Smoke rises over Gaza following an Israeli airstrike on buildings near the separating wall between Egypt and Rafah on May 7, 2024.

Smoke rises over Gaza following an Israeli airstrike on buildings near the separating wall between Egypt and Rafah on May 7, 2024. (Ramez Habboub/AP)

Rafah’s threadbare health network is collapsing when people there need it most.

The city’s largest hospital was shuttered two days ago in a panic after Israel ordered 100,000 Palestinians in southeastern Gaza to evacuate. Small clinics that accommodated hundreds of people a week closed as well, with staff members forced to flee the violence.

Bodies lay where they fell, in the “red zone” that the few ambulances available could not reach because of Israeli bombardment, a Palestinian Red Crescent spokeswoman said Tuesday. Border crossings remained closed Thursday, stranding critically ill patients waiting to be evacuated to Egypt and preventing international doctors and badly needed medical supplies from getting in.

Israel’s military operations in Rafah this week have overwhelmed health care workers, who were already struggling to treat displaced Palestinians suffering from malnourishment, explosive injuries and an array of diseases, which doctors say are spreading rapidly through the city’s filthy and overcrowded tent camps.

Children were most at risk, as they have been throughout seven months of war. Thousands of infants in southern Gaza are acutely malnourished, and nearly all children under 5 in the area are suffering from “one or more infectious diseases,” according to UNICEF.

Israel has called its operations “limited.” Doctors said it was nothing of the sort, as munitions fell on an area smaller than the Istanbul Airport complex, packed with more than a million people.

“There are no words to express the catastrophe of what we are experiencing today,” said Suhaib al-Hams, the director of the Kuwait Specialized Hospital in Rafah, which remained open but critically unprepared for what had come: a flood of patients with brain and head injuries, limbs that needed amputating, and burns so severe they could not be treated “with our simple capabilities,” he said.

There were not enough doctors, he said, and not enough beds.

The Israeli military’s evacuation order Monday and its seizure of the Rafah crossing along Gaza’s border with Egypt — a vital artery for aid, fuel and humanitarian workers — appeared to be the start of its long-threatened invasion of the city, which it says is home to Hamas’s last intact battalions.

President Joe Biden said Wednesday that he would halt the shipment of offensive weapons to Israel if ground forces moved into Rafah. “Civilians have been killed in Gaza as a consequence of those bombs and other ways in which they go after population centers,” he said.

As residents began to flee Monday, Hamas officials announced they had accepted an Arab cease-fire proposal, and the news briefly sparked celebrations in the streets. But Israel said the terms proposed were unacceptable, and the airstrikes have continued.

The cheering could still be heard Monday evening as ambulances started arriving at the European Hospital in Rafah, said Mohammed Abdelfattah, a Palestinian-American doctor from California who is volunteering there. He walked to the emergency room and saw an infant girl “with pink toenails and little feet, with the breathing tube.” She had suffered “severe trauma” from a strike.

“Her mom was sitting behind her, just screaming that she wished it was her and not the baby,” Abdelfattah recalled. A colleague caressed the girl’s foot.

“Someone was doing CPR on the baby, and she didn’t make it,” he said.

That night, doctors started clearing the Abu Youssef al-Najjar Hospital, Rafah’s largest, located in the evacuation area, said Marwan al-Hams, the hospital director. “The medical teams were unable to hold on due to the danger,” he said. “Every moving person is a target.”

Some patients were sent home and others to different medical facilities, he said in an interview Tuesday, as he and his colleagues finished closing up the hospital. Its services, including Rafah’s only dialysis center, could not be easily replaced, he said.

“Today, we had to close two of our medical clinics ahead of schedule despite the overwhelming needs,” Moses Kondowe, the leader for Project Hope’s team based in Rafah, wrote in a message to colleagues Wednesday.

“These medical points are in underserved displacement camps and are the only access to health care many people have.”

If the violence continues and health services remain suspended, he warned, “we can expect to see malnutrition, pregnancy complications, and other health conditions like Hepatitis A and cholera increase.”

Southern Gaza was already in the throes of a health crisis, said Nick Maynard, a British volunteer surgeon who left Rafah on Monday. In addition to explosive injuries, patients had “terrible infective complications as a direct result of malnutrition,” he said during a media briefing Wednesday. Some suffered horrific and humiliating complications from abdominal surgery related to malnutrition, exacerbated by the lack of supplies like colostomy bags.

Two young women he treated last week — a 16-year-old and an 18-year-old — died as a “direct result of malnutrition,” he said. There will “far more of that in the coming months.”

Cindy McCain, head of the World Food Program, said Sunday that northern Gaza was in the midst of a “full-blown famine” that was spreading south.

As medical facilities closed, the European Hospital was now Rafah’s “last lifeline,” said Ricardo Pires, a spokesman for UNICEF, who said he feared it could suffer the same fate as Gaza’s other hospitals during the war, including the al-Shifa medical complex in Gaza City and Nasser Hospital in Khan Younis.

“If this one becomes a war zone as the other ones did — and we’ve seen even mass graves being reported outside these hospitals — what will happen with children’s health care?”

Abdelfattah said the majority of patients who arrived at the hospital were children. They were in the intensive care unit, the emergency room, the burn unit. The had facial fractures or burns covering 60% of their bodies. “It’s been hard to see them,” he said.

The hospital was in a dire state. There was no soap and no sanitizer, and infection control was “nonexistent,” he said. “There’s multi-drug-resistant bugs just spreading like crazy. There are flies in the ICU. I’ve seen flies” in the operating room, he said.

Mahmoud Sabha, another volunteer doctor at the hospital, from Dallas, said in a message to friends that patients were “very scared.”

“They ask me where they should go.” Before they were sedated, some patients recited the Muslim invocation of faith, fearing the worst.

“They are scared they will be abandoned,” Sabha said.

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