As Gaza hospitals collapse, medical workers face the hardest choices

Every day is a choice between who lives and who dies.

Doctors and nurses in the Gaza Strip's teetering hospitals, which are nearing collapse without electricity and basic supplies, say they must now decide which patients get ventilators, who gets resuscitated, or who gets any medical treatment at all. They make snap decisions amid the screams of small children undergoing amputations or brain surgeries without anesthesia or clean water to wash their wounds.

Some veterans of wartime medicine in Gaza say conditions inside the overcrowded and impoverished territory are the worst they have ever seen, as entire apartment blocks, schools and hospitals crumble under an Israeli bombardment that has meted out a devastating civilian toll.

"Our teams are physically and psychologically exhausted," said Basem al Najjar, the deputy of the head of Al-Aqsa Hospital in the city of Deir al-Balah in central Gaza.

"Some doctors remain a whole week in the hospital. Some of their families are brought to the hospital killed or injured. And some doctors go home and are killed there," and then the bodies are brought back to the hospital, he said. He added that three of the hospital's staff members had died at home, under Israeli military bombardment.

Israel has been bombing Gaza for weeks in response to an attack on Oct. 7 by Hamas, the armed Palestinian group that rules the territory. The assault killed roughly 1,400 people inside Israel.

More than 9,700 Palestinians have been killed in Gaza and nearly 25,000 have been wounded, the Gaza Ministry of Health said Sunday. The toll rises every day, with some of the casualties believed to still be buried under rubble.

An Israeli siege of the territory imposed after the Oct. 7 attack has also created crippling shortages of fuel, food, water medicine and other basic goods. Much of Gaza is without electricity after Israel cut off the supply and the main power plant ran out of fuel nearly four weeks ago. Israel is holding up fuel deliveries and sharply limits humanitarian aid entering the territory.

Doctors say they are struggling to keep their patients alive with what few medical supplies they have. Damage from airstrikes and severe fuel shortages have shut down nearly half of Gaza's hospitals entirely, while the ones with their doors still open are providing minimal care, at best, doctors say.

A lack of fresh water supplies and iodine has left wounds filthy, with maggots nibbling at patients' charred and torn flesh, according to interviews with doctors at four hospitals across Gaza. Without adequate water, doctors and nurses are unable to provide sufficient sanitation for their patients, to wash wounds or hospital bedsheets.

In some hospitals, patients arriving in cardiac arrest are not resuscitated, because medical staff choose to work on patients with a greater chance of survival instead. Few of the critically wounded get a hospital bed. Fewer still get a ventilator or anesthesia when operated on, including for brain surgeries, the doctors said. Anesthesia has been in short supply for about two weeks, doctors say.

On top of all those challenges, the hospitals have become temporary orphanages, too, according to medical workers.

In some cases, children have arrived at the hospitals after their entire families were killed in the war or watched as their parents died on hospital gurneys or tile floors. The medical staff have cared for some of the children until a relative can come to take them.

Najjar said that each day in his hospital starts with a fight to preserve dwindling fuel supplies. That struggle is shared by the 19 other hospitals that are still functioning, to varying degrees, in Gaza.

And the pressure on those hospitals is mounting as they compensate for 16 hospitals that are now out of service, according to a Health Ministry statement Thursday.

On Friday, an explosion near the entrance of Shifa Hospital in Gaza City struck a convoy of ambulances carrying wounded people preparing to evacuate to Egypt, according to a Hamas spokesperson and the head of the hospital, Dr. Mohammad Abu Salmiya. Thirteen people were killed and many others injured, Abu Salmiya said, adding that paramedics and patients being evacuated were among the injured while the hospital sustained damage from the explosion.

Two other hospitals came under attack Friday, according to the World Health Organization.

The Israeli military said it had carried out an airstrike on an ambulance "being used by a Hamas terrorist cell." An Israeli military spokesperson, Maj. Nir Dinar, confirmed it was the same strike that had caused the explosion outside the hospital.

Doctors in two hospitals in Gaza said that, with nothing to power air conditioners, the heat has gotten bad enough that it is making patients' wounds fester. Medical staff need their diminishing fuel stocks to light up operating rooms instead.

In the Kamal Adwan Hospital in northern Gaza, surgeries are being done by cellphone flashlight, according to one doctor there. Vinegar is sometimes used to disinfect wounds, with no iodine left.

The Gaza Strip has been plunged into darkness and cut off from the world after the territory's only electricity plant ran out of fuel and as Israel's military has cut telecommunications. Ambulance drivers say they often have to chase the sounds of airstrikes to know where they are needed.

With food in Gaza now so scarce, medical staff members say they eat only one meal a day, if the hospital can provide it to them, and sleep in the hallways with thousands of displaced people who have sought refuge in medical wards across the Gaza Strip.

"We are making hard decisions," said Mohammed Qandil, an emergency medicine and critical care consultant at Nasser Hospital in Khan Younis, a city in southern Gaza.

"We choose who gets ventilation by deciding who has the best chance of survival," he said. "For us as a team, these aren't easy decisions. It's a morally sensitive issue with a lot of guilt."

He paused, reflecting on growing international calls for Israel to agree to a cease-fire to allow humanitarian aid to flow into Gaza.

"We have to make these decisions, but we don't think it's our fault," Qandil said. "We think it is the fault of the whole humankind who are unable to deliver safe, continuous medical aid to us."

He sighed.

"All the people who come here, we cannot save them," he said, taking stock of the lives he watched slip away, many of which he said they would have been able to save before the current conflict.

"The hospital doors are open, but the care we are able to give -- it is negligible."