“This has been a nightmare in every sense of the word; I cannot imagine it would get worse – much worse; so much worse,” Atef said.

Atef, a neurosurgeon who has been through the two previous Israeli wars on Gaza, said what he saw during the current Israeli aggression on Gaza is “just unprecedented.”

“In previous wars, we had to attend to injured people coming to the hospital with brain hemorrhage or broken skulls; with this war, it was ordinary to see people coming with a burnt head skin,” he said.

Like other medical doctors who have the documented horrors of Israeli uncontrolled military offensives that have been indiscriminately targeting civilians and medical facilities, Atef is full of stories about “an unending nightmare that kept recurring every single hour and every single day.”

Atef, like other medical doctors who have been around Gaza hospitals, is aware of the “limitations” that Gaza’s medical facilities have been facing even before this war started on 7 October. “We have been short on almost everything due to the siege; this has been an atrocious war and it has been there for four months now,” he said.

According to the official Palestinian estimates, the number of Palestinians who have lost their lives since the war started is coming close to 30,000 people, with quadruples wounded, many with permanent injuries.

“So many lives could have been saved, so many bodies could have been properly treated and so many permanent injuries could have been avoided – only if we had the means,” Atef clarified. He said the severe shortage of medical equipment is “simply incapacitating” for the medical teams “who are working under such dire conditions.”

“There are days when doctors work over 24 hours without sleep or hardly any; there are medical doctors who would be on duty while their families are coming under Israeli attack; there are doctors who would be working while suffering acute pain,” Atef added. “Things have become so much worse for civilians, medical teams, and medical facilities with the failure to stop the Israeli war,” he explained.

 “At the first few weeks, things were really tough; then came the ground invasion and the deliberate targeting of medical facilities including key hospitals; and then came the forced eviction of the north and the middle of Gaza into the south, with people being packed in a complete absence of basic hygiene requirement, the growing inability of the medical system to handle the outspread of infections, and the utter lack of basic medicines,” Atef said.

“The nightmare has been suffocating; to talk of an Israeli offensive against Rafah where over half of the Palestinians of Gaza have been forced to settle under unbearable living and health conditions is simply to talk of tens of thousands of people being killed with every single hour,” he added.

“We saw the highest number of injuries and casualties with every single attack,” Atef said, adding that this is the function of the lethal weapons and ammunition that Israel has been using in this war.

“The injuries we have been seeing are essentially caused either by an explosion [of a missile] that results in immediate harm or by a shrapnel of the missile, which could hit any part of the body,” he said. “Given the high density of people in Rafah and since there is no safe place to take refuge in because Israel simply attacks everything and anything, an offensive on Rafah would simply mean the end of Palestinians in Gaza,” Atef stressed.

On Friday, the office of the Israeli prime minister announced that Benjamin Netanyahu requested the Israeli military to prepare a plan for the eviction of over a million Palestinians from Rafah ahead of a ground offensive that he said is necessary for Israel to secure its targets of the war. The announcement was condemned widely.

Egypt, Jordan, Saudi Arabia, and the UAE have issued statements warning against the planned offensive, with Minister of Foreign Affairs Sameh Shoukry saying it will have “disastrous consequences.” 

UN Secretary-General Antonio Guterres said an offensive on Rafah will lead to “a gigantic tragedy,” adding that “It is time for a humanitarian ceasefire.” US President Joe Biden said that the Israeli conduct in Gaza has gone “over the top,” adding that he is “pushing very hard now” for a ceasefire.

Atef is not hopeful. He said all promises of a ceasefire or a relatively long truce have failed. In November 2023, with an Egyptian-Qatari-American mediation, a humanitarian pause was secured, whereby Hamas agreed to hand over some of the Israeli captives it took during its one-day operation “Al-Aqsa Flood” against Israeli targets. In return, Israel allowed for the entry of a few more humanitarian aid convoys into Gaza.

“Today, the issue is not even about pushing through more humanitarian and medical aid into Gaza; the fact of the matter is that there are not enough equipped and operating medical facilities around Rafah,” Atef said. “In addition to a few non-properly equipped hospitals, there are of course the field hospitals that some countries have put up trying to help, but it is not enough at all to cover for the volume of people clustered now in Rafah,” he said.

Atef added that some social media groups have been trying to help Palestinians who need medical help to find a medical facility to go to. “It is essentially about those hit by the Israeli strikes, but we also have people who get seriously ill like those with a heart attack for example, and people with acute health problems like cancer patients,” he continued.

Moreover, there is a big problem with getting the ill or the wounded to the hospital. “It is so tough with the unending Israeli strikes; people cannot find their way to the hospital; ambulances cannot make it to the injured and at times cannot bring them to the hospital even when they reach them,” he added.

“There is also a situation whereby Israel is simply deliberately targeting hospitals,” said Atef, who was on duty when Israel attacked Al-Shifa Hospital, earlier in the war. Since the beginning of its aggression on Gaza, Israel has in cold blood attacked hospitals and killed the people inside.

“Certainly, it is important now to find a way to get as much medical material and equipment as possible to the Gaza hospitals, but what is more essential now is to try to stop this offensive – and to end this war,” he concluded.