Israel’s offensive in the southern city of Rafah has strained medical and humanitarian services to the breaking point, aid workers say, with only one hospital still functioning and several aid operations forced to decamp to other parts of the Gaza Strip.
The health care crisis in the city has been compounded by the closure of emergency clinics and other services amid continued clashes and strikes that have killed dozens of civilians.
On Sunday, a strike that Israel said was aimed at a Hamas compound set ablaze a camp for the displaced in Rafah, killing 45 people, according to the Gazan health ministry. Another strike on Tuesday in Al-Mawasi, on the outskirts of Rafah, killed 21 people and injured dozens, the ministry said.
Among the aid operations that have shuttered this week are a field hospital run by the Palestinian Red Crescent, a clinic supported by Doctors Without Borders and kitchens run by World Central Kitchen.
“As Israeli attacks intensify on Rafah, the unpredictable trickle of aid into Gaza has created a mirage of improved access, while the humanitarian response is in reality on the verge of collapse,” 19 aid groups said in a joint statement on Tuesday.
Some of the operations that were forced to move were in Al-Mawasi, where many civilians and aid workers went because Israel designated part of the area as a humanitarian safe zone. Israel’s military said after the strike on Tuesday that it had not fired on that zone. Videos verified by The New York Times indicate that the strike hit near, but not inside, the zone.
Aid workers have noted how difficult it is for people in Gaza to determine whether they are in a designated safe area, as many have limited access to mobile phones or the internet.
“Civilians are being massacred. They are being pushed into areas they were told would be safe only to be subjected to relentless airstrikes and heavy fighting,” Chris Lockyear, the secretary general of Doctors Without Borders, said in a statement.
Ashraf al-Qudra, a spokesman for Gaza’s health ministry, called for safe routes for evacuees, more border crossings for aid and more field hospitals in Rafah.
“There is no medical capacity to deal with the successive massacres in Rafah and in northern Gaza,” he said.
Instead, emergency operations are closing. The Palestinian Red Crescent last night evacuated its Al Quds field hospital, according to a spokeswoman, Nibal Farsakh, because it was too close to recent strikes and artillery fire in Al-Mawasi.
Medical workers are now packing up the equipment there and trying to relocate to an area outside of Khan Younis, further north, she said.
Seven of the Red Crescent’s ambulances are still operating in Rafah, she said. “But the problem is, where do they go?” she added. “There is no hospital that can handle this many casualties.”
Aid workers estimate that around five field hospitals — movable medical facilities that often use tents — are still operating in Rafah, but they described them as completely overwhelmed. The only regular hospital that remains is a maternity hospital in the Tal as-Sultan district, the same area where heavy fighting forced Doctors Without Borders to close a clinic.
Even getting the wounded to a place where they can be cared for is a challenge.
“The streets are full of debris from the destruction, and even more full of displaced people on the move,” Ms. Farsakh said. “This may be the hardest experience we have had.”
For much of the nearly eight-month conflict, Israeli authorities urged civilians to flee south toward Rafah, swelling its population to roughly 1.3 million before the offensive began. In the last three weeks, around one million have been forced to flee again, the U.N. says.
Patients who need urgent medical care outside of the Gaza Strip have been trapped for three weeks, since Israel seized the Rafah crossing with Egypt, according to recent statements by World Health Organization officials.
The W.H.O. said on Wednesday that it had managed to bring in fuel and medical supplies to meet the needs of some 1,500 patients at Al Ahli hospital in Gaza City in the north. But the overall trend is dire, the 19 aid agencies said: “Gaza’s health system has been effectively dismantled.”
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