When the first explosions struck Gaza at around 1:30 am this week, a visiting British doctor stepped onto the balcony of a hospital in Khan Younis and watched as missiles streaked across the sky before slamming into the city. Beside him, a Palestinian surgeon gasped, “Oh no. Oh no.”

After two months of ceasefire, the devastation of Israeli bombardment had returned. The experienced surgeon turned to the visiting doctor, Sakib Rokadiya, and urged him to head to the emergency ward.

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Soon, torn bodies poured in—brought by ambulances, donkey carts, or carried by desperate relatives. What shocked the doctors most was the number of children.

“Child after child, young patient after young patient,” Rokadiya recalled. “The vast majority were women, children, and the elderly.”

Thus began a chaotic 24 hours at Nasser Hospital, the largest medical facility in southern Gaza. The sudden Israeli offensive shattered the ceasefire that had been in place since mid-January, aiming to pressure Hamas into releasing more hostages and accepting revised terms of the truce. It became one of the deadliest days in the 17-month war.

The aerial assaults killed 409 people across Gaza, including 173 children and 88 women, while hundreds more were wounded, according to the territory’s Health Ministry, which does not distinguish between militants and civilians in its count.

More than 300 casualties inundated Nasser Hospital. Like other hospitals in Gaza, it had suffered damage from Israeli raids and airstrikes throughout the war, leaving it without essential equipment and running low on antibiotics and other necessities. After the first phase of the ceasefire expired on March 2, Israel blocked the entry of medicine, food, and supplies into Gaza.

Triage

The hospital’s emergency ward overflowed with the wounded, described to The Associated Press by Rokadiya and Tanya Haj-Hassan, an American paediatrician—both volunteers with the charity Medical Aid for Palestinians. The injured came from a tent camp, where missiles had ignited a fire, and from homes struck in Khan Younis and Rafah, further south.

A nurse was desperately trying to resuscitate a boy sprawled on the floor, shrapnel embedded in his heart. Nearby, a young man sat trembling, most of his arm missing. A barefoot boy carried in his younger brother, no older than four, whose foot had been blown off. Blood covered the floor, mixed with fragments of bone and tissue.

“I was overwhelmed, running from corner to corner, trying to decide who to prioritise, who to send to surgery, who to declare beyond saving,” Haj-Hassan said.

“It’s an incredibly difficult decision, and we had to make it repeatedly,” she said in a voice message.

Some wounds were easy to overlook. One little girl seemed fine—she only felt pain when she breathed, she told Haj-Hassan. But once undressed, doctors realised she was bleeding into her lungs. Looking through the curly hair of another girl, Haj-Hassan discovered shrapnel embedded in her brain.

Two or three injured patients were crammed onto gurneys and rushed to surgery, Rokadiya said.

He scribbled notes on slips of paper or directly onto patients’ skin—one for surgery, another for a scan. He wrote names when he could, but many children arrived with no known relatives, their parents either dead, wounded, or lost in the chaos. Often, he simply wrote “UNKNOWN.”

In the Operating Room

Dr Feroze Sidhwa, an American trauma surgeon from California volunteering with the medical charity MedGlobal, rushed to the hospital’s designated area for the gravely wounded who still had a chance of survival.

But the first child he saw—a girl around three or four years old—was beyond help. Her face was torn apart by shrapnel. “She was technically still alive,” Sidhwa said, but with so many other patients needing urgent care, “there was nothing we could do.”

He had to tell the girl’s father that she was dying. Then he moved on, performing around 15 surgeries back to back.

Palestinian surgeon Khaled Alserr and an Irish volunteer surgeon worked tirelessly alongside him. They operated on a 29-year-old woman with a shattered pelvis, her web of veins bleeding profusely. Despite their efforts, she died 10 hours later in the ICU.

Another patient was a six-year-old boy with two holes in his heart, two in his colon, and three more in his stomach, Sidhwa said. They managed to repair the damage and even restarted his heart after he went into cardiac arrest.

But he, too, died hours later.

“They died because the ICU simply didn’t have the capacity to care for them,” Sidhwa said.

Ahmed al-Farra, head of the hospital’s paediatrics and obstetrics department, explained that the ICU lacked critical antibiotics, among other essential supplies.

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Sidhwa reflected on his experience at Boston Medical Center when the 2013 Boston Marathon bombing happened, killing three people and injuring around 260 others.

“Boston Medical couldn’t have handled the number of cases we saw at Nasser Hospital,” he said.

The Hospital Staff

Rokadiya was struck by the resilience of the hospital staff as they cared for each other while under immense pressure. Workers moved through the hospital, handing out water to exhausted doctors and nurses. Cleaners worked swiftly to remove the bloodied clothing, blankets, tissues, and medical waste piling up on the floors.

At the same time, many staff members were dealing with personal tragedies.

Alserr, the Palestinian surgeon, had to go to the morgue to identify the bodies of his wife’s father and brother.

“The only thing I saw was a bundle of flesh and bones, melted and shattered,” he said in a voice message, without elaborating on how they were killed.

Another staff member lost his wife and children. An anaesthesiologist—who had already lost his mother and 21 relatives earlier in the war—later received word that his father, brother, and cousin had been killed, Haj-Hassan said.

The Aftermath

Around 85 people died at Nasser Hospital that Tuesday, including about 40 children between the ages of one and 17, al-Farra reported.

Airstrikes continued throughout the week, killing several dozen more. Among the dead were at least six senior Hamas figures.

Israel has vowed to continue its offensive against Hamas, insisting the group must release more hostages, despite having disregarded ceasefire conditions requiring negotiations for a long-term end to the war. The Israeli government maintains it does not target civilians and blames Hamas for their deaths, arguing that the group operates within civilian areas.

Tuesday’s bombardment also helped Israeli Prime Minister Benjamin Netanyahu consolidate his political standing. The offensive secured the return of a right-wing party to his coalition, strengthening his government ahead of a crucial budget vote that could have led to its collapse.

Haj-Hassan continues to check on the children in Nasser’s ICU. The girl with shrapnel in her brain remains unable to move her right side. Her mother, limping from her own injuries, came to see her and told Haj-Hassan that the little girl’s sisters had been killed.

“I cannot begin to process or comprehend the scale of mass killing and the slaughter of families in their sleep that we are witnessing here,” Haj-Hassan said. “This cannot be the world we live in.”