GAZA/RAFAH (IRIN) -- As Israel continues to bomb hundreds of targets in the Gaza Strip, hospitals are facing a shortage of medical supplies.
Pre-existing shortages are being exacerbated by heightened need and by the border policies of the Egyptian government, which continues to limit entry into Gaza.
Gaza's Ministry of Health has announced a state of emergency, with the danger of acute shortages of basic medication. Ashraf al-Qidra, spokesperson at the Ministry of Health, said the needs would soon become critical.
"We are already facing a severe shortage - 35 to 40 percent - of needed medicines and disposables, which impacts the treatment of the growing number of injuries because of the current escalation," he told IRIN.
According to the World Health Organization, 30 percent of the essential drug list and half the disposable medical supplies were out of stock in Gaza - even before the crisis.
Together with WHO, the Ministry has appealed for $60 million to urgently cover out of stock medical supplies and medical referrals out of Gaza.
In the past week, the AFP news agency said at least 172 Palestinians have been killed as Israel has attacked hundreds of targets in what it says is a response to rocket attacks and the killing of three Israeli teenagers in the West Bank last month.
The UN has reported that nearly 1,000 houses have been damaged or destroyed, while up to 17,000 people have sought refuge in UN facilities, with Israel threatening a ground attack. Israeli said its troops carried out their first ground raid into Gaza targeting a rocket site on July 14, an operation in which four of its soldiers were injured.
When IRIN visited al-Shifa Hospital in Gaza City, the rooms were packed as medical staff tried to keep on top of their workload. Those injured were rushed to surgery, intensive care or sometimes the morgue. In the reception, relatives rushed around seeking news of their loved ones.
Christian Cardon, head of the Gaza sub-delegation of the International Committee of the Red Cross, said the situation was "exceptional".
"In comparison to the figures of casualties in the last conflict (in 2012), we are already reaching a high level of intensity in fatalities, including women and children. There is a need for more drugs and disposables, and medical items at some point," he said.
He called on all sides to respect medical staff and to allow "hospitals to function day and night (and) ambulances to be able to move everywhere in the Gaza Strip. This is very complicated nowadays in terms of the security situation and intensity of the conflict."
Medical crews have faced difficulties accessing certain areas, while 12 people were injured in a strike on the Palestinian Red Crescent Society in Jabaliya, northern Gaza.
Aed Yaghi, director of the Palestinian Medical Relief Society, called for immediate international action to protect Palestinians and provide medical supplies.
"There should be an active response to avoid further deterioration in the situation in Gaza. It is not acceptable to see people suffer without any action to save their lives," he told IRIN.Egyptian border restrictions
The shortage is made worse by stringent restrictions on the entry of goods into Gaza, imposed by the years-long blockade of the Gaza Strip by Egypt and Israel.
At the Rafah border crossing between Egypt and Gaza, frustrated aid workers struggled to cross into the enclave. Ayman Koueider, a representative of the Arab Doctors Union, told IRIN he and other charity workers were stranded as they had been prevented from entering Gaza to deliver medical and food aid.
The contrast with the last conflict is stark. During those five-day hostilities between Israel and Hamas in November 2012 the then-Muslim Brotherhood-led Egyptian government opened the border with Gaza and facilitated the delivery of medical supplies.
Since the Brotherhood was overthrown by the military last year, the new government under the leadership of Abdel Fattah al-Sisi has become friendlier with Israel and taken a tougher stance against Hamas in Gaza, and the border has remained largely closed.
"They told us in Gaza that they need many necessary medical supplies," Koueider said. "It is a humanitarian situation; ideologies should be left aside," he added, alluding to the tensions between the leaderships in Gaza and Cairo.
Likewise, for those trying to flee, the border has been largely sealed - the vast majority of those that IRIN met crossing into Egypt were not Palestinian.
A Jordanian citizen of Palestinian origin said it had taken him several days to cross into Egypt as the security forces were reluctant to accept him.
Milina Shahin, public information officer at the UN agency responsible for Palestinian refugees in Gaza, said their information was that only a "very limited number" of people had been allowed to cross, though she stressed the body had no formal role monitoring the border.
An Egyptian security source on the border confirmed the government was severely limiting the number of Palestinians allowed to leave, but stressed that the injured were largely being granted access, though relatively few of them had made it to the border.
The source added that one of the reasons for the stringent controls was a fear of radical jihadists crossing into Egypt to carry out attacks.
The blockade is not only affecting medical supplies. The Ministry of Health estimates that Gaza's ambulance service is only running at 50 percent capacity due to lack of fuel. Gaza has long relied on a network of tunnels to import basic goods such as fuel but in the past year the Egyptian military has cracked down, closing most of the tunnels.
The ICRC's Cardon added that hospitals, too, could run out of power. "One of the main concerns will be (ensuring there is) the fuel to make sure the hospitals (run) around the clock. We know that there is a shortage of fuel already."
According to Mahmoud Daher, head of WHO's office in Gaza, an Emirati delegation was able to bring medical equipment and a field hospital into Gaza through the Rafah crossing on 13 July.
According to the UN Office for the Coordination of Humanitarian Affairs, six truckloads of humanitarian assistance donated by the Egyptian Army to the Ministry of Health and to the Palestinian Red Crescent Society, including 2,500 boxes of medical supplies, arrived at the Egyptian side of the Rafah crossing on 12 July.
A number of international NGOs donated medical supplies worth over $800,000 to the Ministry of Health, OCHA added, and Médecins Sans Frontières France is scheduled to send a medical team to work in al-Shifa Hospital later this week.
In addition, some donors have pledged to support medical needs in Gaza, promising WHO the resources to bring supplies through the Israeli border. So far, the government of Norway has pledged $2.5 million and the Islamic Development Bank is looking to follow suit.
However, procurement of the supplies will take a few days, Daher said, and "without big contributions, we cannot replenish these (pre-existing shortages)."
Pre-positioned trauma kits of the ICRC, the NGO MAP UK and others will allow aid agencies to respond to emergency cases over the next 10 days or so, so long as there is no further deterioration, Daher said, "but the problem will be with the people with chronic diseases, cancer, and those who, (because of) a backlog in the system for a long time, have not had proper healthcare."