As Israeli bombs fell, wounded children overwhelmed this Gaza hospital. Dozens died

CAIRO (AP) — When the first explosions in Gaza this week started around 1:30 a.m., a visiting British doctor went to the balcony of a hospital in Khan Younis and watched the streaks of missiles light up the night before pounding the city. A Palestinian surgeon next to him gasped, “Oh no. Oh no.”

After two months of ceasefire, the horror of Israeli bombardment was back. The veteran surgeon told the visiting doctor, Sakib Rokadiya, they’d better head to the emergency ward.

Torn bodies soon streamed in, carried by ambulances, donkey carts or in the arms of terrified relatives. What stunned doctors was the number of children.

“Just child after child, young patient after young patient,” Rokadiya said. “The vast, vast majority were women, children, the elderly.”

This was the start of a chaotic 24 hours at Nasser Hospital, the largest hospital in southern Gaza. Israel shattered the ceasefire in place since mid-January with a surprise barrage that began early Tuesday and was meant to pressure Hamas into releasing more hostages and accepting changes in the truce’s terms. It turned into one of the deadliest days in the 17-month war.

The aerial attacks killed 409 people across Gaza, including 173 children and 88 women, and hundreds more were wounded, according to the territory’s Health Ministry, whose count does not differentiate between militants and civilians.

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More than 300 casualties flooded into Nasser Hospital. Like other medical facilities around Gaza, it had been damaged by Israeli raids and strikes throughout the war, leaving it without key equipment. It was also running short on antibiotics and other essentials. On March 2, when the first, six-week phase of the ceasefire technically expired, Israel blocked entry of medicine, food and other supplies to Gaza.

Triage

Nasser Hospital’s emergency ward filled with wounded, in a scene described to The Associated Press by Rokadiya and Tanya Haj-Hassan, an American pediatrician — both volunteers with the charity Medical Aid for Palestinians. Wounded came from a tent camp sheltering displaced that missiles set ablaze and from homes struck in Khan Younis and Rafah, further south.

One nurse was trying to resuscitate a boy sprawled on the floor with shrapnel in his heart. A young man with most of his arm gone sat nearby, shivering. A barefoot boy carried in his younger brother, around 4 years old, whose foot had been blown off. Blood was everywhere on the floor, with bits of bone and tissue.

“I was overwhelmed, running from corner to corner, trying to find out who to prioritize, who to send to the operating room, who to declare a case that’s not salvageable,” said Haj-Hassan.

“It’s a very difficult decision, and we had to make it multiple times,” she said in a voice message.

Wounds could be easy to miss. One little girl seemed OK – it just hurt a bit when she breathed, she told Haj-Hassan -- but when they undressed her they determined she was bleeding into her lungs. Looking through the curly hair of another girl, Haj-Hassan discovered she had shrapnel in her brain.

Two or three wounded at a time were squeezed onto gurneys and sped off to surgery, Rokadiya said.

He scrawled notes on slips of paper or directly on the patient’s skin – this one to surgery, this one for a scan. He wrote names when he could, but many kids were brought in by strangers, their parents dead, wounded or lost in the mayhem. So he often wrote, “UNKNOWN.”

In the operating room

Dr. Feroze Sidhwa, an American trauma surgeon from California with the medical charity MedGlobal, rushed immediately to the area where the hospital put the worst-off patients still deemed possible to save.

But the very first little girl he saw -- 3 or 4 years old -- was too far gone. Her face was mangled by shrapnel. “She was technically still alive,” Sidhwa said, but with so many other casualties “there was nothing we could do.”

He told the girl’s father she was going to die. Sidhwa went on to do some 15 operations, one after another.

Khaled Alserr, a Palestinian surgeon, and an Irish volunteer surgeon were doing the same. There was a 29-year-old woman whose pelvis was smashed, the webbing of veins around the bones was bleeding heavily. They did what they could in surgery, but she died 10 hours later in the intensive care unit.

There was a 6-year-old boy with two holes in his heart, two in his colon and three more in his stomach, Sidhwa said. They repaired the holes and restarted his heart after he went into cardiac arrest.

He, too, died hours later.

“They died because the ICU simply does not have the capacity to care for them,” Sidhwa said.

Ahmed al-Farra, head of the pediatric and obstetrics department, said that was in part because the ICU lacks strong antibiotics.

Sidhwa recalled how he was at Boston Medical Center when the 2013 Boston Marathon bombing happened, killing three people and sending some 260 wounded to area hospitals.

Boston Medical “couldn’t handle this influx of cases” seen at Nasser Hospital, he said.

The staff

Rokadiya marveled at how the hospital staff took care of each other under duress. Workers circulated with water to give sips to doctors and nurses. Cleaners whisked away the bloody clothes, blankets, tissues and medical debris accumulating on the floors.

At the same time, some staff had their own family members killed in the strikes.

Alserr, the Palestinian surgeon, had to go to the morgue to identify the bodies of his wife’s father and brother.

“The only thing I saw was like a packet of meat and bones, melted and fractured,” he said in a voice message, without giving details on the circumstances their deaths.

Another staffer lost his wife and kids. An anesthesiologist -- whose mother and 21 other relatives were killed earlier in the war -- later learned his father, his brother and a cousin were killed, Haj-Hassan said.

Aftermath

Around 85 people died at Nasser Hospital on Tuesday, including around 40 children from ages 1 to 17, al-Farra said.

Strikes continued throughout the week, killing several dozen more people. At least six prominent Hamas figures were among those killed Tuesday.

Israel says it will keep targeting Hamas, demanding it release more hostages, even though Israel has ignored ceasefire requirements for it to first negotiate a long-term end to the war. Israel says it does not target civilians and blames Hamas for their deaths because it operates among the population.

With Tuesday’s bombardment, Prime Minister Benjamin Netanyahu also secured the return to his government of a right-wing party that had demanded a resumption of the war, solidifying his coalition ahead of a crucial budget vote that could have brought him down.

Haj-Hassan keeps checking in on children in Nasser’s ICU. The girl with shrapnel in her brain still can’t move her right side. Her mother came to see her, limping from her own wounds, and told Haj-Hassan that the little girl’s sisters had been killed.

“I cannot process or comprehend the scale of mass killing and massacre of families in their sleep that we are seeing here,” Haj-Hassan said. “This can’t be the world we’re living in.”

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Associated Press writers Julia Frankel in Jerusalem, Fatma Khaled in Cairo, and Sarah El Deeb in Beirut contributed to this report.