The Gaza Strip’s already feeble health system is being brought to its knees by the fourth war in just over a decade

Hospitals have been overwhelmed with waves of dead and wounded from Israel’s bombardment.

Many vital medicines are rapidly running out in the tiny, blockaded coastal territory, as is fuel to keep electricity going.

Two of Gaza’s most prominent doctors, including the No. 2 in Gaza’s coronavirus task force, were killed when their homes were destroyed during barrages since fighting between Hamas and Israel erupted 10 days ago.

Just as Gaza was climbing out of a second wave of coronavirus infections, its only virus testing lab was damaged by an airstrike and has been shut down.

Health officials fear further outbreaks among tens of thousands of displaced residents crammed into makeshift shelters after fleeing massive barrages.

At one UN-run school where 1,400 people were taking shelter, Nawal al-Danaf and her five children were crammed into a single classroom with five other families. Blankets draped over cords crisscrossed the room to carve out sleeping spaces.

 Palestinians take shelter at a school run by the UN after fleeing heavy Israeli missile strikes on the outskirts of Gaza City.

Blankets and laundry dangled from the railings of the school’s balcony, as women looked down into a yard where children were playing and men sat chatting. No one wore a mask or could do any social distancing in the cramped quarters.

The Gaza Strip’s health infrastructure was already collapsing before this latest war, said Adnan Abu Hasna, a media adviser for UNRWA, the U.N. agency that provides vital assistance to the 75% of the enclave’s population who are refugees. "It’s frightening,” he said.

Other turmoil also weighed on the system. More than two years of weekly Friday Palestinian protests at the border with Israel against the blockade produced a constant stream of casualties from Israeli fire – more than 35,000 injured, many with lifelong disabilities and around 100 still awaiting reconstructive surgery and amputations.

Now health facilities are struggling to handle both the casualties of war and the everyday needs of Gaza’s 2 million people.

Gaza health officials say at least 227 Palestinians, including 64 children, have been killed in airstrikes and more than 1,600 wounded.

The bombardment has driven more than 56,000 Gazans from their homes, fleeing into 59 schools run by UNRWA.

 Medics inspect the rubble of a Gaza healthcare clinic following an Israeli airstrike on the upper floors of a commercial building near the Health Ministry in Gaza City.

The UN agency is providing them with water and basic hygiene supplies, including face masks. Unknown numbers more have taken refuge with relatives.

So far, the current onslaught has not been as directly destructive to health facilities as 2014, when multiple hospitals and clinics took direct hits from Israeli bombing, as did UN schools housing the displaced.

Among the sites damaged was the main healthcare clinic, the only site in Gaza where tests detecting COVID-19 can be analysed, said Dr. Majdi Dhair, head of preventive medicine at the Health Ministry. As a result, coronavirus testing has ground to a halt.

As of Monday, when the clinic was damaged, Gaza had recorded more than 105,000 coronavirus infections, including 986 deaths. Some 80 people were in critical condition with the virus.

Gaza’s COVID-19 vaccination drive, already slow, has come to a standstill, said WHO’s top official in Gaza, Sacha Bootsma.

Only about half of government-run primary care centres are operating. Sixteen of UNRWA’s 22 health care centres were working as of Wednesday. Most of Gaza relies on the UN centres, according to UNRWA.

All of the government’s 13 hospitals are running, though some have sustained damage, and as of Monday, 16 private or NGO-run hospitals were working.

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But all are badly in need of emergency medical supplies. WHO listed some 40 key medicines and medical supplies that it is waiting for, including anaesthetics, antibiotics, sutures and blood bags. Gaza’s border with Israel has been closed throughout the fighting.

Also urgently needed is fuel. Electricity output in Gaza has dropped some 60%, forcing hospitals to rely more on fuel-thirsty generators, Unicef Executive Director Henrietta Fore said in a statement.

During one brief opening, UNRWA was able to bring in five fuel trucks, enough to help it run its facilities for a few weeks.