GAZA -- As the conflict between Israel and Hamas grinds on, the health system in the Gaza Strip has nearly collapsed, with doctors and international aid organizations warning that the last remaining major hospital in southern Gaza is now at imminent risk of not being able to function due to a lack of supplies and staff needed to treat the wounded and sick.
The Nasser Medical Complex, located in central Khan Younis in southern Gaza, was once a lifeline for the southern region of the strip. Now, it is surrounded by neighborhoods under evacuation orders from the Israeli military, and the roads leading to it are under frequent bombardment and shelling.
Despite being designated by the Israeli military as a facility that should not be evacuated, the surrounding area is labeled as a red zone by the Israeli military, meaning citizens in the area should evacuate because military action is likely to occur in the area.
The Israeli military has previously called for evacuations of hospitals in Gaza after evacuating surrounding areas, in advance of large-scale raids which the IDF said were militarily necessary as Hamas operatives had embedded themselves within those hospitals. The IDF previously raided Nasser hospital itself, spending a week at the complex in February 2024.
The IDF has also attacked Nasser hospital without issuing evacuation orders. In March of this year, it conducted a strike on the surgery wing of the hospital. The IDF said it was targeting a member of Hamas' political bureau operating from the hospital and confirmed the strike in a statement at the time. Hamas said the senior Hamas member who was targeted, Ismail Barhoum, was receiving medical treatment in the hospital when he was killed. A doctor at the hospital said a teenager was also killed in the attack.
"The hospital continues to function, continues to provide extremely high-level service even with limited resources," Dr. Mark Brauner, an emergency physician who recently left the facility, told ABC News in an interview Thursday. "But it's extremely uncomfortable to be in close proximity to warfare. Bombs are exploding just hundreds of meters away, and gunfire can be heard throughout the day."
Dr. Brauner said the staff at Nasser Hospital are treating patients who are not only suffering from injuries caused by airstrikes but also from chronic malnutrition.
"One of the most important aspects of healing from an injury is protein intake, and they have no protein in their diets," he said. That delays healing and increases the risk of infection, he said, adding, "There are at least 100 children at direct risk due to the lack of pediatric formula."
The Israel-Hamas war has taken a grim human toll. Since the war began, nearly 56,000 people in Gaza have been killed and more than 131,000 have been wounded, according to Gaza's Hamas-run health ministry. The war began on Oct. 7, 2023, when 1,200 people were killed in a Hamas-led surprise attack on southern Israel. Hundreds more were taken hostage. At least 20 living hostages are believed to still remain in Hamas captivity.
Nasser Hospital is now the only fully functioning major hospital in the southern Gaza Strip. The few remaining hospitals in Gaza City are operating at minimal capacity, and there are no functioning hospitals in northern Gaza.
"Medical services are critically under-resourced, with nearly half of essential supplies already out of stock, and over one fifth, 21 percent, projected to run out in two months," the United Nations Relief and Works Agency for Palestine Refugees in the Near East said in a June 20 update.
Also known as UNRWA, the organization is the main UN agency operating inside Gaza.
Just five out of 22 UNWRA-run health centers and two UNRWA-rented facilities used as temporary health centers are still operational in Gaza as of June 15, UNWRA said.
The Hamas-run Gaza Ministry of Health describes a dire situation when it comes to the territory's health system.
"The remaining operating hospitals in the Strip will have no more time to continue operating in the face of the serious crises they face. Hospitals are experiencing overcrowding with wounded and sick patients, exceeding their capacity, especially in inpatient and intensive care units," the ministry said in a June 25 statement.
Overall, just 45 of Gaza's 312 operating rooms are still in service, and most are functioning with extremely limited capacity, the Gaza Ministry of Health said. Cancer and heart patients are among the most impacted by the medicine and medical supply shortage, with 47% of essential medicines and 65% of medical supplies now at zero stock, the ministry said.
Nine out of 34 oxygen stations are partially operational, and blood banks are nearly empty, according to the ministry.
"Community blood donation campaigns have become futile due to worsening malnutrition and anemia," the ministry said.
The supplies impacted include "medicine for non-communicable diseases, antimicrobials and antiparasitic products, dermatological and eye preparations, analgesic and anti-inflammatory medications, gastrointestinal products, respiratory medications and family planning methods," UNWRA said in the situational update.
Earlier this week, the World Health Organization (WHO) delivered a shipment of medical aid to Gaza for the first time since March 2, WHO Director-General Tedros Adhanom Ghebreyesus wrote on the social platform X.
The shipment of nine trucks included "essential" medical supplies, 2,000 units of blood and 1,500 units of plasma, Ghebreyesus said.
The supplies were transported from Israel through the Kerem Shalom crossing point without any reported looting, and the blood and plasma were delivered to Nasser Hospital's cold storage facility for distribution to other medical centers, the organization and the hospital reported.
COGAT, the Coordination of Government Activities in the Territories, the Israeli authority that oversees supplies that enter the Gaza Strip, confirmed the shipment of medical supplies.
"Along with the blood units, truckloads of medical supplies and emergency and chronic care medicines entered Gaza to support the medical response," COGAT said in the statement. "We continuously facilitate medical and humanitarian responses for the civilian population in Gaza."
However, Ghebreyesus said the delivery was far from sufficient to meet the needs inside Gaza.
"These medical supplies are only a drop in the ocean," he said in the X post. "Aid at scale is essential to save lives. WHO calls for the immediate, unimpeded, and sustained delivery of health aid into Gaza through all possible routes."
For some, even these rare deliveries come too late.
The group Doctors Without Borders evacuated most of its staff from Nasser Hospital two weeks ago, citing safety concerns.
"I don't want to call it a collapsed system anymore. There is no health system in Gaza," Dr. Mohammed Abu Mughaiseeb, the group's deputy medical coordinator in Gaza, told ABC News in an interview.
"The hospitals that remain are overwhelmed with mass casualties, many now coming from the food distribution points. We're treating patients with severe burns and complicated injuries, and we don't have the supplies, the fuel or the infrastructure to handle it," he said.
Some patients are also suffering because the medical care available in the Gaza Strip does not meet the level of care they need.
The Gaza Ministry of Health said 513 patients have died due to restrictions on travel for medical care, and 338 cancer patients have died while waiting to leave for treatment abroad.
An IDF spokesperson did not immediately comment on the current travel restrictions in Gaza.
Despite these challenges, the doctors and staff at Nasser Hospital continue their work.
Electricity shortages are also exacerbating the crisis. Just 49 hospital generators are still running -- and even they are operating with limited fuel, according to the health ministry.
"We are holding on by a thread," Brauner said. "This is not a sustainable situation. If Nasser goes down, the entire southern region will be left without a hospital. And that will be the final collapse."