In the crowded corridors of the European hospital in Khan Younis, exhausted doctors are deciding who should live and who should die among the huge influx of patients arriving from northern Gaza.
Hundreds of victims have moved south in recent days following the evacuation of hospitals in Gaza City, and medical staff are already struggling with acute shortages of medicine, reduced food rations and intermittent electricity and communications.
The injured have joined thousands of displaced people seeking shelter and safety in medical facilities.
Paul Ley, an orthopedic surgeon at the European Hospital, said displaced people were sleeping in elevators, a small team was working around the clock in four operating theaters to amputate infected limbs after days without treatment, and there was an acute shortage of painkillers. Triage decisions had to be made immediately, which in one case meant leaving a 12-year-old child to die with only palliative care to conserve already scarce resources. Ley said the hospital had received 500 patients evacuated from hospitals in northern Gaza in recent days.
“Many were not treated for nine or 10 days because the hospitals there were not functioning even if they were open,” he said. “This is the situation that is happening here now. This is a functioning hospital, but we are overwhelmed. There is nowhere to evacuate… There is no way to evacuate. We’re probably one of the last lines of defense.”
The details of his statements match the claims of other medical personnel as well as journalists in Gaza.
Ley sent the Guardian pictures of some of the injuries he described. There are 78 patients in the burn department of the European Hospital, almost two-fifths of whom are children under the age of five.
“I’ve never seen anything like it,” said Ley, a 60-year-old French national who arrived in Gaza with an International Committee of the Red Cross team nearly four weeks ago.
“I have been in many war zones where the types of wounds are the same, but the number of injured here is huge. We never leave the hospital. We work 24 hours a day.”
Hospital staff hope that a four- or five-day ceasefire between Israel and Hamas, which began today, could lead to a permanent end to hostilities – or at least an opportunity to receive humanitarian aid. However, they also fear the arrival of more patients as the injured are evacuated from northern Gaza during any break.
Many of the wounded who arrived at the hospital had sustained injuries days before, meaning the wounds had become infected. Ley said some of the bandages had not been changed for 10 days, leaving their wounds full of maggots. In other cases, surgeons were forced to amputate limbs that might otherwise have been saved. Another problem is the lack of anesthetics and painkillers.
“We perform operations with minimal anesthesia. If we run out of that, we can’t work, but you never know. There are many people crying, screaming in pain, but we don’t have enough analgesics. We save them for children or very serious cases. Otherwise, we would be changing bandages on sedated patients with 40% burns… Now it has to be done with a lot of pain.”
Within the hospital complex, thousands of desperate families are housed in wooden or cardboard shelters. The Israeli airstrikes did not target the hospital and respected the zone around the facility – although several shrapnel hit the building and the windows were broken by the explosions.
Israeli military officials say they are doing everything to avoid civilian casualties and respect international law. They say Hamas is using Gaza’s 2.3 million residents as human shields and claim to have found evidence of Hamas military facilities in or under hospitals, schools and homes.
On Thursday, Israeli Prime Minister Benjamin Netanyahu said: “The entire laws of war, humanitarian law, to which we are fully committed, makes a simple difference… They say on one line there are combatants, and on the other line they are not -combatants.” You can target combatants… but don’t intentionally target noncombatants. They can be hit unintentionally, but that’s how it is in any legitimate war, he says.
“Hamas is deliberately installing itself in hospitals, schools, in residential areas, in UN facilities. They fire their rockets from there. Thousands of them. They deliberately target civilians and deliberately hide behind civilians and use them as human shields. It is a war crime,” he claims.
Elsewhere in Khan Younis, tens of thousands of people are in UN-run shelters. At one, a pre-war vocational training centre, more than 35,000 people share 48 toilets and four showers, administrators told the Guardian this week.
“The conditions are terrible. All children suffer from coughs or stomachaches. People are fighting over places to sleep and food,” said one administrator.
Since the October 7 attack by Hamas, Israel has imposed an almost total blockade on Gaza. Food supplies from the UN have dwindled to about a kilogram of flour and one can of tuna or beans each day, one administrator said, leaving families to survive on bread made from flour and water and baked on cleaned metal plates in the open.
“There is no food or fuel in the stores. Even wood is rare and expensive, so people cut down trees in the streets. Salt is really rare. Nobody has it, and if you have a little, you can exchange it for a lot of food,” said the administrator.
Ley said the hardest part for doctors was making triage decisions. “We’re doing triage…we’re asking, are we going to treat this patient or that patient because they might have a good chance of survival and take desperate measures on patients who are likely to die in two or three days? “We had a patient, a 12-year-old with 90% burns, so we couldn’t treat him except to relieve his pain at least a little, which wasn’t enough,” he said.
“We try to keep our heads cool and calm, but for the local staff it’s their families, their friends, their people. They never want to amputate, and then they say: ‘I can’t do it anymore,’ so we try to calm them down by telling them that we will do it, that they will feel relief afterwards and not to worry.”
Ley said he was shocked by the condition of some patients. He cites the example of a 35-year-old woman whose husband and children were killed when their family home was destroyed, and who looked so cold and motionless when she was told that both her legs needed to be amputated. “So many of them just don’t feel anything anymore,” he said.
But amid the destruction, there were moments of small hope. Recently, Ley treated a 32-year-old man with shrapnel injuries to his abdomen, left leg and a “fist-sized hole” in his right forearm. The patient’s young sister thanked Ley, saying she was proud of her brother and happy he was alive. She said that her wish when she grows up is to become a surgeon.
“It was very moving,” Ley said, The Guardian reports.
