Ceasefire brings no relief as Gaza's patients battle overcrowded and under-resourced hospitals after Israel's genocide

Ahmed Al-Akka lies unconscious on a metal bed in an outdoor corridor at Nasser Hospital, sedated by strong painkillers after his latest surgery two days ago to remove shrapnel from the fifth vertebra of his spinal column.

The 26-year-old Palestinian sleeps beside the main entrance to the internal medicine department, exposed to everyone passing between floors, because every room, every indoor corridor, every available space inside has already been filled with patients.

His brother Rashdi has sat beside him for 20 days, since they fled Al-Shifa Hospital in Gaza City as Israeli forces approached before the ceasefire.

Ahmed was shot by an Israeli quadcopter drone on August 27 while checking on his family's evacuated home in the Zeitoun neighbourhood of Gaza City.

The bullet tore through his abdomen, severing intestines, damaging nerves in his right leg, shattering his pelvis, and lodging shrapnel in his spine that compressed the nerve on his right side. His right leg is now completely paralysed.

"We moved between hospitals in Gaza City — especially Al-Shifa and the General Services Hospital — before transferring to Nasser Hospital in the south, while our family shelters in Al-Zawayda in the middle area after fleeing Gaza City in the north," Rashdi tells The New Arab.

"Everyone under this reality is scattered," the 40-year-old adds. 

Ahmed needs specialised care, physical therapy, and medical interventions that the overcrowded hospital cannot provide due to tremendous pressure on medical teams and a lack of necessary equipment and medical supplies.

A recent surgery involving an Egyptian neurologist may help reduce pain, doctors told them, but Ahmed's prospects for recovery in Gaza remain bleak.

"The catastrophe is that my brother lost his ability to move his right leg, and any improvement he receives after medical care locally won't exceed 5%," Rashdi says.

"This makes his chance of walking again on his foot and recovering from the rest of his injuries limited in Gaza."

Doctors told Rashdi that treatment abroad offers significant hope for his brother to walk again and recover from other complications affecting his abdomen and extremities. But evacuation remains nearly impossible with thousands of wounded and sick patients waiting months for permits.

"This wastes the opportunity to treat my brother and return him to his life with his wife, whom he married four days before his injury," Rashdi says.

No real breakthrough since the ceasefire

Throughout Nasser Hospital, long queues of patients wait hours for medical examinations in outpatient clinics.

Patients sleep in corridors beside doorways. The scene repeats in every building and department where patients crowd any space that can fit a mattress or bed.

Dr Naseem Basla, a dermatologist, appears exhausted as he examines dozens of cases daily — before the war, he saw no more than 10.

The consequences of Israel's genocide, especially displacement and the absence of personal and public hygiene, caused widespread skin diseases with a near-total lack of necessary medicines to treat them.

For the second time, Dr Naseem examines 11-year-old Amir Al-Jabour's worsening skin condition after the boy failed to obtain prescribed medicines previously. He writes a new prescription with two alternatives — Fucidin or Gentamicin — hoping the child can find one of them.

Amir describes his displacement in the Al-Mawasi area amid the absence of minimum general or personal hygiene and widespread insects and reptiles, which caused deformities in his feet after he couldn't obtain the required antibiotics and ointments days ago.

Dr Naseem reassures the boy that he might obtain one of the required items this time, after learning that only a minimal quantity had arrived, so that he can treat and recover.

The dermatologist confirms that patients with chronic skin diseases such as psoriasis, vitiligo, alopecia, and eczema have no treatment options whatsoever.

"They're left without treatment, without continuous diagnosis, without care or any attention due to unavailability of medicines and other related supplies, even though some medicines are simple, low-cost injections if provided from outside Gaza," he estimates.

"Biological treatments for psoriasis, vitiligo and others don't exist, in addition to the unavailability of immunosuppressive drugs that were interrupted for long periods, reaching eight months of complete interruption, then became available, then interrupted again," he adds.

Dr Naseem notes widespread scabies infection exceeding 70% at some stages, and lice and nits spreading at the same rate due to the absence of personal and public hygiene under displacement conditions and tremendous population crowding, with sewage spread, according to his estimate.

"These threats still exist and can spread more than before after witnessing a decline when the occupation allowed entry of cleaning materials, but the crisis remains large with the absence of most medicines and supplies for treating skin diseases, like all other diseases."

From 700 beds to 300: Al-Shifa's collapse

Dr Mohammed Abu Salmiya, the director of Al-Shifa Medical Complex in Gaza City, confirms that no breakthrough or major relief has occurred for the entry of medical supplies and medicines.

"There's a huge shortage in medicines reaching 60% and reaching 70% in medical supplies, especially in orthopaedic, chest, heart, vascular, and brain and nerve surgeries. We also have a huge shortage in equipment for these surgeries," Dr Mohammed tells The New Arab. 

He reveals thousands of wounded patients need reconstructive bone surgeries requiring devices, equipment, X-ray machines and special operating rooms, which are not available at all.

Kidney patients suffer from a lack of medicine, causing daily deaths among them due to an acute shortage of medicines and supplies.

"There's a shortage in ventilators and a large shortage in laboratory materials by 70%, preventing us from conducting many tests, in addition to a shortage of X-ray machines — there's only one X-ray machine in the complex," Dr Mohammed adds.

"Therefore we haven't noticed real improvement in the hospital's health system since the ceasefire, despite arrival of very small quantities sufficient for a few days of necessary medical supplies."

The Al-Shifa director compares pre-war and current capacity: "In Al-Shifa Medical Complex we had 700 beds, 22 operating rooms, Palestine's largest incubator with 60 beds, 60 dialysis machines, 40 intensive care beds, three CT imaging devices, an MRI machine, two cardiac catheterisation devices, a lithotripsy device, six X-ray machines, 15 ultrasound devices and much more — all destroyed."

He adds, "Currently, the bed capacity is less than 300 beds, 13 intensive care beds, 12 incubators, 30 dialysis machines, and everything else was completely destroyed. This means daily deaths occur from inability to provide medical interventions for patients whose lives could have been saved if devices and equipment were available."

He continues: "We used to save patients suffering acute heart attacks or premature infants weighing 600g. Now their fate is death because all devices are destroyed and all supplies and medicines are unavailable."

While the complex director notes they performed more than 30,000 scheduled surgeries annually before the war, these operations haven't been conducted during the past two years due to dealing with war-wounded and life-saving attempts. He reveals more than 40,000 patients need operations that if not executed urgently, their fate will be death.

Dr Mohammed explains that the occupation systematically destroyed Gaza's health system, with more than 70% of hospitals and medical centres destroyed, leading to increased patient deaths. 

"We lost 40% of dialysis patients and lose daily many wounded whose lives could have been saved if medical needs were available," he tells The New Arab. 

"For example, cancer patients suffer greatly and have no chemotherapy or radiation treatment, so many patients die. Of 4,500 cancer patients out of more than 12,000 with the same disease need urgent and decisive medical interventions, and these interventions aren't available," he says.

He adds: "It's important to note the large shortage in medical teams after we lost 1,700 medical staff as martyrs and 350 detained, knowing that some of them are major medical figures with no replacement."

The director warns that occupation's delay in allowing entry of medical devices, supplies, medicines and various health system needs means more deaths of patients whose lives could have been saved, according to his estimate. He notes more than 22,000 patients, including 6,000 children, need urgent treatment outside Gaza, but the occupation still obstructs their travel.

"Therefore we also demanded entry of large medical delegations and allowing large numbers of patients to leave to save their lives," Dr Mohammed says.

"I can confirm the gap remains large between what's available and what occupation allows to enter versus what's currently required for the health sector, in addition to the subsequent plan requiring regular entry of health sector needs and providing large funding."

He mentions continuous communication with relevant international institutions that confirm many trucks for the health sector are waiting for occupation permission to enter, noting only promises so far to allow entry of some health needs to Gaza.

Mohamed Solaimane is a Gaza-based journalist with bylines in regional and international outlets, focusing on humanitarian and environmental issues

This piece is published in collaboration with Egab