Izedine Lulu was besieged in Gaza’s al-Shifa Hospital when he heard that Israel had bombed his family home in November.

His brothers, sisters and father had all been killed.

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The 21-year-old medic could not go to find their bodies because al-Shifa was surrounded by Israeli tanks and snipers.

He could only tend to his patients, alive and dead.

“Eight patients in the [intensive care unit] died before my very eyes,” Lulu told Al Jazeera. “It was the first time I had ever buried people on the hospital’s [premises].”

“There is no support for medics in Gaza, but I think it’s our duty to keep working.

“We need to stay in the hospitals,” said Lulu, who is now working at al-Ahli Hospital.

Coming home

Lulu is one of hundreds of Palestinian and foreign medics trapped in a warzone after Israel took control of the Rafah crossing between Gaza and Egypt earlier this month, the only way out of the besieged enclave.

The foreign volunteers came to Gaza to help civilians during what United Nations experts have described as a genocide. Many of those with Western nationalities have recently been evacuated by their embassies following the end of their missions, yet new volunteers have been unable to enter Gaza.

Lulu, 21, is one of dozens of Palestinian medics working to save lives in Gaza [Courtesy of Izedine Lulu]

The loss of foreign medics has further gutted the few hospitals still standing in Gaza, all of which are grappling with catastrophic shortages of medicines and medical supplies that are needed to treat the mounting casualties.

Israel has killed or injured 100,000 people – men, women and children – following the Hamas-led attack on southern Israel on October 7, in which 1,139 people were killed and 250 were taken captive.

Since then, Israel has completely destroyed 23 out of 36 hospitals and killed 493 health workers, according to the World Health Organization (WHO) and Gaza Health Ministry, respectively. The former also said that there was a “systematic dismantling of healthcare” in Gaza as a result of Israel’s war.

The acute danger has prompted qualified health professionals to flee Gaza, compelling doctors to come from abroad to help the medics who stayed behind.

Mosab Nasser, who left Gaza nearly 30 years ago to study medicine, is one of those who returned.

He came back in April as the CEO of Fajr Scientific, a non-profit that dispatches volunteer surgeons to conflict zones.

Nasser and his team of 17 surgeons were working in the European Gaza Hospital in Khan Younis where they saw some of the most horrific war casualties.

“We have seen mothers, fathers and children with broken bones and broken skulls,” Nasser told Al Jazeera. “In some cases, we can’t determine if the victim is a male or female after they were crushed or hit.”

After Israel captured and closed the crossing between Gaza and Egypt, Nasser and his team were stuck for several days.

Most of his team – United States and United Kingdom nationals – eventually managed to leave through Gazas’s Karem Abu Salam (Kerem Shalom) crossing after coordinating with their embassies. As a US citizen, Nasser also left.

However, his team was forced to leave two members behind, one Egyptian and one Omani doctor who are still in Gaza as their countries were unable to secure their evacuation. They are now waiting for the WHO to organise their departure.

With the majority of the team’s departure, the European Hospital now has hardly any surgeons left. Nasser said that most qualified Palestinian health workers had fled to the coastal area of al-Mawasi after Israel began its military operation in Rafah, a town that borders Egypt and where 1.4 million Palestinians from all over Gaza had sought refuge.

Nasser predicts that the hospital will be overwhelmed with casualties if Israel expands its operations. The only other major hospital in Khan Younis was Nasser Hospital, which has been out of service since Israel attacked it in February.

Injured Palestinians are brought to the Kuwaiti Hospital after Israeli strikes in Rafah on May 20, 2024 [Mahmoud Bassam/Anadolu via Getty Images]

In April, a mass grave of more than 300 bodies was uncovered there. Men, women, children and medics were among the victims – some were found naked with their hands tied.

“We know it will be tough leaving the people of Gaza and the [Palestinian hospital] staff to face the crisis alone,” Nasser said, just days before evacuating.

Children losing their sight

Mohammed Tawfeeq, an Egyptian eye surgeon with a different volunteer mission in Gaza is still stuck in the European Hospital.

Matter-of-factly, he spoke of the countless children he has seen who have lost their eyesight from war injuries.

“About 50 percent of our patients are children,” he told Al Jazeera.

Unlike other Gaza hospitals, the European Hospital, which has foreign volunteers working in it, has relatively stable electricity and more medications such as anaesthetics.

However, the staff is overburdened.

Tawfeeq sees about 80 patients a day and does not know how the hospital will cope once he evacuates. The hospital may have to rely on healthcare workers to perform complicated surgeries despite being untrained and ill-equipped.

Lulu has that dilemma. He was in his fifth year of medical school before the war, yet he is now treating blast and bullet wounds without basic medical supplies in the north of Gaza.

He told Al Jazeera he recently had to operate on a boy whose face was disfigured from an explosion. The hospital had no electricity or anaesthesia.

“The boy was crying as I was trying to restructure his face for three hours,” Lulu said. “We had to use the light from our phones to see [in the dark].”

Hospital attacks

Foreign doctors feel “relatively safe” since the WHO shared the coordinates of the European Hospital with the Israeli army.

But Palestinian medics do not.

Since October 7, the Israeli army has conducted more than 400 attacks on Palestinian health facilities and personnel in Gaza. In addition, about 118 medics have disappeared into the labyrinth of Israel’s shadowy detention centres, according to the WHO.

Medical student Deema Estez, 21, spoke with resignation about a young boy who came in with a brain haemorrhage to the hospital where she was volunteering.

There were no doctors there to help him when he arrived.

Deema Estez operates on a patient during Gaza’s war. She says she has amputated the limbs of countless children [Courtesy of Deema Estez]

He was forced to wait for hours with his mother and father, until someone was available. Estez later learned that he died.

She also spoke about the countless times she has amputated children’s limbs, sometimes removing “more than half their body”.

Despite the trauma and danger, Estez refuses to leave Gaza, for now.

The killing and arrest of medics means there is an acute shortage of medical staff, with medical students like Estez having to fill the gap.

She joined a medical team in northern Gaza during Ramadan, after convincing her parents that it was her duty to help. Estez says her colleagues are overburdened with fear while trying to save lives.

“Just last week, Israeli forces were firing artillery near the hospital entrance,” she told Al Jazeera.

Israel has recently attacked a nearby hospital, al-Awda, in Jabalia camp. Israeli troops have reportedly surrounded the facility and prevented ambulances from leaving, according to Wafa Palestinian News Agency.

Estez warns that if Israel kills any more doctors, it will compound the burden on Gaza’s crippled health sector.

“[F]or now, I’m going to stay and help my people,” she said.

“I realise it is dangerous. At any moment, we could be targeted.”