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 air strike and has been shut. Health officials fear further outbreaks among tens of thousands of displaced residents crowded 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 criss-crossed the room to carve out sleeping spaces. “The school is safe from the war, but when it comes to corona, with five families in a room, everyone infects each other,” said al-Danaf, who fled Israeli tank shelling on the northern Gaza town of Beit Lahiya a few days ago. The Gaza Strip’s health infrastructure was already collapsing before this latest war, said Adnan Abu Hasna, a spokesman for UNRWA, the UN agency that provides vital assistance to the 75 per cent of the enclave’s population who are refugees. “It’s frightening,” he said. The sector has been battered by three previous wars between Israel and Gaza’s Hamas rulers. This war began May 10 when Hamas fired long-range rockets toward Jerusalem in support of Palestinian protests against Israel’s heavy-handed policing of the Al-Aqsa Mosque compound, a flashpoint site sacred to Jews and Muslims, and the threatened eviction of dozens of Palestinian families by Jewish settlers. Since then, Israel has struck hundreds of targets across the Mediterranean coastal strip. Israel says it is trying to cripple Hamas, which has fired hundreds of rockets into Israel. During each of the wars, hospitals and clinics were damaged or destroyed, and medical personnel killed. And after each, authorities had to slowly rebuild, hampered by the blockade imposed by Israel and Egypt since Hamas took power in 2007. Suzy survived an Israeli strike. Dozens of other children haven’t 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. “It’s layer upon layer of crisis. And there never is really enough time between each crisis to rebuild,” said Matthias Schmale, the UNRWA director in Gaza. “The [health care] system has gradually been quite significantly weakened. I wouldn’t say it’s on its knees, but getting close.” Gaza health officials say at least 227 Palestinians, including 64 children, have been killed in air strikes and more than 1,600 wounded. Twelve people in Israel have been killed by rockets. The bombardment has driven more than 56,000 Gazans from their homes, fleeing into 59 schools run by UNRWA. The UN agency is providing them with water and basic hygiene supplies, including face masks. Unknown numbers more have taken refuge with relatives. UNRWA learned from the last war, in 2014, when some 292,000 displaced people crammed into its schools and other shelters during 50 days of fighting. Since then, the agency has installed showers, more bathrooms and extra water and electricity capacity into some of the schools in case they might be needed again for shelters, officials said. Israel’s Netanyahu vows to fight on as Biden urges Gaza ‘de-escalation’ 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. Still, Israeli attacks this time have damaged at least 18 hospitals and clinics, the World Health Organization said. Nearly half of all essential drugs have run out. Schmale said at least three health care centres have been levelled, including a trauma and burn centre run by Medecins Sans Frontieres. Among the sites damaged was the main health care 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 halted. “It’s like a ticking bomb because people are not tested, and those who are infected won’t know that they are infected,” Dhair said. 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 stopped, said the WHO’s top official in Gaza, Sacha Bootsma. Just under 39,000 people, or 2 per cent of Gaza’s population, have received vaccinations. There are only enough doses to vaccinate another 15,000, and those expire in June, raising fears they will be unusable by the time they can be given. 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. Israeli air strike destroys Gaza building housing media outlets 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 per cent, forcing hospitals to rely more on fuel-thirsty generators, Unicef Executive Director Henrietta Fore said. During one brief opening, UNRWA was able to bring in five fuel trucks, enough to help it run its facilities for a few weeks. But other trucks of food and medicine could not enter, reportedly prevented by ongoing shelling. Two days ago, Egypt sent in a supply convoy that included medical supplies and fuel, but that fuel is expected to run out on Thursday. If the border stays closed, supplies will begin to run out and “we will need so-called humanitarian corridors open to bring stuff in,” Schmale said.