Gaza City hospitals close, patients flee as Israeli forces advance

CAIRO — Israel’s intensifying attacks inside Gaza City are causing the region’s already threadbare health care system to buckle, doctors and health officials say, sending medics and patients fleeing and overwhelming strained hospitals in the enclave’s south.

Major hospitals in Gaza City said they have not received site-specific evacuation orders from the Israeli military, though they all lie within evacuation zones. But relentless bombardment and Israeli fire from drones and advancing tanks in recent weeks have put several hospitals and more than two dozen primary health care providers in Gaza City out of service, according to medical staff and the United Nations.

The Israeli military began to pound Gaza City, which it says is the last Hamas stronghold in the Gaza Strip, in August — a prelude to the ground invasion it launched Sept. 16. It warned hospital officials in Gaza City last month to prepare a plan for possible evacuation.

At first, many health officials and personnel vowed to stay. Then the strikes and tanks began closing in.

Gaza’s only specialized pediatric hospital, al-Rantisi Children’s Hospital, was forced to close on Monday after it sustained damage in an Israeli attack on Sept. 16. Eighty children were receiving care when three artillery shells struck the hospital without prior warning, hospital director Jamil Suleiman said in an interview. The attack caused the hospital’s computer systems to fail, shut off its water supply and “spread panic,” he said. The patients who were able to walk — about half — soon left on their own.

“The army did not officially order the hospital to shut down, but they blocked anyone attempting to enter, as drones were firing on any movement in the hospital area,” Suleiman said. “Gradually, the situation deteriorated: People could not safely reach the hospital, and medical staff were at great risk traveling in and out. As a result, we made the decision to close and evacuate the hospital.”

The Israel Defense Forces did not immediately comment on the strike at the hospital.

Remaining patients were sent to other hospitals in Gaza City — but much of the facility’s medical equipment is still stuck inside, and drones fired on staff who attempted to recover it, Suleiman said.

Israel’s offensive has already driven more than 250,000 people from Gaza City in the past month, the U.N. said last week. Still, hundreds of thousands of people are estimated to remain.

Jordan’s military said this week that it was evacuating the field hospital it runs in Tel al-Hawa in Gaza City, after intense Israeli shelling and bombardment nearby damaged the building’s facade and hospital equipment and interrupted some services. The field hospital was transferred to Khan Younis in southern Gaza, “to preserve the safety of its staff,” the Jordanian armed forces said in a statement.

Two eye hospitals and a major rehabilitation and prosthetics center also shut down due to the Israeli offensive, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), which said 16 other medical points and 11 primary health care centers were forced to suspend or shut down services in Gaza City.

Treatment for disease or disability is increasingly unavailable in northern Gaza. Israeli attacks this week destroyed two medical centers belonging to the Palestinian Medical Relief Society, according to the organization, which is run by the Ramallah-based politician and doctor Mustafa Barghouti. The IDF did not immediately respond to request for comment on the attacks.

Al-Quds Hospital in the Tel al-Hawa area is now surrounded by Israeli military vehicles, according to Nebal Farsakh, a spokesperson for the Palestine Red Crescent Society, which runs the hospital. Their presence has made it impossible for any new patients to enter and for the 101 doctors, administrative staff, patients and their relatives inside to safely leave the premises.

Andee Vaughan, a nurse who left the hospital on Tuesday after a three-month volunteer mission, said that in recent days, armed drones had begun firing at the hospital buildings — with some bullets penetrating the walls.

In a statement, the IDF said that “no strike was conducted directly toward the hospital” and that the incident was “under review.”

But explosions from strikes and explosive-laden robots detonating nearby were so loud, Vaughan said, that one infant — a 31-week-old who was brought in with respiratory distress — was dropping into bradycardia with nearly every bomb. Medical staff managed to slowly wean her off oxygen, but Vaughn said she fears a particularly loud strike may stop the baby’s heart altogether.

The situation at al-Shifa Hospital, Gaza’s largest, is also “extremely dangerous,” Motaz Harara, the hospital’s emergencies director, said. Earlier this week, Israeli tanks came within about 160 yards of the complex before pulling back. Drones and warplanes whir overhead constantly, he said.

The hospital was raided twice previously by Israeli forces — once in November 2023 and once in March 2024. The IDF damaged the hospital and detained medical staff during those raids. Fear of suffering humiliation and mistreatment inside Israeli prisons compelled many doctors to pre-emptively leave this time, said one doctor who fled on Monday by foot to Nuseirat in central Gaza. The doctor spoke on the condition of anonymity out of concern for his safety.

As a result, staffing at the hospital is down to about 20 to 30% of its normal levels, Harara said. About 150 patients remain at the hospital. “We fear the tanks could move closer or surround the hospital at any moment,” he said, adding that the Health Ministry has an emergency evacuation plan ready if the time comes.

That moment may be imminent: The IDF released aerial footage Wednesday that it said showed “significant live fire … being conducted out from Shifa Hospital” several days earlier. “The use of a civilian structure, and particularly an active hospital, is further proof of Hamas’ cynical and systematic modus operandi of exploiting civilian infrastructure as manned terror command posts,” the IDF said.

The Washington Post geolocated the footage to the surgery department of al-Shifa. The IDF declined to comment on the date the video was taken.

Hospitals are supposed to receive extra protections during wartime under international humanitarian law, but those protections disappear if a facility is being used for active military purposes.

Mohammad Abu Salmiya, the hospital’s director, denied that any gunfire emerged from the hospital in an interview with Al Jazeera on Thursday.

What will happen to the patients and medical workers who remain in the north, whether by choice or necessity, remains unclear. The only road leading south is clogged with men, women and children, traveling by foot or piling into cars or atop carts, seeking refuge further south. If the IDF does not approve additional routes, any medical evacuation of ill or injured patients to the south would be complicated by the heavy traffic along the coast, doctors and the U.N. official said.

Already, “a lot of people with chronic illness are really suffering because of delayed medical care, delayed transport times,” Kathleen Gallagher, an American volunteer surgeon with MedGlobal, a U.S.-based medical nonprofit, said in an interview from Nasser Hospital in Khan Younis.

“Our ambulances are stuck in that traffic. We’ve had several trauma patients in the last 48 hours. I lost one yesterday that came from another hospital. I can’t say that it was traffic necessarily, but I think he was salvageable had we gotten to him an hour earlier,” she said. The overcrowding is “certainly expected to get worse.”

Hospitals in the enclave’s center and south have been already flooded with patients displaced from Gaza City in recent weeks, many of them seeking treatment for malnutrition, according to medical workers and organizations working in them.

Nasser Hospital is at 300% capacity, according to Michael Falk, another volunteer doctor with MedGlobal who has spent the past three weeks there. Staff are building a 150-bed tent ward in the vicinity to accommodate more patients, he said, but it’s unlikely to meet the needs, he said. The hospital is already rationing gauze and antibiotics, which has hurt recovery rates of trauma patients postsurgery.

Ahmed al-Farra, head of pediatrics and maternity at Nasser Hospital, said Monday in an update posted to Facebook that the pediatric department was seeing “unprecedented crowding,” with several premature babies forced to share one incubator, and sick or malnourished children lining the hallways because no more beds are available.

Palestinian doctors and nurses — the backbone of the health system — are “exhausted” and “emotionally shredded,” often displaced themselves and living in crowded tents, Gallagher said.

The Kuwaiti Hospital in Mawasi, a narrow strip of land where many displaced residents are staying, suspended scheduled surgeries after supplies ran out, its director, Suhaib al-Hams, said in a statement Monday.

“Government and field hospitals in southern Gaza are unable to handle the huge numbers of residents and displaced people,” Hams said.

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• Cheeseman reported from Beirut. Hazem Balousha in Toronto and Heba Farouk Mahfouz in Cairo contributed.