As Israeli troops bear down, the health care system in Gaza City is coming under fire and being pushed toward collapse.
Nearly two weeks into Israel’s latest ground offensive on Gaza’s largest city, two clinics were destroyed by airstrikes, two hospitals shut down after being damaged and others are barely functioning, with medicine, equipment, food and fuel in short supply.
Many patients and staff have been forced to flee hospitals, leaving behind only a few doctors and nurses to tend to children in incubators or other patients too ill to move. Bombardment outside shakes hospitals' walls and Israeli drones buzz around, often firing nearby, making it dangerous to come and go, according to health workers.
Al-Quds hospital, at the southern edge of Gaza City, hurriedly evacuated most of its patients this past week as Israeli forces closed in.
Medics dropped off one patient at a field of rubble. Covered in gauze for severe burns on 40% of his body, they told him to find his way to a clinic for treatment, according to Andee Vaughan, an American nurse who was among the medics.
"It is insanity," Vaughan said in an interview the day she also was evacuated. "That is the state of the health care system," which she says Israel is purposefully dismantling.
Al-Quds once had capacity for 120 patients. Now, roughly 20 remain, including two babies in intensive care. About 60 doctors, nurses and patients’ families are sheltering there.
Vaughan is from Seattle and volunteered through the Palestinian Australian New Zealand Medical Association since July. She kept a video diary of her time at al-Quds, occasionally posting on social media.
She shared dozens of videos with The Associated Press, which verified them. Volunteers in Gaza like her have become a vital source of information, as Israel has forbidden foreign media.
Like at other hospitals, water, electricity and oxygen are in short supply at al-Quds. The hospital oxygen station was hit by Israeli gunfire.
Israel says its campaign in Gaza City aims to destroy Hamas’ infrastructure and free hostages taken during its Oct. 7. 2023, attack on Israel that started the war. The military has ordered the entire population to leave and go south, saying it is for their safety.
On Thursday, Nebal Farsakh, a spokesperson for the Palestinian Red Crescent, which administers al-Quds, said Israeli vehicles had surrounded it, "completely restricting" the movement of remaining staff and patients, while drones fired upon the hospital and nearby buildings.
Israel accuses Hamas of using health facilities as command centers and for military purposes, putting civilians in harm’s way, though it has presented little evidence. Hamas security personnel have been seen in hospitals and have kept some areas inaccessible.
The Israeli army said Saturday that the incident at al-Quds "is under review." Repairs were completed at the hospital's water tanks and work is being allowed to fix its oxygen room.
Vaughan was evacuated Tuesday with another doctor and headed south.
"I am getting messages from my coworkers there asking me why I left," said Vaughan, speaking from a guesthouse in Deir al-Balah after she was evacuated. "They are telling me they are going to die."
Hospitals are coming under fire
Despite Israeli orders to leave, hundreds of thousands of Palestinians remain in Gaza City, which had close to 1 million residents before the ongoing offensive. International experts say the city is in a famine.
Israel has closed the border crossing into northern Gaza since Sept. 12, preventing direct aid shipments to the city. Aid groups have scrambled to deliver supplies from the south, traversing dangerous roads as Israel increasingly restricts their movement, according to the United Nations.
Over the past week, Israeli strikes destroyed at least two clinics at opposite ends of Gaza City and forced two others to shut down, including a children’s hospital and a specialized eye center, according to the UN. The Jordanian government said a field hospital it had run was evacuated as Israeli troops closed in.
The UN says 27 other medical stations and primary health care centers in Gaza City, many of them crucial in malnutrition treatment, were forced to suspend or shut service in September.
Nearly 100 patients fled Wednesday and Thursday from Gaza City’s main hospital, Shifa, as Israeli tanks approached. Fearful of getting caught up in a raid, many staff stopped showing up to work.
"The fear is real," said Hassan Al-Shaer, medical director at Shifa.
More than 160 medical workers from Gaza were estimated to be in Israeli detention as of February, according to rights groups. Israel said the detentions are carried out in accordance with the law, saying some were involved in "terrorists activities" or were members of Hamas.
On Wednesday, the Israeli army claimed on social media that gunmen were operating inside Shifa. It attached a grainy video it said showed gunmen opening fire. The AP couldn't verify the claim and doctors at Shifa denied it, calling it a pretext to raid the hospital.
On Saturday, the Israeli army said it's allowing humanitarian convoys of international aid organizations and health personnel to reach the Shifa Hospital area, even though it's "an active combat zone."
Hospitals are emptying out as Israeli forces advance
Israeli troops raided al-Quds for a week in November 2023, temporarily shutting it down. Parts of it were destroyed, and at least one civilian was killed, the Red Crescent said then.
The UN and some human rights groups say Israel has systematically targeted hospitals, using direct strikes, siege tactics and raids.
Once a hospital is out of service, nearby residents typically relocate, said Azra Zyada, a UK-based health systems analyst who works closely with medical teams in Gaza.
Before the latest offensive on Gaza City, staff at al-Quds began discharging non-critical patients, fearing for their safety, Vaughan said. They also diverted traffic away from the hospital as Israeli drones fired at surrounding buildings, she said.
A nurse's video diary
Vaughan shot cellphone video of warplanes and projectiles descending on the city and around the hospital.
In one, her room shakes, and huge plumes of smoke block the view from her window. In another, from one of the hospital’s lower floors, a child carrying a water jerrycan as large as himself stops as an explosion rocks the walls.
Last week, hundreds of Palestinian families who had sheltered in and around the hospital fled, many after previously fleeing Israeli forces advancing from the north.
On Saturday night, Vaughan said a caravan that drove near the hospital came under fire. A teenager sustained a superficial head wound, she said.
He may have been the last patient to be admitted to al-Quds.
A day later, Vaughan shadowed the nurses of the neonatal unit. She held "skin to skin" one of the two remaining babies — just 13 days old — to try to soothe her. The baby's heart rate dropped dangerously low as explosions went off nearby, Vaughan said.
From her fifth-floor bedroom window, Vaughan recorded nearby strikes.
"They just hit the hospital again," Vaughan said in a video. She recorded an Apache helicopter strike in the distance.
On the fourth floor, there were glass shards on some beds from shattered windows. Fresh blood stained a deserted mattress. Vaughan filmed an empty hospital floor that was cleared out.
"The floor was overflowing with patients in the halls and now it is desolate because everybody had to flee," she said in the video shot Monday.
For her own safety, Vaughan moved that day to the basement.
The next day, soon after Vaughan left, her colleagues reported to her that Israeli military vehicles had approached the southern gate of the hospital.
