The health system in Gaza faces a catastrophic collapse as Israel Defense Forces (IDF) continue to bombard the enclave and lay siege to at least one remaining hospital in northern Gaza where patients and staff are threatened with starvation, according to aid groups and eyewitnesses.
Meanwhile, airstrikes on the southern city of Khan Yunis are forcing large numbers of already displaced civilians further south to the Rafah border crossing, where medical services are scant, people are without food and sleeping on the streets, and respiratory illnesses and other diseases are running rampant.
Health workers report desperate conditions across the Gaza Strip and allege that IDF warplanes are deliberately targeting civilians. Some are even warning that IDF snipers are shooting to kill anyone, including doctors and patients, who attempt to enter or flee the besieged al-Awda Hospital in northern Gaza — or even get too close to a window. The aid group Doctors Without Borders said on Tuesday that a surgeon was injured by a “shot fired from outside the facility,” and it was not the first report of Israeli snipers targeting people inside.
“We are at al-Awda Hospital in the northern area, and have been under siege for four days. No one can move or enter or leave the hospital,” said an al-Awda Hospital staffer named Mohammed in a voicemail recorded over the weekend. “The sniper killed our colleague when he [was standing by] the window at the 4th floor.”
Mohammed, who asked that only his first name be used to protect his family’s safety, left a series of voicemails with news outlets and aid negotiators over the weekend that were shared with Truthout by the pro-peace American Friends Service Committee (AFSC). An international aid negotiator in Jordan confirmed Mohammed’s identity.
The al-Awda Hospital, one of the only remaining medical facilities in northern Gaza, has been under siege by Israeli forces since last week. Mohammed said about 250 patients and personnel are about to run out of food and clean water after airstrikes destroyed the facility’s water tanks. Doctors are running out of medical supplies and unable to bring in more medication without risking exposure to a sniper attack.
Mohammed said people at the hospital are essentially held hostage and being starved out of the facility, with patients and staff only eating one meal of rice or bread a day.
According to voice messages from Mohammed, Israeli snipers targeted a pregnant woman who was attempting to enter the al-Awda maternity ward with a family member last week. This message has been lightly edited for clarity:
The first day of siege the sniper shot two women 70 meters away from the hospital who were coming to have maternity services for one of them. The pregnant woman could run and arrive to the hospital and had the baby, but the second one, her sister-in-law, was killed in the street; she is still out there — no one can bring her in. The same day, the sniper shot the son of our colleague when he was coming to the hospital, but we succeeded to save his life.
After previously bombing and laying siege to other hospitals in Gaza, the IDF conducted raids in what it said were searches for Hamas militants and left the facilities destroyed. The fate of al-Awda Hospital remains unclear, and an AFSC aid negotiator told Truthout that the IDF has so far refused to allow aid organizations access to the clinic.
Since the deadly October 7 Hamas attack on communities in southern Israel sparked the unprecedented Israeli retaliation, the IDF campaign has left at least 17,700 Palestinians dead, 46,000 injured and 1.9 million people displaced from their homes. Thousands more are missing and believed to be dead under the rubble of destroyed homes and shelters.
UNRWA, the United Nations refugee authority, recently confirmed that 133 employees have been killed as UN officials and aid groups beg both sides to allow more aid into Gaza.
“The situation of civilians in Gaza is untenable, we are reaching a point of no return,” UNRWA said on social media on Saturday.
Palestinians and aid officials fear that reaching the “point of no return” will include the mass expulsion of residents from Gaza, where entire neighborhoods are now destroyed.
“The decimation of northern Gaza and the displacement of millions of Gazans to the south is the first stage of such a scenario, and it is already complete,” UNRWA Commissioner-General Philippe Lazzarini wrote in the Los Angeles Times. “The next stage is underway — forcing people out of the urban center in Khan Yunis and closer to the Egyptian border.”
Israel has rejected claims that the IDF is trying to force Palestinians from Gaza, but civilians say nowhere is safe and they are running out of options. Reem Zidiah, a 22-year-old student, was first displaced when the IDF targeted and destroyed her family’s apartment building in Gaza City with some families still inside. She fled south with her family to a small apartment packed with dozens of family members in Khan Yunis, but over the weekend, the IDF left phone messages overnight warning her family to leave once again.
“We were displaced for a third time, I’m now 10 minutes away from the Egyptian border,” Zidiah told Truthout in a text message.
Like thousands of others, Zidiah is now in Rafah, the last stop before a border crossing with Egypt that remains closed to most civilians. She shared a video of families living in tents and makeshift shelters in an overcrowded area where people are falling ill in the winter weather.
“Being displaced is awful in itself, what about being displaced three times, warning us to run from one place to another like animals — as Israeli officers called us, ‘human animals,'” Zidiah said. “I just look at the pictures of my life before the aggression and feel like it’s a lie or a bad joke, all my friends, my house are just gone.”
On December 9, the aid group Doctors Without Borders began supporting the Al-Shaboura clinic in Rafah and immediately treated 130 patients in a single day.
“Every other patient in the clinic has a respiratory tract infection due to prolonged exposure to cold and rain,” said Nicholas Papachrysostomou, an emergency coordinator with Doctors Without Borders, in a statement. “People are living in extremely poor hygiene conditions. In some shelters, 600 people share a single toilet. We are already seeing many cases of diarrhea. Often children are the worst affected.”
Like many others, Zidiah is now suffering from the flu and a cough, but she said pharmacies are closed, and thousands of people are waiting in line for the only medical help available.
“It’s not enough that we don’t feel safe even in the ‘safe areas’ they are promoting,” Zidiah said. “No food, no water available, and now diseases spread due to bad weather and overcrowding in the south.”
This story has been updated.