Israel’s month-long assault has knocked the three main hospitals in Rafah out of operation, according to the World Health Organization. One field hospital in Gaza’s southernmost city remains partly functional, but it is increasingly difficult to reach due to nearby fighting.
The crippling effect of Israel’s ground invasion on medical facilities in Rafah has added urgency to the already critical effort to rehabilitate Nasser Hospital in the neighbouring city of Khan Younis, where many of those displaced by the offensive have been forced to flee.
“The Israeli army just expanded its ‘safe zone’ in Khan Younis to include Nasser Hospital, so we’re expecting an influx of thousands of [displaced people] escaping the assault in Rafah,” Atef al-Hout, director of the Nasser Hospital, told The New Humanitarian on 4 June.
Al-Hout was referring to the so-called ‘humanitarian area’ Israel declared when it ordered hundreds of thousands of Palestinians to evacuate areas of eastern Rafah at the beginning of May: This encompasses parts of al-Mawasi, Khan Younis, and Deir al-Balah.
Human rights groups have consistently said that Israel’s evacuation orders are illegal, and that its unilaterally declared ‘humanitarian area’ is unsafe and lacks the basic necessities to sustain life.
Nasser Hospital – the largest medical facility in the south of Gaza – was badly damaged and left almost entirely empty after a weeks-long Israeli siege followed by a prolonged raid in mid-February.
Only 16 of Gaza’s 36 hospitals remain partially functional, and more than 490 healthcare workers have been killed.
In late April, the Israeli military gave the Palestinian Ministry of Health in Gaza permission to begin working to get the facility up and running again, according to al-Hout, and repairs began just days before Israel launched its assault on Rafah on 6 May.
“Our teams are racing against time to partially re-open the emergency and dialysis departments at a minimum capacity within two weeks,” al-Hout told The New Humanitarian during a visit to the hospital in late April. “These are deemed the most urgent.”
That effort paid off when the dialysis department re-opened in mid-May. This was all the more important as it was shortly after what had been the only remaining dialysis department in Gaza shut down – when Israel’s invasion forced staff and patients to evacuate the Mohammed Yousef El-Najar hospital in Rafah.
The emergency department is now also working at full capacity, and several other departments – including the maternity unit – are working at limited capacity. Al-Hout said that the collapse of the healthcare system in Rafah has forced the rehabilitation teams to speed up their work to open these departments ahead of schedule to treat dozens of injured and sick patients escaping Rafah.
The partial reopening of the facility, however, will only make a small dent in the dire medical needs in Gaza.
Over one million people have fled Israel’s ground invasion and bombardment of Rafah, while the amount of aid entering the enclave has been reduced to a trickle. Aid agencies are anticipating an “acceleration in deaths from starvation, disease and denied medical assistance”, 20 organisations wrote in a joint letter last week. At least two children have died of malnutrition and a lack of medical care in recent days.
Meanwhile, with the Rafah border crossing with Egypt closed since Israel seized control of it at the beginning of May, between 7,000 and more than 11,000 Palestinians in need of urgent medical evacuation have been stranded in Gaza, according to a WHO spokesperson.
More than 83,000 Palestinians have been injured by Israel’s nearly eight-month military campaign in Gaza, and over 36,500 have been killed, according to health officials in the enclave. Only 16 of Gaza’s 36 hospitals remain partially functional, and more than 490 healthcare workers have been killed.
The healthcare system in Gaza has been “systematically dismantled”, Médecins Sans Frontières (MSF) warned last month. “Each medical centre or humanitarian delivery system has been or is being destroyed, to be replaced by less effective, improvised options,” the organisation said.
From raid to rehabilitation
Against this backdrop, rehabilitation efforts like the one at Nasser Hospital are urgent but can also only do so much. UN officials have said a ceasefire, the opening of border crossings, and unimpeded access are needed to begin to address the dire needs in Gaza.
The New Humanitarian has reported regular updates on how Israel’s military campaign has been affecting Nasser Hospital since Israel launched its assault and near-total siege on Gaza following Hamas’ deadly assault into Israel on 7 October last year.
The Israeli siege and raid of Nasser Hospital was part of its ground invasion of Khan Younis, which began in mid-January and lasted until early April. By the time Israeli forces withdrew from the city, over 80% of the buildings in Khan Younis were destroyed and most of the rest were uninhabitable, according to estimates.
During the raid on Nasser Hospital, Israeli soldiers stripped medical workers at the facility naked, and beat and humiliated them, doctors and staff told The New Humanitarian. By March, only seven staff members were left out of the 195 who worked there before the attacks, and by early April only one nurse remained with a handful of patients.
After the Israeli military withdrew from Khan Younis, a small number of staff began to trickle back. Towards the end of April, workers at the hospital uncovered three mass graves in the compound containing nearly 400 bodies, prompting calls from the UN for an independent investigation into possible war crimes.
When the Israeli military gave permission to re-open the facility, the number of returning staff increased, but it is still only a fraction of the previous total. In the weeks that followed, workers and volunteers hurriedly mopped floors, refurbished walls, cleared piles of debris and trash, and removed damaged vehicles and rubble from the complex’s courtyard, and from passageways between buildings.
The rehabilitation effort focused on the building housing the emergency, dialysis, radiology, and laboratory departments, which, according to al-Hout, were deemed to be the most important to get up and running.
Destroyed equipment
When The New Humanitarian visited at the end of April, Hamed Sharab, a 30-year-old medical equipment engineer, was leaning over the dusty electronic panel of Nasser Hospital’s main X-ray machine phoning colleagues at other battered hospitals across Gaza to try to find replacement parts.
“This [machine] is old, and before the war it was scheduled to be retired. The same could be said for the other one we managed to fix today,” he said. “But this old, failing equipment is our only option now.”
Israeli shelling caused a fire at the warehouse for spare parts, destroying Nasser Hospital’s back-up inventory. Israel’s military operations throughout Gaza have made it more difficult – if not impossible – for Sharab and his team to source alternatives from other facilities.
"We used to obtain some of what we needed from al-Shifa Hospital in Gaza City," Sharab explained. "This became, however, highly perilous since the Israeli army cut off connections between the northern and southern parts of the [Gaza] Strip, and then stopped completely following [al-Shifa] Hospital’s destruction."
Al-Shifa Hospital was left in ruins following a weeks-long raid by Israeli forces in March. Mass graves containing hundreds of bodies were also uncovered there following the withdrawal of Israeli troops in April. Rehabilitation efforts have since led to the restoration of very minimal medical activities at the hospital.
At Nasser Hospital, the extent of damaged equipment went far beyond just the X-ray machine Sharab was working on. In some departments, all of the equipment had been destroyed, while in others, more than 50% of it had, according to data from Nasser’s maintenance team.
"All infant incubators – including the incubator itself, ventilator, computer, and patient vital signs monitoring screen – are damaged beyond repair," Sharab said. "The same could be said for the reception department screens, which are completely wrecked, and the intensive care unit, where the ventilators and X-ray fluoroscopy machine, along with associated computers, have been destroyed.”
Al-Hout gave another example: Nasser Hospital used to have 500 beds. “We were also surprised after returning to the complex and finding that all hospital beds are nowhere to be found,” he said.
Much of the equipment that was destroyed – including hard drives containing operating systems, software, and patient data – is “irreplaceable”, according to Sharab. "There is a clear intent in seizing and sabotaging entire medical device computers, rendering most of them inoperable." he said. "We will try to work in less-than-optimal conditions because of this."
Success and limits of rehabilitation
To get the neonatal intensive care unit functioning again, Nasser Hospital had to source ventilators and other medical equipment from other hospitals in Gaza. The rehabilitation effort was led by the Ministry of Health in Gaza and the Nasser Hospital administration, with MSF also providing support. The WHO contributed dialysis machines and medical supplies to other departments and helped coordinate rehabilitation efforts while providing critically important fuel for the hospital’s electricity generators.
Hanaa al-Laham, a radiologist, worries that the progress made could all be lost if Israel reinvades Khan Younis or decides to raid the hospital a second time.
When the rehabilitation effort began, staff were unable to restart the five large generators that had previously powered the hospital, forcing them to borrow generators from hospitals that have been forced to shut down.
"The generators that sustained our operations are now piles of discarded metal, their main panels lost. The same fate befell the rest of our medical equipment," al-Hout said.
Now that the facility is starting to function again, Hanaa al-Laham, a radiologist, worries that the progress made could all be lost if Israel reinvades Khan Younis or decides to raid the hospital a second time. Al-Laham described the rehabilitation of the hospital as “the ultimate humanitarian mission”. She returned to the facility to help after being displaced from Khan Younis to Rafah.
"I have to return to work and help those in need, especially since Khan Younis lacks a central hospital at the moment," she said. "The biggest dilemma, however, is the availability of resources to ensure the re-opening is successful and that we can provide the essential services needed to save lives."
Speaking to The New Humanitarian on 4 June, after the partial reopening, al-Hout said: “The equipment problems are still unresolved. But we’re relying more on the field expertise of our medical staff, as much as we can, to compensate for any shortcomings.”
Under ideal conditions, al-Hout estimated that it would take around three months to get the hospital running at full capacity again. “If we successfully import spare parts, equipment, and supplies [that are] unavailable locally, it could be done,” he said.
To do that, however, the hospital administration would need to be able to import parts to fix broken machines and source new equipment from outside of Gaza – something that is impossible with Israel severely limiting what is allowed to enter the enclave, including blocking essential medical equipment.
“Even before the war, we were met with several obstacles in attempting to import parts for the hospital's medical equipment, largely due to the economic embargo imposed by the Israelis," al-Hout added, referring to Israel’s 16-year blockade of Gaza.
As a result, the possibility that the hospital will be fully restored while Israel’s military campaign and its total control over Gaza’s borders continue is likely next to zero.
Edited by Mohamed Kotb and Eric Reidy. This article is published in collaboration with Egab.
