With most hospitals closed, Gaza’s doctors struggle to care for premature babies — often without power.

By Ibtisam Mahdi and Ruwaida Kamal Amer

KHAN YOUNIS, GAZA — THE ISRAELI ASSAULT on the Gaza Strip has left the health sector in the besieged coastal enclave in a state of unprecedented, near-total collapse, according to an investigation by +972 Magazine and The Intercept.

The dire conditions were prompted by Israel’s intensive bombardment, sometimes targeting hospitals and surrounding areas, along with power cuts, shortages of fuel and medical supplies, and an exponential increase in injuries.

Doctors Struggle What It’s Like To Give Birth In Gaza
Doctors examine an injured child at Al-Shifa Hospital after Israeli attacks on Gaza City, Gaza, on Oct. 21, 2023. Photo: Ali Jadallah/Anadolu via Getty Images

More than half of the 30 hospitals in Gaza have closed completely, according to the Health Ministry. For others, the window of operation remains precariously short: The crisis has pushed many of the remaining healthcare centers to the brink of closure, rendering them incapable of providing vital medical services. Healthcare workers and hospital employees fear that, even as casualties rise daily, the healthcare system will soon be unable to accommodate new patients.

“We ran out of fuel and the electricity is cut off. The hospital is out of service.”

“For several days we have been talking about the lack of fuel and electricity inside the hospital,” Dr. Sobhi Skaik, the director of the Turkish Friendship Hospital in the Mughraqa area in the central Gaza Strip, said in an interview last week. “And now what we feared and repeatedly warned about has happened: We ran out of fuel and the electricity is cut off. The hospital is out of service.”

People injured by the fighting are not the only ones affected by curtailed healthcare services. Vulnerable people include patients with serious illnesses like cancer and especially pregnant women and infants, according to health care workers. Neonatal care relies on specialized equipment powered by electricity; the constant power interruptions in Gaza put infants and especially premature babies at risk.

Doctors Struggle What It’s Like To Give Birth In Gaza
Wounded Palestinians arrive at Al-Najjar Hospital after an Israeli airstrike on their home in the city of Rafah, southern of Gaza Strip, October 19, 2023. (Abed Rahim Khatib/Flash90)

“The power cuts in the nursery create many risks because there are devices and medicines that need important care and a particular room temperature,” said Dr. Sherine Abed, a neonatologist at Al-Shifa Hospital, who is now serving at Al Aqsa Martyrs Hospital in Deir al-Balah after relocating with her family to the southern part of the strip. “The premature babies need special care that requires operating the devices constantly.”

During an interview, Skaik paused, reeling in disbelief that all contact with patients in Gaza are being severed. “Since the start of the war, many patients could not reach the hospital, but we did not stop serving them,” he said. “Currently, there is no follow-up with cancer patients.”

His hospital specializes in cancer treatments and is the only institution that, under normal circumstances, serves adult cancer patients in Gaza. “A cancer patient in Gaza dies three times,” Skaik said. “The first time because of cancer. The second time because of a lack of medicines. And the third time because of being targeted by Israeli warplanes during his treatment.”

Doctors Struggle What It’s Like To Give Birth In Gaza
Children injured in an Israeli attack are treated at Al Aqsa Martyrs Hospital in Deir Al Balah, Gaza, on Nov. 05, 2023. Photo: Ashraf Amra/Anadolu via Getty Images

Pregnant Women and Infants

Since the start of the war, miscarriages, premature births, and fetal deaths have increased threefold at the Obstetrics and Gynecology Department at Al-Shifa Hospital in Gaza City, according to Dr. Abed Abu Hasira, a doctor in the department. Over 50,000 pregnant women in Gaza are living in constant fear of losing their babies as the war rages on.

“The current situation in light of the war is extremely bad for pregnant women,” said Dr. Walid Abu Hatab, an obstetrician and gynecologist at Al Aqsa Martyrs Hospital. Thousands have been displaced, and the widespread damage makes reaching healthcare centers difficult, hindering regular appointments during pregnancy — especially risky for those in need of care for pregnancy-related or preexisting conditions.

Doctors Struggle What It’s Like To Give Birth In Gaza
Palestinians wait to receive the bodies of their relatives who were killed in an Israeli air strike, at Al-Najjar Hospital, southern Gaza Strip, November 7, 2023. (Abed Rahim Khatib/Flash90)

“There are some pregnant women who cannot reach the hospital easily due to the intensity of the bombing,” Abu Hatab said. He recounted the story of a patient for whom the journey to the hospital would normally have taken five minutes; in her condition and with the area destroyed, it ended up taking hours, causing her health to deteriorate. Abu Hatab said he was able to treat the woman and her newborn upon their arrival, but with great difficulty.

In some cases, women must make not only crosstown journeys but also travel long distances inside the Gaza Strip because they’ve been displaced from their homes. Many structures, especially in Gaza City in the north, are damaged, leaving untold numbers homeless. And, on October 13, Israel warned people in northern Gaza to move south or risk being targeted as militants — a declaration that Amnesty International said could amount to a war crime.

In the wake of the warnings, one of the women to flee the north was 25-year-old Nesma Hajjaj, who was seven months pregnant at the time. “I am from Gaza City,” she said in an interview. “And, because I am pregnant, I was very afraid that there would be a bombing near my house.” Unable to find transportation, Hajjaj and her family walked toward southern Gaza. “Along the way,” she said, “I felt severe pain, labor pain, so I went to Al Aqsa Martyrs Hospital.”

“I hope that my baby recovers quickly before the hospitals completely run out of fuel.”

The stress of displacement and war contributed to the premature birth of her child. “My child has now been in the nursery for 10 days under monitoring, suffering from many health problems,” Hajjaj said.

Sherine Abed, the doctor working at Al Aqsa Martyrs Hospital, explained that there were 22 infants currently in the neonatal ward — some of whose families have been unable to travel to the hospital. “Families have many difficulties in reaching and seeing their children due to the conditions of war and the continuous bombing,” she said.

Doctors Struggle What It’s Like To Give Birth In Gaza
Palestinians at the rubble of a destroyed building after an Israeli airstrike in Khan Younis, southern Gaza Strip, November 8, 2023. (Atia Mohammed/Flash90)

In Hajjaj’s case, she decided to stay at the hospital to be near her child. “I am worried about him and afraid of losing him,” she continued. Hajjaj is keenly aware of the fuel shortages plaguing the remaining open hospitals in Gaza and fearful what the continuing war portends.

“I am shocked,” she went on. “I cannot express how I feel about this situation. Will the generators and devices stop working in the hospital? What will happen to these children and what is their fate? Does this mean that if they survive the bombing, they will not survive the siege and deprivation that Israel imposes on us? I hope that my baby recovers quickly before the hospitals completely run out of fuel.”

Cancer Patients

There are more than 10,000 cancer patients in the Gaza Strip, said Skaik, of the Turkish Friendship Hospital. Before the war, the hospital received 550 patients a day, provided chemotherapy treatments to 150 patients, and gave hypnosis treatments to around 130 patients a day.

The Turkish Friendship Hospital is one of 16 hospitals that have shut down amid the war, according to the Health Ministry in Gaza. Others include Beit Hanoun Hospital, Al-Wafa Hospital, and specialized institutions like the International Eye Hospital.

Like others, the Turkish Friendship Hospital suffered an acute shortage of fuel to power its generators. “Fuel is necessary to operate water pumps and generate oxygen, the preparation of medicines, and the operation of medical devices, as well as the operation of the Internet,” Skaik said. “The hospital is completely computerized, and thus information is lost and it is difficult for us to determine the doses and medicines and follow-up on patients.”

“Today there are no medicines for treatment at all, as the hospital has exhausted all cancer and painkiller drugs.”

Doctors Struggle What It’s Like To Give Birth In Gaza
Wounded Palestinians are treated on the floor due to overcrowding at Al-Shifa Hospital, Gaza City, central Gaza Strip, October 18, 2023. (Mohammed Zaanoun/Activestills)

The hospital was damaged when Israeli airstrikes repeatedly targeted its surroundings. The third floor, where two rooms were dedicated to hypnosis therapy for cancer patients, was destroyed. Explosions also damaged parts of the second floor. The bombings prompted evacuations within the facility, with patients being moved into the basement. “A number of patients suffered minor injuries from flying glass and suffocation as a result of these airstrikes,” Skaik said.

The 17-year Israeli blockade imposed on Gaza because of Hamas’s rule over the enclave had already taken its toll on healthcare supplies. The war and the attendant tightening of the siege by Israel — which cut off fuel, electricity, water, and other basic necessities after Hamas’s October 7 attack — has emptied whatever stocks were available.

“Before the war, there was a great shortage of essential medicines for the treatment of cancer,” Skaik said. “Today there are no medicines for treatment at all, as the hospital has exhausted all cancer and painkiller drugs.”

As the hospital’s ability to deliver services waned, all the patients, medical, and technical staff were asked to leave. At the time, about 70 patients were left at the hospital and in need of follow-ups — including cancer patients receiving specialized care.

“When the hospital was emptied,” Skaik said of cancer patients, “the cases that were classified as serious were transferred to the hospital near the patient’s residence, and the rest of the patients were provided with some medicines and asked to go home or find shelter in one of the operating clinics or refugee centers.”

Doctors Struggle What It’s Like To Give Birth In Gaza
Palestinians shelter at a temporary tent camp set up for those who were displaced from their homes by Israel’s evacuation orders and airstrikes, Khan Younis, southern Gaza Strip, October 19, 2023. (Abed Rahim Khatib/Flash90)

With the hospital closed and communications cut off, Skaik and his staff don’t know what happened to patients registered there: who is alive, injured, or dead.

Blockade and Little Aid

Located west of Gaza City, Al-Rantisi Hospital for Children is the only healthcare facility in the Gaza Strip set up to give care to pediatric cancer patients. Currently, said Dr. Mustafa Al-Kahlot, the director of the hospital, there are 70 children registered as patients, along with their displaced families.

Urgent action is required to facilitate the patients’ treatment abroad, Al-Kahlot said: Swift intervention will significantly enhance these children’s chances of recovery. Yet the necessary treatments remain beyond reach in the Gaza Strip.

The need has been acknowledged by outside authorities: The patients had secured medical referrals to leave for hospitals in Egypt before the outbreak of the war, but Israeli authorities are refusing to allow them to be transported out of the strip for treatment.

In an interview, Al-Kahlot painted a bleak picture of pediatric patients grappling with a severe lack of treatment options. Their fear is exacerbated by repeated attacks on the hospital’s vicinity, most recently a November 6 attack that struck the third floor. The damage was extensive, several were wounded, and four people were killed.

Doctors Struggle What It’s Like To Give Birth In Gaza
Palestinians unload medical aid from a truck at Al-Nasser Hospital in Khan Younis, southern Gaza Strip, October 23, 2023. (Atia Mohammed/Flash90)

Things have gotten so dire that most hospitals that remain open are running short on basic supplies like cotton suture thread, said Dr. Marwan Al-Hams, director of Youssef Al-Najjar Hospital in the southern Gazan city of Rafah. Any small hospital, he said, would need these supplies for routine daily work.

“It is not enough for one day in a hospital. They just want to help us with burial and not medicine or what we need inside the operating rooms.”

It is exactly these types of shortages that have been at the center of what little international diplomacy has been undertaken on behalf of Palestinians in Gaza. U.S. President Joe Biden’s administration has boasted about getting Israel to let several aid trucks into Gaza at a time.

Asked about the medical aid that entered the Gaza Strip from the Rafah crossing with Egypt, Al-Hams sighed. “It is not enough for one day in a hospital,” he said. Half the aid that reached the Al-Najjar Hospital was burial bags, he said, and much of the second half was water bottles and other materials that don’t meet the hospital’s basic needs.

“They just want to help us with burial and not medicine,” he said, “or what we need inside the operating rooms.”

Doctors Struggle What It’s Like To Give Birth In Gaza
Wounded Palestinians are taken to ambulances after an Israeli airstrike in the city of Rafah, southern Gaza Strip, October 29, 2023. (Abed Rahim Khatib/Flash90)

In the northern parts of the Gaza Strip, the situation is even worse. The Indonesian Hospital, located in Beit Lahia, has been damaged severely by Israeli airstrikes. The hospital became an international football, with Israel saying Hamas built the facility to disguise military infrastructure and the Indonesian government firing back that it built the hospital for the Palestinian residents of Gaza. Either way, the damages and fuel shortages have severely reduced the hospital’s capabilities.

“Approximately 70 percent of the services of the Indonesian Hospital stopped due to the failure of generators as a result of running out of fuel,” said Dr. Atef Al-Kahlout, the director of the Indonesian Hospital. He worries that the fuel shortages will interrupt the use of dialysis machines, potentially leading to the deaths of many patients diagnosed with kidney failure.

The shortages led to what in the West would be unthinkable decisions: choosing between patients who, under normal circumstances, would all be able to survive. Hospitals in the Gaza Strip are forced to identify which cases have higher survival rates and give them the opportunity for surgery or space in intensive care wards.

Al-Kahlout doesn’t hide that he and his colleagues have to make these calculations, but he resents it: “We consider this decision one of the most difficult decisions imposed on us by wars.”

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