Who lives or dies Gaza surgeon speaks of horror of impossible choices

In the crowded corridors of the European hospital in Khan Younis, exhausted doctors decide who among the huge influx of patients arriving from the north of Gaza should live or die.

- Jason Burke

Hundreds of casualties have been moved south in recent days after the evacuation of hospitals in Gaza City, overwhelming medical staff already struggling with an acute lack of medicine, diminishing food rations and intermittent power and communications.

Paul Ley, an orthopaedic surgeon at the European hospital, said displaced people were sleeping in lifts, a small team was working round the clock in four operating theatres to amputate limbs infected after days without treatment, and there was an acute shortage of painkillers. Triage decisions had to be made instantly, which, in one case, meant leaving a 12-year-old child to die with only palliative care to preserve dwindling resources.

Ley said the hospital had received 500 patients evacuated from hospitals in northern Gaza in recent days. "Many have not received treatment for nine or 10 days because hospitals there were non-functional even if they were open," he said. "This is a functioning hospital, but we are being overwhelmed. There is nowhere to evacuate to... There is no escape route. We are probably one of the last lines of defence."

Ley's account matches those of other medical staff and reporters in Gaza. Ley sent pictures of some of the injuries to the Guardian.

Israel launched its offensive on Gaza after Hamas killed more than 1,200 people in southern Israel. Since then, more than 14,000 people have been killed in Gaza, Palestinian officials say.

In the burns unit of the European hospital are 78 patients, nearly two-fifths of them children under five.

"I have never seen anything like it," said Ley, a 60-year-old French citizen who arrived in Gaza with a team from the International Committee of the Red Cross almost four weeks ago. "I have been in many war contexts where the type of wounds are the same, but the number is huge. We never leave the hospital. We work round the clock."