Contending with limited supplies, equipment and capacity in hospitals are among the myriad challenges confronting medical practitioners tending to hundreds of people, including children, wounded in the Israel-Hamas conflict in Gaza.
At the Doctors Without Borders (MSF)-supported Al Shifa Hospital, Gaza’s main surgical facility, staff have reported a shortage of painkillers, leaving wounded patients screaming in agony.
Recently, one of MSF’s doctors had to amputate a young boy’s foot without anaesthetics and he described how dire the situation was in Gaza.
“You can see, this other guy, he’s the anaesthetist. He is trying to keep the boy’s mouth open to breathe. So, we amputate him in front of his mother and his sister, because there is no space, and the sister is waiting to be operated on next,” said MSF Surgeon Dr Obeid.
The health consequences of the current crisis in Gaza go beyond injuries from attacks, according to the organisation.
Pharmacies were running out of medicines and people with chronic illnesses could soon face life-threatening complications because of the shortage of medical supplies. Hospitals were running out of fuel to power their electricity generators, leaving them increasingly unable to treat the injured and ill.
MSF teams have been responding to a growing humanitarian catastrophe in Gaza since the eruption of a full-scale war between Israel and Hamas on October 7.
The Palestinian health ministry on Tuesday said that Israeli airstrikes had killed more than 700 Palestinians in Hamas-run Gaza overnight, the highest 24-hour death toll in Israel's declared two-week-old total siege of the narrow strip.
UN agencies pleaded “on our knees” for emergency aid to be allowed unrestricted into Gaza, saying more than 20 times current deliveries were needed to support the Palestinian population after two weeks of Israeli bombardment.
The Israeli military said it had hit more than 400 Hamas militant targets and killed dozens of its fighters overnight, but that it would take time to destroy Gaza's ruling Islamist group.
With international aid agencies warning of a humanitarian catastrophe unfolding in the tiny, impoverished strip, one of the world's most densely populated places, French President Emmanuel Macron flew to Israel to offer support.
Macron told Prime Minister Benjamin Netanyahu that France stood “shoulder to shoulder” with Israel in its war with Hamas but that it must not fight “without rules”. Netanyahu said Israel would try to protect civilians as it worked to ensure they “will no longer live under Hamas tyranny”.
UN Secretary-General Antonio Guterres also pleaded on Tuesday for civilians to be protected in the war, voicing concern about “clear violations of international humanitarian law” in Gaza.
The World Health Organization, in the latest of increasingly desperate UN appeals, called for “an immediate humanitarian ceasefire” to allow safe deliveries of aid.
Gaza's health ministry said at least 5 791 Palestinians had been killed by Israeli bombardments since October 7, including 2 360 children.
Ministry spokesperson Ashraf Al-Qudra said it was the highest 24-hour number of deaths in the two weeks of Israeli bombing.
After an airstrike in Khan Younis in south Gaza, Abdallah Tabash held his dead daughter Sidra, refusing to let go as he held her bloodstained face and hair. “I want to look at her as much as I can,” he said.
Israeli tanks and troops are massed on the border between Israel and Gaza awaiting orders for an expected ground invasion. It is an operation that may be complicated by fears for the hostages' welfare and by militants heavily armed by Iran dug into a crowded urban setting using a vast network of tunnels.
Hamas freed two Israeli women on Monday. They were among the more than 200 hostages taken during the rampage - the third and fourth to be released.
One of those freed, Yocheved Lifshitz, 85, said she was beaten by militants as she was abducted and had difficulty breathing.
“They stormed into our homes. They beat people. They kidnapped others, the old and the young without distinction,” she said, seated in a wheelchair and speaking in barely a whisper to reporters.
“I’ve been through hell,” Lifshitz said.
Inside Gaza, a group of hostages were led into what Lifshitz called a “spider’s web” of damp tunnels and eventually reached a large hall where, under 24-hour guard, a doctor visited every other day and brought them medicines they needed.