Can Rafah’s crumbling healthcare withstand a full-scale Israeli offensive?

As a full-scale Israeli invasion of Rafah looks increasingly inevitable, the focus has shifted to the humanitarian crisis that could only worsen in the besieged city where an estimated 1.2 Palestinians had sought refuge after being forcefully evicted from other parts of Gaza.

The Israeli army carried out overnight air strikes in Rafah, located at the southern end of Gaza on the border with Egypt, after threatening some 100,000 residents in the eastern parts of the city to leave, forcing thousands to move to what it calls "an expanded humanitarian area" covering Al Mawasi and Khan Younis to the north of the besieged enclave.

Amid the growing fears, many organisations worry that the Israeli invasion will only exacerbate the existing humanitarian crisis.

"There are some field hospitals and health units in Mawasi, but as with other parts of Gaza, it's nowhere near enough. They're overwhelmed and struggle to get supplies — even basic things like painkillers," Michael Selby-Green, the international media coordinator for Islamic Relief Worldwide, tells TRT World.

The impact of an invasion in Rafah, he adds, would likely totally overwhelm what is left of the healthcare system around Rafah.

"It would be a brutal new chapter in the Israeli attack of the enclave."

'New wave of displacement'

According to the World Health Organization (WHO), an incursion into Rafah could lead to the three hospitals there — Al-Najjar, Al-Helal Al-Emarati, and Kuwait hospitals — becoming inaccessible and non-functional.

"Escalation could also render the European Gaza Hospital inaccessible. This will have a knock-on effect on the overall health system as patients will need to be transferred to other already overcrowded hospitals, putting their health further at risk," WHO said in a comment emailed to TRT World.

"A new wave of displacement will lead to more overcrowding, reduced access to essential food, water, and sanitation services, and increased infectious disease outbreaks."

Seven months of Israeli military offensive has left Gaza in a harrowing state, with Tel Aviv's war on the besieged enclave killing nearly 35,000 Palestinians, seventy percent of them children and women, and wounding more than 78,000 others.

Satellite data analysis by Corey Scher of City University of New York and Jamon Van Den Hoek of Oregon State University estimates that 50 to 61 percent of all buildings in Gaza, between 144,000 and 175,000 structures, have been destroyed, the BBC reported in January.

Hospitals have also not been spared and have become battlegrounds. Unabated bombardment compounded with power and basic necessity shortages has driven almost every hospital in Gaza out of service, as medical facilities sustain attacks with doctors, patients and civilians inside.

"What we've seen throughout the whole of Gaza is a destruction of the healthcare system," says secretary general of Médecins Sans Frontières (MSF), Christopher Lockyear. "There's not really a healthcare system left to speak of at the moment, and we're incredibly worried."

'Nowhere safe'

The Israeli military has attacked areas designated as a 'safe zone' before, including Rafah and Al Mawasi, causing civilian fatalities and injuries.

Aid groups and organisations, including Islamic Relief and MSF, have repeatedly highlighted that "there is nowhere safe in Gaza", even "so-called humanitarian areas" where Israel has now forced people to move.

"Al Mawasi is already a densely populated area — a lot of people living on the beach next to the sea with no infrastructure, no water, no electricity, no sanitation, no latrines, no toilets — that's not set up for a large-scale reception of even more people from within Rafah," Lockyear tells TRT World, rejecting the notion of a safe zone.

"So really, I don't know where people will go realistically in a way, which is not going to further add to the deplorable health situation following the catastrophic violence that we've seen throughout Gaza," he added.

Lockyear explains Rafah city is one of the few areas in the enclave that, despite needing much more in terms of medical supplies and access for aid workers, has been the central hub for humanitarian operations and aid support.

Destroying that little access that "we have as a humanitarian community is going to obviously further reduce the access that people have to humanitarian assistance with no clear alternatives yet," he adds, noting that Al Mawasi is not an area set up for the reception of large numbers of civilians.

"I think it's really important to point out that, yes, there's the primary impact of this very violent conflict — the injuries, the mental trauma — but there is also a huge amount of suffering and morbidities that we don't see on a daily basis: increasing rates of malnutrition, increasing rates of diarrhoea," Lockyear says, adding the pressure for people to move again is "an obscene thought".

"The population is traumatised, and this threat of a Rafah invasion has been something which has been compounding that trauma. It's been hanging over the heads of the people in Rafah for months and months now."

Contingency efforts

Efforts are being made to provide essential healthcare services, including a new field hospital in Al Mawasi, as well as a large warehouse in Deir Al Balah to ensure prompt and efficient access to supplies. Supplies have also been prepositioned at Al-Aqsa and European Gaza Hospitals.

WHO says it is also refurbishing Nasser Hospital, once the largest hospital in southern Gaza, so that it can resume basic healthcare services.

WHO and partners are also establishing additional primary health centres and medical points in Khan Younis and the Middle Area, while medical supplies will be prepositioning to enable these facilities to detect and treat communicable and non-communicable diseases and manage wounds.

In the north, it said the expansion of services is being supported at Al-Ahli, Kamal Adwan, and Al-Awda hospitals through emergency medical teams and allocation of supplies.

"We urge all parties to respect international humanitarian law and protect health facilities, health workers and patients. Hospitals must not (once again) become battlegrounds," WHO said.