Revisiting Gaza’s Nasser Hospital, after 11 weeks of war

The Nasser Hospital in the city of Khan Younis is the biggest health facility still functioning in the south of the Gaza Strip, where many of the almost 1.9 million Palestinians estimated to have been displaced since 7 October have been pushed by Israel’s military campaign.

When The New Humanitarian visited the facility weeks into the war conditions were already dire, with shortages of essential supplies and an endless stream of wounded and dead from Israel’s bombing, including loved ones of the hospital’s healthcare workers.

Since then, the situation has grown even more desperate as the near-total siege imposed by Israel since 9 October has continued to choke off medical supplies and many of the hospital’s staff have been prevented from reporting to work due to the ongoing hostilities.

Mohamed Qandeel, head of the emergency department at the hospital – otherwise known as Al-Nasser Medical Centre or the Nasser Medical Complex – said in early December that nearly 80% of the doctors have been blocked from reaching the facility because of Israel’s ground offensive, which expanded to Khan Younis after a temporary ceasefire ended on 1 December.

“The situation for us here at the hospital has become much worse, and the impact of the offensive is tangible,” Qandeel told The New Humanitarian. “Our doctors are torn between looking after their families and their well-being, securing shelter, water, and food for them, and between their sense of duty and responsibilities towards their people.”

Israel’s airstrikes, shelling, and ground attacks on the Gaza Strip have rendered 27 out of the 36 hospitals in the enclave inoperative as of 19 December, according to the World Health Organisation (WHO). 

Only nine hospitals – all in the south of Gaza – remain partially functional and able to receive new patients, as nearly 85% of the people who live in the territory have been displaced from their homes and the death toll from the more than two-month-long war continues to soar. 

“These hospitals are operating at three times their capacity, while facing critical shortages of basic supplies and fuel,” according to the UN’s emergency aid coordination body, OCHA. 

The war began on 7 October following a raid by Hamas, the Palestinian political and militant group that governs Gaza, into southern Israel that killed around 1,140 people, two thirds of them civilians, according to Israeli officials.

Israel’s retaliatory military campaign has killed at least 20,000 Palestinians – nearly 70% of whom are children and women, according to health officials in Gaza. It has also wounded over 50,000 others, and more than 8,000 Palestinians in Gaza are missing, with many presumed to be dead beneath the rubble of collapsed buildings.

The sheer number of casualties, the shrinking cohort of doctors and healthcare workers, and the lack of fuel and medical supplies has pushed Gaza’s exhausted and depleted health sector to breaking point.

In a press conference on 19 December, Gaza health ministry spokesperson Ashraf al-Qudra said 310 health workers have been killed by Israel’s military campaign and 99 others had been arrested by Israel, including the senior management of some of the hospitals.

A long shot of medical staff standing side by side and next to the bodies of Palestinians killed in Israeli strikes, amid the ongoing conflict between Israel and Palestinian Islamist group Hamas, at Nasser hospital in Khan Younis, in the southern Gaza Strip, December 20, 2023.
Medical staff stand next to the bodies of Palestinians killed in Israeli strikes at Nasser Hospital in Khan Younis on 20 December 2023.

Qandeel said the ratio of doctors to wounded persons in the earlier days of the war was already 1 to 50 patients in the intensive care unit at Nasser Hospital, with three doctors present. “This ratio has significantly increased now,” he said.

Many of the doctors working at Nasser Hospital have been displaced from their homes and impacted by the other effects of the war. “The hospital’s administration has lost contact with many doctors due to the difficulty in communication and damage done to mobile phone providers, resulting in repeated interruptions to telecommunications,” Qandeel said. 

Telecommunications in the strip have been repeatedly cut off for varying lengths of time since the beginning of the war.

“Repeated attempts to contact our staff during times of heightened workload are never successful. The hospitals nearby Nasser are small and their staff are overwhelmed. Our emergency department receives hundreds of patients everyday,” Qandeel added. “The situation is catastrophic.” 

The UN has recorded hundreds of attacks on healthcare services in Gaza since 7 October, in what one UN expert termed an “unrelenting war” on the health system in the enclave. UN experts also warned seven weeks ago that time was running out to “prevent genocide and humanitarian catastrophe”.

‘We won’t leave. We’re here to stay’

Israeli military officials have justified the shift in its attacks to Khan Younis, Gaza’s second largest city, by saying Hamas’ leadership is located there. Such claims raised fear among staff members of Nasser Hospital because similar claims that Hamas was using al-Shifa hospital – the largest medical complex in the enclave, located in Gaza City – as a “command centre” were used to justify Israeli forces’ storming the facility in mid-November.

The raids on al-Shifa reportedly led to dozens of deaths, with Israeli soldiers forcing out staff and patients and detaining doctors. Israel has yet to provide conclusive evidence that Hamas was operating from the facility. A team from WHO visited the hospital to deliver supplies on 16 December and described the scene inside the depleted emergency department as a “bloodbath”.

Meanwhile, attacks around Nasser Hospital have ramped up. On 13 December, OCHA said the vicinity of the facility was repeatedly bombarded, blocking dozens of casualties from accessing it. And on 17 December, the hospital was also hit at least twice, including by an artillery shell that struck the maternity ward, killing a 13-year-old child and injuring several others, according to the Health Ministry in Gaza.

“There’s the fear of [the Israeli military] raiding us here. Nothing is beyond them. But if this happens, all services will grind to a halt. Hundreds will die and health workers will be forced to leave. It’s the worst thing that can happen.”

Qandeel said the increased targeting of the Nasser complex was “terrifying” many of the hospital’s staff members who feared the “al-Shifa Hospital scenario getting repeated”.

“But we won’t leave. We’re here to stay,” he added.

Ahmed Taher, a paramedic in Nasser Hospital, has not seen his family in weeks and lives in constant fear of not seeing them again. Shortly after the humanitarian pause, he helped his seven children and wife settle among a growing number of displaced people seeking refuge in the secluded region of al-Mawasi in eastern Gaza, and then returned to the hospital.

He has since been inundated with a flow of casualties, which he said are only increasing in numbers and the severity of their condition.

“It has been tough, very tough,” said Taher, a 43-year-old paramedic with 15 years of experience. “We’re trapped here. There’s constant shelling and road closures. The buildings around us are being targeted one by one.”

“There’s the fear of [the Israeli military] raiding us here. Nothing is beyond them,” he said. “But if this happens, all services will grind to a halt. Hundreds will die and health workers will be forced to leave. It’s the worst thing that can happen.”

The situation since the pause expired is “much worse than it was before the pause”, he added. “Most of the people displaced in Khan Younis were forced to move again to Rafah and al-Mawasi, and the shelling has been relentless. There is no safety.”

‘Again, it wasn’t enough’

Atef al-Hout, the general director of Nasser Hospital, told The New Humanitarian that, although it’s one of the larger medical centres in Gaza, its capacity was “barely meeting the needs of patients under normal circumstances”.

Since Hamas came to power in Gaza in 2007, Israel has imposed a blockade on the enclave, severely limiting the movement of goods and people in and out of the territory, leading to a process of de-development that has hobbled the healthcare sector. 

“Everyone knows that Gaza has a deficit of hospital beds,” al-Hout said, referring to the period before the war. 

“[The] hospital had a capacity of 340 beds with a 90% to 80% occupancy. But, since the war started, I now have 770 patients inside the hospital – 200% occupancy,” al-Hout continued. 

To try to accommodate the surge in patients, Nasser’s staff has increased the number of beds in each room: Rooms that previously had two beds now have four, and rooms that had four beds now have six or seven. But that still hasn’t been enough, al-Hout explained. 

“We added beds in the corridors. Again, it wasn’t enough, so we placed beds in the waiting areas, which was still not enough, so we placed patients in the emergency units and outpatient clinics,” he said. “The circumstances aren’t suitable for this purpose, but we had no choice.”

The working hours of the staff who can still make it to work have also skyrocketed. Before the war, there were around 1,300 employees, but now only 50-60% of those are still able to make it to work. The administration has split them into two teams that work alternating 24-hour shifts.

“Psychologically and emotionally, our healthcare workers are exhausted. They sometimes sit in a corner and break down in tears, not out of exhaustion but because of what they have seen. The casualties are shocking – children torn to pieces, women and elderly. They cry because they can’t help them.”

With most healthcare facilities no longer functioning, medical workers from other parts of Gaza are trying to come to Nasser Hospital to help out, according to al-Hout, although it’s difficult and dangerous to travel from other areas of the enclave due to the Israeli military campaign. 

Nasser’s staff is “exhausted”, al-Hout said. “They worked non-stop for 50 days with very little rest. Some are exhausted, and others must take care of their families first and get them to safety before coming to work.”

‘We are humans’

After nearly 11 weeks of war, the staff at Nasser Hospital are also struggling with mental health issues. 

“From one side, the doctors are constantly worried about their own families,” al-Hout said. “But they try not to think of their own personal losses, and continue to perform their duty.” 

Lack of supplies is another issue. 

“During the temporary humanitarian pause, medicines were supplied, but they were not categorised, so we don’t know what came in,” he said.

“The other problem is that the supplies came in huge [quantities],” al-Hout continued. “We had to store them outside the hospital because we don’t have enough storage space on the premises. Now, it’s hard to reach them, especially as they’re not sorted. The humanitarian pause was not long enough to do so.” 

Israel’s advancing ground incursion into Khan Younis is another source of stress for health workers.

“The casualties arriving here usually require surgical intervention. Despite the exhaustion, the emergency room and its surgeons are working around the clock,” al-Hout said. “They don’t rest more than two to three hours at a time.” 

Doctors are being forced to select which patients to save and which ones they have to leave to die. 

“In past hostilities, we never used to triage – even during COVID. But today, we are forced to. I sometimes have to apologise to the casualties and tell them that I cannot provide the service they need,” al-Hout said. 

Even for those who are treated, “I can only provide the bare minimum just to preserve their lives,” al-Hout continued. “The numbers are huge. We even had to evacuate patients who needed to remain in hospital because there wasn’t enough room. There are too many cases. We receive up to 100 injuries daily, so we don’t have the capacity to keep them all inside. We’re not talking about simple wounds. These are usually critical wounds requiring surgery.” 

“Psychologically and emotionally, our healthcare workers are exhausted,” al-Hout said. “They sometimes sit in a corner and break down in tears, not out of exhaustion but because of what they have seen. The casualties are shocking – children torn to pieces, women and elderly. They cry because they can’t help them.” 

“We are humans. We are not angels, and we are not superhuman. We are ordinary people. We have feelings, ideas, and personal problems,” he said. “Despite all this, we put everything aside to provide care for our patients.”

This article is published in collaboration with Egab. Edited by Dahlia Kholaif and Tom Brady. 

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