Inside a darkened operating theatre in Gaza’s largest hospital complex, staff swaddled dozens of tiny premature babies seven or eight to a bed, in a desperate effort to keep the infants warm – and alive. With no oxygen supplies or power for incubators, nurses attempted to provide what care they could for 39 babies who were transferred from the neonatal unit in another part of the sprawling complex after a strike on Dar al-Shifa’s intensive care unit. Just getting them to the theatre was a potentially deadly mission after staff reported attacks on anyone moving inside the hospital compound. “The neonatal unit is not connected to the main surgical units within the al-Shifa medical complex; it was dangerous to go from the main building to get the babies,” said Marwan Abu Sada, the head of surgery at al-Shifa, which was once considered the heart of Gaza’s healthcare system and is now operating under fire. “We called the International Committee of the Red Cross [ICRC] and the Israelis just to ensure the passage of the babies from the neonatal ICU to the surgical area.” Thirty-nine infants managed to survive the transfer, but their conditions worsened over the weekend. “We lost the life of one baby today. Yesterday we lost two and I am afraid that all of the babies will lose their lives,” said Abu Sada. Al-Shifa had the largest neonatal unit in Gaza and nowhere else could care for the infants, he said, making evacuation impossible. “We no longer have any oxygen supplies, or even fuel to run a generator.” Hospitals across Gaza City are in a struggle for survival, with only one facility able to receive the hundreds of wounded arriving daily. Staff in al-Shifa were working under bombardment and without power, clean water, or food. “Shifa is besieged; no one can get out, and no one can enter,” Abu Sada said. “It is dangerous for us, even the medical staff, to look out the window. We are so afraid of the shooting.” Amid fears of sniper fire, hospital staff have moved all 600 remaining patients away from the windows and into corridors deeper inside the complex. The hospital, in the west of Gaza City, has already endured six strikes over the past two days as Israeli tanks and snipers closed in, Abu Sada said, including one that struck an extension to the intensive care unit on Sunday. The Palestinian health minister, Mai al-Kaila, in the West Bank town of Ramallah, said 12 patients inside al-Shifa had died in the past two days. A drone was targeting people in the compound, she said, and staff were forced to leave at least 100 decomposing bodies in the hospital grounds because they have been unable to reach them. The rotting corpses were a potential health risk, she said, while staff had witnessed stray dogs tearing into the bodies. Ambulances are unable to bring the wounded to the hospital or take any patients to other facilities, said Abu Sada, although one person who was shot in the surrounding neighbourhood managed to flee into the grounds of al-Shifa on foot. Another, he said, was shot in the chest when he looked out of the window and died instantly. “It is a horrifying scene for the entire staff. We are so afraid, so scared of the bombardments. But we must stay here, we are ethically obliged to treat patients, and we cannot leave with our patients still inside. Even if we could, where would we go?” he asked. Israeli officials have repeatedly demanded that Palestinians flee to the south of the strip, including from hospitals where thousands are sheltering, despite pleas from staff who say evacuating critical patients would be deadly. The UN estimates that 1.5 million people are now displaced within the Gaza Strip –almost 70% of its population. Al-Kaila said the Israeli demands to evacuate hospitals meant the wounded would be left to fend for themselves on the street. “This is not an evacuation, but an expulsion at gunpoint,” she said. The Israel Defence Forces (IDF) have repeatedly claimed that Hamas operates from bunkers underneath al-Shifa. This is strenuously denied by Hamas and hospital staff. Col Moshe Tetro, who heads the Gaza coordination and liaison unit within the IDF, said: “There is no shooting at the hospital and there is no siege,” in reference to al-Shifa. “The east side of the hospital remains open. Additionally, we [the IDF] can coordinate [with] anyone who wants to leave the hospital safely.” The ICRC said: “The rules of war are clear. Hospitals are specially protected facilities under international humanitarian law. “The ICRC urgently calls for the immediate protection of all civilians, including humanitarian workers and medical personnel. This protection is not only a legal obligation, but a moral imperative to preserve human life in these terrible times.” At least 11,100 people have been killed in Israeli bombardments of the GazaStrip since 7 October, when Hamas militants attacked Israeli towns and kibbutzim, killing an estimated 1,200 people. But on Saturday night, health officials in the besieged enclave said they were unable to update the daily death toll due to the attacks on medical infrastructure. Barbara Leaf, the US state department’s highest-ranking official on the Middle East, previously said the death toll in Gaza was likely “higher than is being cited”. The Jordanian air force said it had carried out another emergency aid drop of medical supplies to its field hospital in Gaza on Sunday, while other facilities in Gaza City said they had been forced to cease operations. Al-Quds hospital in Gaza City, where an estimated 14,000 people are sheltering, was reportedly surrounded by Israeli tanks on Saturday. The Palestinian Red Crescent, which runs al-Quds, said the hospital was “no longer operational. This cessation of services is due to the depletion of available fuel and power outages.” “The hospital has been left to fend for itself under ongoing Israeli bombardment, posing severe risks to the medical staff, patients and displaced civilians,” it added. Early on Sunday, the World Health Organization (WHO) said it had lost communication with its contacts inside al-Shifa hospital. “The last reports said that the hospital was surrounded by tanks,” it said. “Staff reported a lack of clean water and risk of the last remaining critical functions, including ICU ventilators and incubators, soon shutting down due to lack of fuel, putting the lives of patients at immediate risk. “The WHO has grave concerns for the safety of the health workers, hundreds of sick and injured patients, including babies on life support and displaced people who remain inside the hospital. The number of inpatients is reportedly almost double its capacity.” The humanitarian organisation Médecins Sans Frontières (MSF) has demanded protection for hospitals across Gaza. “Electricity in a hospital is a lifeline and we know without it patients die. If action isn’t taken right now, if we do not stop this bloodshed immediately with a ceasefire or at the bare minimum a medical evacuation of patients, these hospitals will become a morgue,” it said. MSF described the situation as a “death warrant of civilians currently trapped in al-Shifa hospital signed by the Israeli military”. Al-Shifa hospital ran out of clean water after storage tanks on the roof of the facility were struck in the bombardments, which also hit oxygen supplies in the complex, according to staff and al-Kaila, who said blood supplies had spoiled due to the lack of power. Al-Kaila added that people in the surrounding area had died after being unable to access treatment. Abu Sada said hospital staff had been surviving on dates for energy as food supplies dwindled. An estimated 15,000 people were sheltering in al-Shifa as of Saturday morning, after thousands fled the intensifying bombardments. “It is a huge problem that we have no regular water supply in the hospital,” he said, adding that patients and staff risked dehydration. The hospital lost power on Saturday. In al-Ahli Arab hospital on the eastern side of the city, the only facility able to receive patients, Dr Fadel Naim said supplies of blood had run out. “The situation is catastrophic,” he said. “We have a limited team, our colleagues are in al-Shifa hospital, and they can’t come to help us. At the same time, we are receiving hundreds of injured people as well as those with chronic diseases like diabetes or hypertension, diarrhoea and dehydration. “There are pregnant women arriving, some needing a caesarean section, and we simply can’t help all of them. We operate like a field hospital, conducting the emergency and minimum possible intervention to save lives and stop bleeding. Many of these patients need surgical intervention, many have compound fractures with bleeding. “We do only life-saving surgeries.”