Health services in Rafah at a critical stage after Israeli invasion and fuel blockade

Health services in Gaza are under intense strain as Israel's seventh-month-long offensive took a new turn this week with the invasion of the southern Rafah governorate, a vital humanitarian hub and centre for thousands of sick and wounded civilians.

World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus said he was extremely concerned about Israel's "increased military activity" in Rafah.

On Thursday, he warned that hospitals in southern Gaza had only enough fuel to operate for three more days, following Israeli forces' control of the Rafah border crossing—an essential aid entry point—now sealed shut.

"The Rafah military operation is further limiting our ability to reach thousands of people who have been living in dire conditions without adequate food, sanitation, health services and security. This must stop now," Ghebreyesus wrote on social media site X.

As Israel's seven-month-long offensive shifted southward, hospitals in Rafah became crucial, especially as other hospitals in the northern and central governorates, such as al-Shifa and Nasser Medical Complex, faced significant air and ground attacks by the Israeli military.

Currently only 12 hospitals out of 36 in Gaza are "partially functioning", according to an 8 May report from WHO. 

How many hospitals are in Rafah?

More than 150,000 Palestinians have reportedly fled the eastern parts of the city following Israeli military directives, with hundreds of thousands more expected to be forced to move in the coming days.

The directive has also impacted key hospitals and clinics in the area. Three of Gaza's main hospitals are in the southern governorate, including Abu Yousef al-Najjar, Al-Helal Al-Emirati Maternity Hospital and Kuwait Hospital, all of which are now at grave risk. Four out of seven working field hospitals are also in the Rafah area.

Doctors and patients of the Abu Yousef al-Najjar Hospital were forced to evacuate on Tuesday, putting the lives of some 200 dialysis patients at risk, Reuters reported.

Footage shared online by local journalists showed hospital wings dramatically abandoned with beds and equipment strewn across the floor.

مستشفى الشهيد أبو يوسف النجار في حي الجنينة برفح مُفرغ من المرضى والأطباء بعد تهديد الاحتلال.. الأطباء والمرضى والجرحى لا يريدون تكرار مشهد المقابر الجماعية كالتي حصلت في مستشفى الشفاء ومستشفى ناصر

من يمنع إسرائيل عن الاستمرار في تدمير المستشفيات؟ pic.twitter.com/SgybsywioF

— Yasser (@Yasser_Gaza) May 8, 2024

The other two hospitals will soon be unreachable by patients, staff and ambulances, and will be unable to function, the WHO reported.

Al-Helal Al-Emirati, Rafah’s main maternity hospital where more than half of Gaza births had been taking place, was forced to stop admitting patients.

It has left the small Kuwait Hospital, with a 16-bed capacity, as the only functioning hospital in Rafah, according to NGO Medical Aid for Palestinians, or just one field hospital in the area.

Critical stage of fuel supplies

Israel's blockade of the Rafah crossing has severely jeopardised power supplies for hospitals and for civilians seeking to evacuate in vehicles.

Since the start of the war, fuel supplies have entered Gaza from outside the strip, along with water, food and medicines allowed under Israeli regulations.

One of the three hospitals in Rafah, Al-Najjar, is no longer functioning due to the ongoing hostilities in its vicinity and the military operation in Rafah.

The closure of the border crossing continues to prevent the UN from bringing fuel. Without fuel all humanitarian…

— Tedros Adhanom Ghebreyesus (@DrTedros) May 8, 2024

Israel has not yet reopened the Rafah crossing since its forces seized it on Monday, despite calls from the international community for it to do so.

Fuel is now in critically short supply, which threatens to shut down hospitals and is endangering the lives of hundreds of patients.

Medical Aid for Palestinians said on Friday that "five hospitals, five field hospitals, 28 ambulances, 23 medical points and 17 primary health care centres will be out of operation in less than 48 hours," unless Israel immediately allows fuel into Gaza.

The closure of the crossing has also meant critically ill patients cannot be evacuated. Some 140 patients, including injured children, were due to leave on Tuesday for treatment, according to Gaza's health ministry.

Israel has repeatedly warned of a major military offensive into Rafah, where it believes four Hamas battalions are based.

The US and other allies have expressed opposition to an invasion into Rafah due to fears for the safety of 1.3 million Palestinians in the city, most of whom have fled fighting in other areas and moved south following Israel’s previous orders.

This morning’s news is deeply concerning - expansion of the Israeli military offensive in #Rafah and also now in the north of #Gaza, where the famine is at its worst.
We are hearing that people don’t know where to move to because nowhere is safe.#CeasefireNow https://t.co/iyjHZRDWO1

— Melanie Ward (@melanie_ward) May 11, 2024

Charity Islamic Relief Worldwide said on Saturday that there is chaos and panic in Rafah as the elderly, sick, disabled and malnourish infants are among those being forced to move.

"Most are now sheltering in horrific conditions, without adequate access to food, water or other essentials," the UK-registered charity said in a statement.

An Islamic Relief staff member in Gaza said Palestinians have entered a "new period of unprecedented hardship" following Rafah evacuation orders this week.

"It’s an unimaginable scene, with tens of thousands of people looking for shelter.

"People are pale and thin, tired and afraid. There are children, women, elderly people and people with disabilities trying to flee in wheelchairs. Injured people have to leave hospital with recent bandages and bloodstains," the staff member said.