Doctor Raphaël Pitti and nurse Imane Maarifi returned to France on February 6 after a gruelling 16-day stint at the overcrowded European hospital in southern Gaza, where thousands of displaced people have joined the injured and sick, seeking shelter and safety.

Their account offers rare insight into the plight of the Palestinian enclave – a mostly no-go zone for the international media – much of which has been reduced to rubble after four months of devastating bombings and ground fighting.

In the opening stages of the Israel-Hamas war, Khan Younis witnessed an influx of tens of thousands of people fleeing the fighting in the enclave’s north. But in recent weeks, the southern city has itself become the focus of fierce clashes, leaving displaced Gazans at the mercy of daily bombardment.

“The local population are caught in a trap, living in extremely difficult conditions,” said Pitti, an emergency physician who was part of a seven-member team of health workers sent by the NGO PalMed Europe. “People sleep out on the pavement, under makeshift shelters,” he added. “The streets are filthy and the recent rainfall has left stagnant water everywhere.”

According to the medics, some 25,000 people are currently amassed around the hospital near Khan Younis and around 6,000 are crammed inside the facility. More arrive each day, hoping to find shelter or treatment.

“People lack everything,” said Maarifi, 37, whose last patient, a newborn baby, died of hypothermia in her arms. She recalled trying to resuscitate a patient on the floor in a corridor and seeing children steal gloves from her pocket “to make balloons out of them”.

‘Heartbreaking choices’

Israel launched its offensive after more than 1,100 people were killed in an October 7 attack on southern Israel by Hamas, the Islamist militant group that runs Gaza. Since then, more than 28,000 people have been killed in the Palestinian enclave, most of them women or children, according to health officials in the Hamas-run territory.

Israel and the United States accuse Hamas of using Gaza’s population as human shields and say Hamas and Palestinian Islamic Jihad members are operating out of hospitals in the territory.

The European hospital is one of the last functioning medical facilities in the enclave. In its overcrowded corridors, medical staff and volunteers try as best they can to provide care to the sick and wounded, in daunting conditions.

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“You have volunteers doing the work of orderlies, nurses doing the work of doctors, and doctors standing in for surgeons,” said Maarifi, lamenting a critical shortage of medicine and equipment.

“There are no sheets, sterile drapes or compresses,” the nurse added, and the dwindling supply of painkillers has to be used sparingly. Her voice choking up, she recalled having to make “heartbreaking choices” between “a child hit by shrapnel” and another “whose leg had been torn off”.

In addition to the injured, the hospital is overwhelmed by patients suffering from chronic diseases, respiratory problems or illnesses linked to poor living conditions.

“We can no longer do any dialysis or chemotherapy. Patients who need treatment are either dying or doomed to die,” said Maarifi. She cited the case of a pregnant 24-year-old patient with diabetes who developed complications due to the shortage of insulin, lost her baby and died the next day.

‘Collapse of public health’

“We are heading for a collapse of public health in Gaza,” said Lucile Marbeau, spokesperson for the International Committee of the Red Cross (ICRC), which works in partnership with the Egyptian Red Crescent (which is in charge of coordinating international aid to Gaza) and its Palestinian counterpart.

“The war-wounded are amputated on a daily basis, the chronically ill can no longer receive treatment, and living conditions are stoking fears of a resurgence of diseases such as polio, cholera and chickenpox, which we won’t be able to treat,” Marbeau added.

She pointed to the worsening situation in nearby Rafah, on the border with Egypt, where desperate Gazans are gathering as Israel’s offensive pushes further south.

The city of around 270,000 inhabitants has seen its population increase sixfold since the start of the war, and is now home to more than 1.3 million people. Like Khan Younis, it has become a sprawling camp for displaced people crammed into tents and makeshift shelters.

Marbeau spoke of “deplorable hygiene conditions”, noting that water treatment plants have stopped working, depriving the population of toilets. “Access to drinking water is also very difficult and people are not getting enough to eat because the prices of the few foodstuffs available have soared,” she added.

Humanitarian aid ‘a drop in the ocean’

On December 22, the UN Security Council passed a resolution calling on all sides in the conflict to allow “safe and unhindered delivery of humanitarian assistance at scale” into the enclave. But more than a month later, NGOs on the ground say only a trickle of the required aid has reached the people of Gaza.

“It’s a drop in the ocean,” said Marbeau, who also flagged the need for specific equipment to carry out repairs to basic infrastructure, such as plumbing work to improve access to drinking water.

The UN resolution also urged all parties to guarantee the “protection of humanitarian workers” and their “freedom of movement” throughout the enclave – conditions that are far from being met.

“Access to the north of Gaza is still impossible because of the security conditions there,” said Marbeau, whose team has been unable to visit northern parts of the enclave since the beginning of November. “It is now the most deprived area and we are unable to help vulnerable people there,” she added.

Expectations of an imminent Israeli ground offensive on Rafah have raised further alarm – particularly given that the border city is also the entry point for critically needed humanitarian aid from Egypt.

“A ground offensive in such a densely populated area would have dramatic consequences for the civilian population,” Marbeau warned. “We must, at all costs, show greater respect for humanitarian law in this conflict if civilians are to be spared.”

This article has been translated from the original in French.