The Israeli military campaign has brought Gaza's healthcare system to the brink of collapse

Before Israel's invasion of Gaza last year, Dr. Mahmoud Al-Reqeb worked at one of the largest hospitals in the Palestinian territory and ran a private clinic, caring for women during their pregnancies.

He now lives in a plastic tent in Rafah, a Palestinian border city where about half of Gaza's population has sought refuge, and treats patients for free in another tent. Living under Israeli bombardment, with shortages of food and clean water, the pregnant women he serves struggle to find safety and basic nutrition, not to mention prenatal care.

Since the Israeli army began bombing Gaza six months ago following the Hamas-led attack on October 7, its forces have destroyed entire hospitals, hit ambulances and killed or arrested hundreds of health workers. According to aid groups, Israeli restrictions on goods entering Gaza have prevented life-saving medical supplies from reaching patients. Furthermore, shortages of fuel, water and food have made it difficult for health workers to provide basic services.

The result has been the near collapse of the healthcare system that once served Gaza's population of more than two million people. According to the World Health Organization, as of the end of March, of 36 large-scale hospitals across Gaza, only 10 were “minimally functional.”

Israeli officials say the medical centers were targeted because Hamas fighters have taken up residence in and under the structures, and that this is the only way to eradicate the armed group. Hamas and health workers have denied this accusation. Humanitarian groups, researchers and international bodies are increasingly describing Israel's dismantling of Gaza's medical capabilities as “systematic”.

“If you planned to destroy a health system, you would end up exactly where we are today,” said Ciarán Donnelly, senior vice president of the International Rescue Committee, a humanitarian group working in Gaza.

Mr Donnelly said he had worked in the humanitarian aid sector for two decades and could think of no other war in which a health system had been destroyed so completely and so quickly.

When asked for comment, the Israeli military referred to previous statements made regarding the embedding of Hamas fighters in the facilities. Evidence reviewed by The New York Times suggests that Hamas used Al Shifa hospital – which the Israeli army raided – as cover, stored weapons inside and maintained a long tunnel. The Israeli military has not presented similarly extensive evidence regarding most of the other health centers it has attacked.

Dr. Al-Reqeb's old facility, Nasser Hospital, was attacked by Israeli troops in February. When he goes to his new job, at an Emirati-funded hospital – one of the few facilities in Gaza providing specialized gynecological and obstetric services – he is one of fewer than 10 doctors treating 500 patients a day with a “severe lack of supplies, staff , medicines and equipment,” he said.

“I was very shocked when I realized the level of damage the medical system is experiencing,” Dr. Al-Reqeb, 33, said in a telephone interview. “It's completely destroyed.”

The devastation of the health system has spread across Gaza. Cancer patients had to stop chemotherapy. People with kidney failure no longer have access to life-saving dialysis. Pregnant women have been left without monitoring that could help identify life-threatening conditions like preeclampsia.

“Sometimes I cry,” said Dr. Zaki Zakzook, an oncologist who was once one of Gaza's most prominent oncology doctors and now lives in a tent with his family in Khan Younis. “I am watching my patients being executed, slowly and gradually.”

Dr. Zakzook has been able to do little for his patients since the war forced the closure of the cancer hospital where he worked, he said. He now sees patients at a southern hospital but no longer gives them chemotherapy, fearing that it would weaken their immune systems at a time when the medical system is unable to cope with infections, he said. Instead he offers palliative care, such as painkillers.

“I'm trying to do my best, others are trying the same, but what can we do?” He said.

In February, Israeli forces stormed Nasser Hospital, a large facility in Khan Younis. According to Doctors Without Borders, a humanitarian group whose staff witnessed the attack, they bombed the hospital's orthopedic department and arrested dozens of health workers.

“The evidence at our disposal indicates deliberate and repeated attacks by Israeli forces against Nasser Hospital, its patients and its medical staff,” the organization wrote. The Israeli army said it was searching for Hamas fighters and the bodies of Israelis captured in the Oct. 7 attack.

In March, the Israeli army raided Al Shifa hospital for the second time, killing nearly 200 people, described as terrorists. Israeli troops left behind widespread devastation after extensive firefights with Palestinian militants in and around the compound. He said his troops had come under fire from armed men in and around one of the hospital buildings. Gaza authorities said 200 civilians died in the raid. Neither claim can be independently verified.

After the raid, the hospital premises were littered with bodies and shallow graves, according to the World Health Organization, which led a team to assess conditions at the hospital this month.

In a statement after his visit, the WHO said the hospital was “an empty shell”, with no patients and most of its equipment “unusable or reduced to ashes”.

“There's growing evidence that a red cross or a red crescent actually puts a target on you, rather than the other way around, and that's just an appalling degradation of human values,” said Dr. Tim Goodacre, a surgeon who has been traveling to Gaza for years to help train Palestinian doctors and volunteered at a local hospital in January.

Before the war, Abdulaziz Saeed's 63-year-old father was waiting to receive a kidney transplant in March. Mr Saeed and his mother had both been approved as potential donors. Then the war began. The doctor who was supposed to perform the operation was killed, Mr. Saeed said, and “all our plans were cancelled.”

His family now shares a home with dozens of displaced people in the town of Deir al Balah, and his father, who previously required three dialysis sessions a week for kidney failure, can only receive one a week at Al Martyrs' Hospital -Aqsa.

“The biggest problem is the lack of medical personnel,” Saeed said. “There were three specialist doctors in the kidney department. Two of them were killed and the third is unreachable.”

Anas Saad, a 24-year-old nurse at the hospital, said many of his colleagues resigned after repeated attacks on medical facilities.

“This is no longer a safe place,” Saad said. “I'm doing my best to help people survive. However, it is becoming extremely risky, as hospitals can be stormed or bombed at any time.”

Dr. Tanya Haj Hassan, an American pediatric intensive care doctor, recently entered Gaza as part of a team of foreign doctors to volunteer at the hospital. He described “apocalyptic” scenes, including a girl who, he said, died after an Israeli bulldozer ran over a tent, crushing it, and a boy in a wheelchair whose entire family had been killed but who believed that the his parents would come to get him because “no one has the courage to tell them”. Her account could not be independently verified.

The whole of Gaza “just looks like it's been hit by a nuclear bomb,” he said. “The reality is that they eliminated one hospital at a time. 'Hospital at a time': I can't even believe I'm saying those words.”

Hwaida Saad contributed reporting from Beirut, Lebanon, and Johnatan Reiss from Tel Aviv.

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