu said would see ground forces “take control of all areas” of Gaza. The plan reportedly includes completely clearing the north of civilians and forcibly displacing them to the south.
More than 600 people have been killed and 2,000 injured across Gaza over the past week, according to the territory’s Hamas-run health ministry. The UN says tens of thousands of people have been newly displaced.
Netanyahu also said Israel would allow a “basic” amount of food into Gaza to prevent a famine. But the UN has so far been unable to collect the dozens of lorry loads of supplies allowed in since Monday.
MSF said the volume of aid allowed in so far was not nearly enough, describing it as “a smokescreen to pretend the siege is over”.
On Tuesday, the WHO’s representative in the Palestinian territories said he had recently returned from Gaza and witnessed how the health system was facing attacks and acute shortages of supplies.
“Every time you get into Gaza you always think it cannot get worse. But it gets worse,” Dr Rik Peeperkorn told reporters in Geneva.
He described how al-Awda hospital was “overwhelmed with injuries” and running low on supplies. Hostilities had damaged the facility, disrupted access and deterred people from seeking healthcare, he added.
He said the Indonesian hospital was barely functioning, almost inaccessible, and that most patients had left last week after a staff member was killed, one patient was injured and the facility was damaged during intensified hostilities.
Only 15 people, including patients and staff, were still inside the hospital as of Tuesday, urgently in need of food and water, he added.
The hospital’s generator was also struck by an Israeli quadcopter on Monday night, causing a large fire and a blackout, according to MER-C Indonesia, the NGO that built the facility.
On Wednesday, a woman inside the hospital told the BBC by telephone that two of the patients were in a “serious condition”.
In the background of the call, crashes could be heard.
“Five minutes ago, there was intense shooting in the surroundings of the hospital,” she said, adding that she could see tanks.
The woman also said that they still had supplies of food inside the hospital, but were “facing a water crisis”.
The IDF told the BBC it was operating in the area around the hospital and targeting “terrorist infrastructure sites”, but that it was not targeting the hospital itself.
In another incident on Tuesday, a paramedic said his ambulance was shot at by an Israeli drone while he was transporting staff and food between al-Awda and Kamal Adwan hospitals.
Khaled Sadeh said he was with another ambulance when bullets hit both vehicles’ windshields. Nobody was injured.
Dr Salha shared photos of the ambulances and confirmed that Mr Sadeh was unable to return to al-Awda because of the threat of Israeli fire.
The BBC supplied details of the allegations and photos to the IDF, but it said it “could not confirm” the reports.
Hospitals and medical personnel are specially protected under international humanitarian law.
Hospitals only lose that protection in certain circumstances. They include being used as a base from which to launch an attack, as a weapons depot, or to hide healthy fighters.
The IDF has insisted that its forces operate in accordance with international law. In most instances where it has attacked hospitals, it has said they were being used improperly by Hamas – an allegation the group has denied.
In the southern city of Khan Younis, the European hospital – the only facility providing neurosurgery, cardiac care and cancer treatment in Gaza – has been out of service since 13 May.
That day, the hospital’s courtyard and surrounding area was hit by a series of Israeli air strikes that Israel’s defence minister said targeted an underground bunker where the head of Hamas’s military wing, Mohammed Sinwar, was hiding. Gaza’s Hamas-run Civil Defence agency said the attack killed at least 28 people, but it is not clear yet whether Sinwar died.
The facility has also been inside an Israeli-designated evacuation zone covering almost the entire eastern half of Khan Younis since Monday.
Dr Tedros said Nasser, al-Amal and al-Aqsa hospitals, as well as one field hospital, were within 1km of the zone.
Dr Victoria Rose, a British surgeon working at Nasser hospital, said in a video posted on social media on Wednesday that she was very worried about the facility being evacuated or cut off by an Israeli troops advance from al-Aqsa, which in the central town of Deir al-Balah.
“If we get cut off from the Middle Area, there really are no other hospitals around us that could cope with the evacuation of Nasser,” she explained.
“We have some amazing field hospitals… but none of them are capable of doing the type of surgery that we’re doing here. And none of them have ICU capacity or generated oxygen. So, even all of them together couldn’t cope with the amount of patients that we have.”
She warned: “If Nasser is evacuated, we really are looking at the imminent death of hundreds of patients because we won’t be able to take them anywhere.”
Nasser was also hit by an Israeli strike on 13 May, killing two people including a Palestinian journalist who was being treated for injuries he sustained in a previous strike on a tented camp at the complex. The attack also destroyed 18 beds in a burns unit, according to the WHO.
The IDF accused the journalist of being a Hamas operative and alleged that the hospital was being used by the group to “carry out terrorist plots”.
Another strike on Monday severely damaged Nasser’s medical warehouse and destroyed critical WHO supplies, according to the hospital’s director.
