The brief

WITHIN MINUTES OF THE OCT. 31 ISRAELI attack on the Jabalia refugee camp in Gaza, the victims began flooding the Indonesian Hospital a mile away. Dr. Marwan Sultan, the hospital’s medical director, says that most of the injured and dead were women and children. Some had deep burns, serious head injuries, or missing limbs, Sultan told TIME four hours after the attack. There are only 16 intensive-care beds in the hospital, which was running dangerously low on fuel, threatening the lives of his patients. If the electricity goes, says Sultan, “they will die. They will die.”

The conditions for medical care in Gaza are deteriorating across the besieged 140-sq.-mi. coastal strip. Surgeons are operating by flashlight and rationing water, anesthesia, and the generator fuel needed to perform surgeries, provide electricity for incubators, and care for kidney-dialysis patients, doctors and health organizations tell TIME. The roughly two dozen hospitals still operating in Gaza are absorbing the patients of the 12 that have closed because of a lack of supplies and the ongoing bombing, says the World Health Organization (WHO). “Medical teams are on their knees,” says Hisham Mhanna, spokesperson for the International Committee of the Red Cross in Gaza.

All war zones are awful, but Gaza presents a unique hell. Much of the enclave of 2 million is now a battlefield, with civilians and combatants intermixed, and homes and businesses sitting side by side with military infrastructure. Nowhere is that reality felt more keenly than at the territory’s hospitals, which have simultaneously become safe havens and potential targets, and where the impact of Israel’s offensive is measured every day in lives—more than 9,000 killed as of Nov. 2, including 135 medical personnel, according to the Palestinian Ministry of Health.

AFTER THE OCT. 7Hamas attacks that killed more than 1,400 people in Israel and started the war, the Israeli military began a massive bombing campaign. On Oct. 13, it ordered civilians to depart the northern part of the strip for the south, and on Oct. 27 it sent in ground troops and armored vehicles. Hamas has fought back above and below ground, from a network of concrete tunnels extending hundreds of miles.

For the estimated 1 million people displaced by fighting, the search for shelter has brought many to makeshift tent cities. More than 50,000 are packed into the Al-Shifa hospital complex