Israel's planned military offensive to take control and occupy Gaza City will threaten the lives of thousands of patients in hospitals across the area, according to local health authorities.
Last month, the Israel Defense Forces (IDF) called on hospitals to begin evacuating sick and injured Palestinians from their wards ahead of the full-scale invasion of the city, demanding they be sent south along with hundreds of thousands of others currently living in Gaza City.
Warning: This story includes details and images which may be distressing
Rami Musa Diab al-Habil, 47, is among the patients currently lying in Al-Shifa Hospital in Gaza City.
Mr al-Habil, his wife and daughter were hit by shrapnel in an explosion in early August. His wife was killed, his daughter injured her hand, and he suffered wounds to his abdomen.
"It disabled my main artery that feeds the thigh. I was in a state of death," he told the ABC.
His wound is still open, bandaged up by the doctors at Al-Shifa using what meagre resources they have available to them.
Blood clearly visible on the dressings.
"How am I going to go to the south with a wound like this?" he said.
"From the beginning of my abdomen to the end of my groin, split open.
"How am I able to go to the south? I can barely get up and down on the bed; I am not leaving."
Mr al-Habil said he was prepared to die in Al-Shifa.
"I will stay here in the hospital to the last breath, and if the hospital is besieged, if it is completely besieged by the occupation army, I will remain in it until I complete healing."
Jamil Tafis, 23, was also bedridden in Al-Shifa with a severe leg injury, which he said was caused by Israeli forces operating in the Zeitoun neighbourhood in Gaza City.
Doctors had been forced to wrap his legs in bandages, secured with bricks, to keep the bone straight.
"There are no sterile operating rooms … my leg needs metal plates, I cannot move," he said.
"I cannot move to the south, I am injured, I cannot move.
"If the occupation forced me to go to the south, I cannot — meaning any wrong movement in my leg leads to its loss."
Mr Tafis said he was in immense pain, with a lack of painkillers available at Al-Shifa and elsewhere in the strip.
"As of today, I have been waiting two days for an operation, and they say to me, possibly, that it is another 20, 30 days.
"We have to wait in line; there are too many cases at the hospital.
"If devices were available — the plate devices — and the medicines were available, and the operating rooms, and the hospital was in its condition before the war, then within a week or five days they would have discharged me."
A 'pre-disaster' call to evacuate
The director-general of the Palestinian Ministry of Health in Gaza, Dr Munir Abdallah al-Barsh, told the ABC the warning from Israeli authorities is impossible to heed.
"This call is in the nature of a call for killing and a call to execute the wounded and the injured and the starved in Gaza City," he said.
"This call is a pre-disaster call — if the Israeli occupation proceeds with its plan to enter Gaza City, it means there is an execution of all patients and the injured.
"This is what happened previously when they entered al-Nasr Children's Hospital [in December 2023] and fired bullets at the doctors and nurses, and they left the premature babies inside the incubators, and they died and their bodies decomposed."
Dr al-Barsh said there were around 2,000 patients in hospitals across Gaza City — and that none of the facilities in the area, or further afield in Gaza, were operating at full capacity, given damage sustained during repeated strikes and raids over the course of the 22-month-long war.
He revealed there were 120 Palestinians currently on ventilators.
"They need operating rooms and intensive care rooms; they cannot move at all from their places and need daily care," Dr al-Barsh said.
"Their fate is death on the beds."
Overcrowded healthcare system
Dr al-Barsh warned that hospital capacity in the southern parts of the Gaza Strip, where Palestinians are being told they must move, is at more than 300 per cent.
"For every hospital bed there are three patients," he said.
"Therefore, we also cannot transfer this overcrowding to the southern areas, which we know beforehand have great overcrowding.
"Second, we do not have the ambulances nor the carriers that can transport this number because of its size, and also due to the unavailability of the fuel necessary for that."
Dr al-Barsh also pointed to the recent attack at the Nasser Hospital in Khan Younis, where 22 Palestinians were killed, as evidence that such facilities are under significant threat.
Health workers and journalists were among those killed in the attacks, which the IDF says are subject to an internal investigation.
"The Israeli tanks are posted at a little distance from Nasser Hospital; therefore, this hospital is already threatened by the action of the occupation," he said.
"And also the occupation stormed the hospitals — Nasser Hospital four times, and al-Aqsa Martyrs Hospital, and all the hospitals in the south."
On August 21, the IDF announced it had been making a series of calls to international organisations and Gaza's health officials to warn them of the looming occupation mission and tell them to evacuate patients.
"This requires you to prepare a plan to transfer the medical equipment from north to south, so that you will be able to provide treatment for all the patients in the Strip's south and prepare the hospitals to receive the patients coming from the north," audio of one of the calls released by the IDF outlined.
"We are going to provide you with a place to be in, whether it is a field hospital or any other hospital."
The ABC asked the Israeli agency responsible for managing services in Gaza, COGAT, a series of questions about hospital capacity, the inability to move serious injured patients, and fuel shortages.
No response was provided.
IDF international spokesman, Lieutenant Colonel Nadav Shoshani said discussions were underway about where the hospital bed capacity could be found in the south.
According to WHO data, in southern Gaza there are only about 1,200 total inpatient beds in the few partially functioning hospitals; an average of about 10 beds per 10,000 of the estimated population in the south. ICU, emergency and maternity beds are in much shorter supply.
