At a field hospital that has become one of Gaza's main trauma centres, a doctor who has worked in a dozen war zones described the situation as the most "catastrophic" he had ever seen.
"It is devastating," said Javed Ali, International Medical Corps's head of emergency response in Gaza.
Speaking to AFP this week from a field hospital northwest of the areas of Rafah ordered evacuated by Israel, he said the situation around the far-southern city was "dire".
The hospital, in the coastal area of Al-Mawasi which Israel has designated a "humanitarian zone", has swelled in a matter of months into a more than 150-bed facility made up of numerous white tents and shipping containers.
Since the first evacuation orders for Rafah were issued on May 6, ahead of a long-feared ground invasion of the southernmost part of Gaza, nearly half of the 1.4 million people who had been sheltering there have left, according to UN agencies.
"There has been a massive movement of population," Ali said, adding that most had avoided Al-Mawasi, which was already dramatically overcrowded, heading instead for the war-scarred city of Khan Yunis, which was a battleground until just last month.
Those arriving were "exhausted, they are scared, they don't have resources", Ali said, adding that many patients were asking for "money, support ... so they can move their families to safety".
'Critical items' missing
Gaza's bloodiest war began with Hamas's unprecedented October 7 attack on Israel, which resulted in the deaths of more than 1,170 people, mostly civilians, according to an AFP tally of Israeli official figures.
Israel's retaliatory offensive has killed more than 35,000 people in Gaza, mostly civilians, according to the Hamas-ruled territory's health ministry.
While the number of people sheltering in Al-Mawasi's sea of tents may not have grown much in recent weeks, the pressure on the field hospital there certainly has.
With access to hospitals in Rafah largely cut off, the facility has seen the number of daily visits to its emergency department balloon from around 110 to close to 300, Ali said, describing "polytrauma cases with broken bones in every part of the body".
The situation has been exacerbated by last week's temporary closure of two major aid crossings into Rafah, which disrupted the supply of medicines and fuel for hospital generators.
Ali said that the field hospital "saw this coming" and prepared surplus stocks, but it had not predicted the surging number of patients.
"It's getting totally out of hand," he said. "Our supplies will not last."
He said the field hospital was already seeing shortages of "very critical items".
It had for instance run out of "all paediatric formulations of antibiotics and painkillers" at a time when around 20 children were recovering from surgery.
'Catastrophic'
The biggest worry though was "space", with major surgeries doubling from the previous average of around 25 a day, Ali said.
There has also been a dramatic rise in the workload of the maternity ward, which has gone from around 10 deliveries a day to about 25, along with up to eight C-sections.
With expectant mothers unable to access the specialist maternity hospital in Rafah, there has also been a "massive increase in the number of complicated pregnancies", he said.
Ali, who during a 15-year career has worked in war zones from Afghanistan and Sudan to Nigeria and Ukraine, said the situation in Gaza was "far more catastrophic".
"The immense number of trauma cases, the lack of resources, the interrupted supply chain... It's something that I've never seen."
In most wars, men account for the majority of gunshot and shrapnel wounds, but in Gaza the number of women and children injured "is very, very high", Ali said, describing young children "with shattered limbs".
With only a third of Gaza's 36 pre-war hospitals even partially functional, according to the UN, and with displaced people often stuck far from health facilities "access has become extremely compromised".
The field hospital in Al-Mawasi has grown to be the "main trauma referral centre" in southern Gaza, Ali said, "and we are working in a tent".
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
