At Gaza’s Al-Shifa Hospital, the War Isn’t Over

Gauze saves lives, but Al-Shifa Hospital in Gaza City must ration what little it has, months into a supposed ceasefire.

Both gauze and its English name are widely thought to derive from Gaza and the Arabic word for blended silk, khazz. While perhaps apocryphal, the presumed connection testifies to the bounty that the small strip of land at the eastern edge of the Mediterranean, rich in weaving traditions, has provided humanity. As a wound dressing, gauze is an everyday miracle. Its loose weave ironically strengthens its durability, making it able to absorb blood, discharge, pus, and drainage without becoming oversaturated and thereby returning such material to a wound site.

Gauze’s value becomes evident during its absence. Bacteria like to sit in pools of bodily fluid. An undressed wound beset by bacteria will become infected. Then “the problem explodes,” says Nahreen Ahmed, a pulmonary specialist from Philadelphia who lived and worked at Al-Shifa, the largest hospital complex in the Gaza Strip, from November 25 to December 11, 2025.

The near-absence of gauze in the land of its apparent birth means that health care providers have no choice but to send patients home without it. Those patients do not typically return to a sterile home. More than two years after Israel responded to Hamas’ October 7, 2023, massacre with a military ferocity that the International Association of Genocide Scholars found to “meet the legal definition of genocide,” the patients’ homes are tents. The winter flooded many tents with filthy water. Infections that begin at the wound site will spread to the bone and require a preventable amputation. A similar shortage of antibiotics compounds the problem. “It started with gauze,” Ahmed reflects.

Although hospitals are supposed to be protected under international law, the Israel Defense Forces (IDF) included them in a campaign of devastation that familiarized the world with the neologism “domicide,” or the destruction of residences. According to the World Health Organization, only 14 of the strip’s 36 hospitals are functioning. By last summer, the Israeli military had killed more than 1,700 health care workers; it still holds 220 in detention. When the Israeli government announced in October that its forces would abide by a US-brokered ceasefire, Palestinians in Gaza who had survived two years of unrelenting devastation hoped for a return to normalcy. So did a network of foreign health workers, many of whom had previously entered Gaza at extreme physical risk.

Those foreign doctors knew their Palestinian colleagues faced an enormous task. A genuine ceasefire would be challenging enough for Gaza’s decimated health care infrastructure. For two years, it only had space to address emergencies caused by military attacks. An actual end to the slaughter would overwhelm the remaining doctors with patients seeking care for everything not immediately life-threatening, from chronic conditions to mundane illness, all of which the devastation of Gaza exacerbates.

Gauze was supposed to be abundant. But seven foreign doctors and aid workers who volunteered in Gaza, including four who were there after the ceasefire was meant to have taken effect, described a perverse situation in which Israel permits doctors into Gaza but not medical equipment, prompting several to smuggle vital implements of care into their personal belongings. And the reality since October is that Gaza’s remaining doctors must deal with both an influx of patients needing routine treatment and a continuing, if reduced, pace of casualties from the IDF, and do it all without crucial supplies. Doctors told WIRED the public-health crisis they witnessed looked to them more like a new phase of the genocide than its aftermath. During this phase, the Israelis no longer need to open fire to kill Palestinians, though they still do that, too. (In a statement to WIRED, the Israeli occupation authority, known as the Coordination of Government Activities in the Territories, or COGAT, said it “continues to facilitate the entry of medical equipment and medicines in line with requests from international organizations.”)

“The war is not over,” says an international doctor who spoke to WIRED from Al-Shifa and who requested anonymity for fear of Israeli reprisal. “The casualties are not the way they were before. They’re isolated incidents, but they’re still happening.” It happens with intensity when Israeli soldiers perceive Palestinians to cross the poorly demarcated “yellow line” into Gazan territory occupied by the IDF. “All the people that are being injured, the people that are dying—it’s all within this arbitrary yellow line.”

Between the ceasefire declaration and mid-February, Israel killed more than 600 people, pushing the official death toll from the Palestinian Ministry of Health above 72,000, which is likely an undercount. While Israel partially reopened the Rafah crossing earlier that month, in two weeks Israel permitted the departure of only 260 people out of more than 18,500 in desperate need of medical care no longer available in Gaza, according to the United Nations. As ominously, during that period, Al Jazeera reported that Israel allowed only 269 people back into Gaza, raising fears that those who leave will never be permitted to return home.

Palestine famously provides Israel and its allies with a laboratory for its weaponry of the future, from artificial-intelligence targeting to quadcopter drones stable enough to fire guns. Meanwhile, Gaza’s remaining hospitals are reduced to “Civil War [era] medicine,” Ahmed said. To help, foreign doctors smuggle in 9-volt batteries, cochlear implants, and Tylenol, putting themselves at risk of being banned from Gaza. Perhaps most importantly, they smuggle gauze.

International medical workers began traveling to Gaza soon after Israel besieged it. To enter Gaza, doctors, nurses, and other aid workers flew to Cairo and caravanned up through the Sinai Peninsula to the Rafah Crossing. The Egyptians permitted Israeli inspections of the trucks, ostensibly to prevent weapons smuggling, a process that slowed the advance of aid to a crawl. Mark Perlmutter, a North Carolina–based hand surgeon who first visited Gaza in the spring of 2024, recalled seeing lines of 18-wheelers “30 miles long, bumper to bumper,” filled with food—“dead chickens, rotting vegetables”—that were idling, in line with former Israeli defense minister Yoav Gallant’s pledge that “no electricity, no food, no fuel” would be allowed into Gaza.

Yet the Egyptians permitted the doctors entry, along with their medical instruments. Thaer Ahmad, a Chicago emergency-medicine specialist who traveled to Gaza in January 2024, filled six oversize valises with chest tubes, antibiotics, and more. Perlmutter bought $30,000 worth of supplies on eBay—including drills, surgical instruments, and 700 pounds of screws and plates for delicate microfracture surgeries to reattach and stabilize severed fingers. He says he used up his supplies in his first week in Gaza.

Then, in May 2024, the IDF pushed into Rafah, the southern Gaza city on the Palestinian side of the crossing, and took control. No longer was Egypt a viable entranceway for the medical workers. Now they had to fly to Jordan, pass over the Allenby Bridge into the Israeli-occupied West Bank, then travel through Israel to the Kerem Shalom checkpoint, also at the southern edge of Gaza.

Nahreen Ahmed, the Philadelphia lung doctor, had entered Gaza from Egypt twice since October 7. October 2024 was her first time accessing it from Kerem Shalom. Through the WHO, she was informed she could take only a large bag and a backpack, which first had to pass through two layers of security at Allenby. In her bags she stuffed gauze, reagents, whatever she heard would be useful. “I’m not sure we were necessarily allowed to be doing that, but they certainly didn’t stop us,” Ahmed recalls. She did not see the Israelis confiscate anything from her or anyone else.

Feroze Sidhwa, a California surgeon, returned to Gaza in March 2025. On his first trip, a year earlier, he came through Rafah, where he had no problems taking in useful supplies. But at Kerem Shalom, he says, “we were not allowed to bring anything in, just personal effects.” Cognizant of Gaza’s severe lack of medical equipment, Sidhwa “decided to chance it.” He spread medications throughout his luggage that he prepared to pass off as his own—along with handheld ultrasounds he couldn’t, but which the Israelis didn’t find.

That same month, Perlmutter took more than $10,000 worth of microsurgical instruments to Amman, along with antibiotics like doxycycline to prevent infection. He did so even after hearing that none would be allowed—and that one discovered smuggler could disqualify an entire team from entry. At Kerem Shalom, the Israelis found and confiscated his instruments and “counted my pills,” permitting Perlmutter only what he could plausibly claim were his own. He hid antibiotics “in my butt cheeks,” he says. “I felt like I was bringing contraband into a prison.”

Ahmed returned to Gaza in late November 2025, the month after the ceasefire declaration. Her network of international doctors informed her that the Israelis had become “a lot stricter,” she says. And what they let in seemed arbitrary: Stories circulated on group chats of doctors getting spinal rods and even a CPR mannequin through, but also of medicines being confiscated and groups barred. When she got to Allenby, a doctor who was carrying test tubes and lab reagents that had been permitted on earlier trips “was kicked out completely,” Ahmed says.

Ahmed “was really stressed out” but had come prepared. On her previous trip, she heard Palestinians request specific things that she would need to present as her own. To sneak in an extra iPhone and iPad, she logged in as herself and created a passcode, telling the authorities who later thumbed through for pictures that they were her work devices. Nine-volt batteries and tiny magnets, necessary for powering medical equipment, were inside her luggage as the Israelis rummaged through it. Cochlear implants looked like wired earphones. She had autoimmune medications, which need refrigeration, inside a toiletry bag with ice packs. All of it got into Gaza undetected. “Those are usually the moments when many of us are kicking ourselves,” she says. “Like, ‘Oh man, they only fixated on the tablet this time, I could have brought 10 more packets of the cancer medication.’”

The supply restrictions and unpredictable enforcement are familiar to generations of Palestinians living under Israeli occupation. Now doctors from across the world have experienced them. “This is highly orchestrated to interfere with the delivery of health care,” says Perlmutter. “Why would you [confiscate] antibiotics if it was not your goal to advance an infection that you knew existed?”

I put Perlmutter’s question to COGAT. “We firmly reject claims of any deliberate attempt to harm medical services,” the occupation authority told me in a statement. “The requirement for prior coordination stems from security and order considerations and is intended to supervise the type and quantity of equipment entering the Gaza Strip and to ensure that it is not used for non-humanitarian purposes.” Asked about Perlmutter’s microsurgery instruments, COGAT replied: “As the equipment had not been pre-coordinated and approved in accordance with the procedures known to organizations, it was confiscated by Israeli customs.”

I cannot see Gaza for myself. Israel has kept foreign reporters out since October 7. Gaza’s journalists told its story better than outsiders like me ever could. Israel killed at least 260 of them for it. “Three of these killings, including one murder, occurred after the October 2025 ceasefire,” the Committee to Protect Journalists noted in a February report that found Israel “has now killed more journalists than any other government” since CPJ began keeping records 34 years ago.

No matter how often an algorithm showed you the ruins of Gaza, “nothing can prepare you for entering into a landscape like that,” says Elise Thorburn, a Canadian ER doctor who arrived two weeks into the supposed ceasefire. What she saw as she took the coastal al-Rashid Road north did not “resemble a human habitat in any way.” Silence from the collapsed buildings and shattered roads gave way to masses of displaced people living in plastic tents or the remains of structurally unsound buildings. “Not one building,” Thorburn says, “is unaffected.” Concrete dust, suspended in the air from the estimated 68 million tons of debris, makes it feel “hazy all the time,” she adds.

Ahmed paid attention with alarm to what Gazans breathe in. Her experience treating patients with COPD from the World Trade Center leads her to forecast that the effects of the genocide will remain in the lungs of its survivors for decades.

As Ahmed began her fourth visit to Gaza, crossing at Kerem Shalom in November 2025, more urgent concerns immediately made themselves known. She quickly heard “a couple big bomb blasts” close to Rafah. “I guess we’re back in the middle of this,” she thought. Ahmed has treated patients in war-ravaged Sudan, Syria, Yemen, Ukraine, and the Rohingya refugee camps in Bangladesh, from where her parents immigrated to the United States. Unlike there, she says, all of Gaza is a target. “In Dnipro, I could walk across the street and not worry about a sniper,” she says. She started calming the newcomers in her party when she saw the fear in their eyes as they beheld Gaza.

Ahmed had not seen the ravaged campus of Al-Shifa in a year. The main surgical building still looked “torched,” she says, the legacy of two punishing IDF assaults in November 2023 and March 2024. The March 2024 raid lasted two weeks and resulted in the deaths of hundreds of people, whether staff, patients, or people seeking shelter. Israel claimed, without providing evidence, that Hamas had turned Gaza’s hospitals into bases for staging attacks and were accordingly legitimate targets. Ahmed says she would have seen Hamas infrastructure had it been present, either at Al-Shifa or at Nasser Hospital in Khan Younis, where she worked during a harrowing January 2024 assault. She lived in Nasser’s basement, near where the supposed tunnels would have been. “I have never once, in my four visits there, ever seen a militant inside any of the hospitals,” she says.

The slower pace of bombardment during the supposed ceasefire permitted Al-Shifa, a pillar of health care in Gaza, to make some cosmetic repairs. Functionality had improved since Ahmed was there in 2024, to include the reopening of a pediatric intensive-care unit, but the hospital remained a “shell of what it was.” Ahmed’s home for two weeks, along with the other international volunteers, was on the second floor of the New Obstetrics Building. “Layers of dust” continue to coat the wards, destined for Palestinian lungs. Without gowns, gloves, and masks that sit across the border, it’s difficult to create a sterile environment. Staff rifle through structurally unsound buildings to hunt any supplies that survived the IDF sieges. “If there’s a box of gauze, and the gauze is usable, that’s a win,” Ahmed says.

The discrepancy between patient need and hospital resources prevented the Palestinian staff from having time to generate plans for what the foreigners would do. International volunteers like Ahmed floated between the ER and the ICU as necessary. Ahmed, an ICU doctor and teacher, treated patients, performed bedside teaching, and advised hospital staff on how to perform ultrasounds, an important technique considering that Al-Shifa has no CT scanner. Sometimes less experienced volunteers would express alarm over the absence of critical supplies. Ahmed would take them aside and tell them they risked embarrassing the Palestinian doctors, who have experienced unimaginable trauma to treat their patients. Many of them are junior residents who must make agonizing choices in rationing care. “In Gaza, a lot of the senior doctors are gone,” Ahmed says. “Either they evacuated, or they were imprisoned, or they were killed.”

Those doctors haunt the hallways of Al-Shifa.

The chaos levels of the hospital are lower than when the bombs fell nonstop. Ahmed had time for tea, coffee, and conversation. She learned that spare time was dangerous in its own way. “That’s when the emotional chaos happens,” Ahmed explains. “That’s when you have time to think about what you’ve experienced.”

An ICU doctor, unprompted, beckoned Ahmed to a view of the Al-Shifa courtyard. He told her that during one of the sieges, the IDF detained one of his colleagues. After asking what the man knew about Hamas, they told him he was free to go. “He said he watched his colleague, his friend, cross through that courtyard and then get shot by a sniper,” Ahmed recalls. A nurse returned to Al-Shifa from a year in Israeli detention. As he reentered the ICU, he looked for absent colleagues and learned they were dead. “People are seeing him, and it’s almost like they’re seeing a ghost in him, and then on the flip side, he’s seeing ghosts,” Ahmed says.

“Everyone has a story, the most devastating trauma that they will kind of casually bring up to you,” says Thorburn, the Canadian ER doctor, who worked at Al-Ahli hospital in Gaza City, not far from the much larger Al-Shifa. Many of the doctors she worked with at Al-Ahli split time at Al-Shifa as well. She recounted treating a young man “who had gotten too close to the yellow line” and had “half his head blown off” by a drone. Thorburn asked a Palestinian doctor working with her at the patient’s bedside if the situation made him angry. He replied that he can’t feel anything anymore. The announcement of the ceasefire gave him momentary happiness, but that went away.

“It’s shocking and hard to emulate the level of resiliency and sumud that the Palestinian nurses and doctors show,” Thorburn says, using an Arabic term for perseverance that has become synonymous with Palestinians. “That being said, when you develop relationships with people and sit down and talk with them, the cracks start to show.”

It is hardly just the doctors. As patients seek more than emergency care, they have a hard time accepting the chronic shortages of supplies. There is “an anger that wasn’t necessarily there before” at Al-Shifa, Ahmed says. Even as Gazans process the trauma of having survived, they watch, as impotently as their doctors, while people die “due to things that are completely reversible and treatable,” like infections or a lack of blood-pressure medication. Although doctors report such deaths as war-related on official forms, they might never show up in the casualty tolls published by the Ministry of Health.

There is no such ambiguity with other patients that Thorburn and Ahmed saw.

On Thorburn’s first night at Al-Ahli, she treated a 17-year-old boy whose femoral artery had been severed by either a bullet or a piece of shrapnel. “He died that night,” she recalls. Despite a slower rate of fire than before October, trauma wounds, like those from gunshots or artillery, remained “an extremely common occurrence.”

In early December, Ahmed recalls, “we heard tanks advancing from the edge of the yellow line.” Soon, a 14-year-old girl was rushed into the ICU with a shrapnel wound to the abdomen. The girl needed 250 milliliters of blood, “a precious resource” at Al-Shifa, and a splenectomy. Even with minimal supplies, even amid an attack that was not supposed to happen, the doctors at Al-Shifa saved her life.

By the time Ahmed left, the girl was discharged, “smiling.” Her wounds were so severe that the doctors used some of their gauze allotment on her. But the girl had no choice but to return to her family’s tent, hardly a stable environment for recovery. Even before she was admitted to Al-Shifa, she was “so malnourished.” The return of some amounts of food to the shelves has been little help to her family, who cannot afford to pay inflationary prices. Ahmed, full of worry for the girl, remains in touch.

On December 11, Ahmed recorded a four-minute voice note to memorialize her thoughts on her last day in Gaza. In the background, she points out, are bulldozers. Rescue teams took advantage of the relative calm to exhume the courtyard, which has become a grave of necessity for untold numbers of people at Al-Shifa. “The smell of death is literal, in this case,” she says on the voice memo. An Al Jazeera story from three days earlier reported that the Palestinian Red Crescent had recovered 150 bodies.

“This hospital is haunted by all these stories of people that were killed, and then all of the stories that are now being told, because we have a little bit of space and time to hear them, about what happened to people,” Ahmed says. “It’s not just the campus in Al-Shifa. It’s everywhere in Gaza.”

Along with the assaults on Palestinian life, health, and movement comes an assault on what remains of their sovereignty. The Israeli government in recent months has opened the floodgates to both state and settler seizures of West Bank land. President Trump has established a “Board of Peace” to rule Gaza, beginning with the construction of a 350-acre military base to station 5,000 troops.

The declaration of a ceasefire, however one-sided, has prompted many, particularly in the United States, to move on. Sidhwa, the California trauma surgeon, says this “ is a total disaster—it means the Palestinians are going to be destroyed in Gaza.” As Israel’s accomplice, supplying it arms and diplomatic cover during the genocide, the United States is also the only potential check on its behavior. “It’s very dispiriting that we don’t have a political culture or a media culture, or even the moral culture, to recognize that we should care about our own crimes,” Sidhwa says.

But Gaza is more than a crime scene. “Obviously, much of it is destroyed, but Gaza City is beautiful, the people are beautiful,” Thorburn says. At Al-Ahli, she lived with 10 young women in their twenties. They were nurses, radiology technicians, medical students, lab techs. They took Thorburn to the beach to watch people fish—a dangerous activity with the Israeli navy offshore—enjoy a picnic with what food they had, and otherwise do “their very best to live a normal life.” Resisting the attempts to rip them apart, they weaved themselves together, each reinforcing the others, like gauze.