It's not yet been a week since the latest conflict in Gaza began, but already the casualties on the Palestinian side are proving to be overwhelming for overstretched hospitals.
Since the initial Israeli air strike that killed Ahmad Jabari, head of Hamas's Ezzedine al-Qassam Brigades, on November 14, Israel's military said it has struck at least 800 targets, and Hamas has responded with 500 rockets.
The imbalance in military power between the two sides is evident by the number of dead and injured in Gaza versus Israel.
At least 39 Palestinians have been killed since the start of this latest round of fighting, with three Israelis killed in the same period. By Saturday afternoon, 13 Israelis had been injured - including 10 soldiers - compared to 350 Palestinians, 73 per cent of them children and elderly, according to a statement made at a press conference by Gaza police chief Taysee al-Batsh.
Coping with the injuries is taking its own toll on Gaza's battered medical infrastructure.
According to the Palestinian Central Bureau of Statistics, there are 24 medical centres in the Gaza Strip to serve a population of 1.7 million. Israel, in contrast, has 377 hospitals and a population of roughly 7.93 million.
There are also 21 health centres run by United Nations Relief and Works Agency (UNRWA) in Gaza. Despite fighting, the clinics, which serve Palestinian refugees, were able to open and function on Saturday, although they were not fully staffed.
Major medical shortage
Medhat Abbas, director-general of Al Shifa Hospital in the Gaza Strip, told Al Jazeera that there is currently a 40 per cent shortage of medicines and medical supplies in Gaza's hospitals.
"This is including trauma and emergency requirements, in addition to some orthopaedic kits," said Abbas.
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posts from residents in Gaza and Israel [Al Jazeera]
The large number of injured people flowing into Gaza's 13 hospitals - Abbas estimated 390 in the first four days of fighting - are sure to drain what little supplies they have left.
Saline solution, suturing supplies, anaesthetics and tools, such as plates, rods, screws, needed to stabilise complex fractures are in especially short supply, he said.
"What would have been enough for one week will be consumed in a few hours," said Abbas, adding that hospitals also need spare parts for CT scanning machines, which are crucial for diagnosing injuries. Most of the injuries stem from shrapnel wounds and bone fractures, with a few patients requiring amputations.
The only hope - outside a ceasefire - is that the border at Rafah remains open to allow patients to be sent to Egypt for treatment while letting medical supplies to flow into Gaza.
"I hope that a truce will be achieved because if things continue like this - with victims falling here and there and our supply shortages...it's a disaster," said Abbas.
"You're talking about a tragedy."
From bad to worse
Even before this latest round of fighting, Gaza hospitals were already stretched thin.
Basim Naim, Gaza's health minister in 2011, told Al Jazeera in June of that year that 178 types of necessary medications were at "near zero balance in stock" and that 190 kinds of medicines in stock were "either expired or are close to their expiry date".
Abbas said most of the medications arriving in Gaza are already expired.
"These drugs, they go in the incinerator and pollute the environment, but they don't help us," said Abbas,
"This war is coming on top of a siege, which is already known by the deficit of electricity and the shortage of fuel - we don't have enough to meet 10 days of our requirements."
During the last conflict, in 2008, Abbas said hospital staff had to "use linens to stop bleeding".
Aid and humanitarian groups, including UNRWA are trying to get supplies into Gaza.
"There are constant shortages of supplies in the hospitals in Gaza, which can only be exacerbated by the ongoing violence," said Robert Turner, Director of UNRWA operations in Gaza.
While he said there is "good general hospital care" in Gaza, he added that: "Ongoing shortages of supplies and equipment due to the blockade and financial difficulties and power shortages make [for] extreme challenges at the best of times."
Trapped and sealed in
Getting staff to the hospitals is also proving to be an issue.
Wala'a Summour, a medical intern, said that she has been effectively sealed into her neighbourhood by the constant air strikes.
"I can't leave my area because there have been intensive air raids, but I'm in constant contact with my hospital," said Summour.
"You can not move from one area to another. There are no cars on the street," said Summour, adding that many other medical staff are also isolated.
Hospital staff who are able to report for duty are working 24 continuous hours and then given two days off, Abbas said.
Getting medical supplies into hospitals also requires a tactical approach, and presently, the Egypt border at Rafah is the only route open to Palestinians, with limited aid making it though.
It's crucial that whatever makes it through is useful, said Turner.
"During an event such as this there is generally a lot of in-kind contributions or medicines and supplies, many of which are likely to come through Egypt," said Turner.
He added that UNRWA, Ramallah's ministry of health, the World Health Organisation and the International Committee of the Red Cross are trying to move in 205 pallets to support ocal hospitals.
Hatem Shurrab, the spokesman for UK-based charity Islamic Relief Worldwide, said the situation in Gaza is: "So far under control but is quickly deteriorating."
"We have enough supplies for one month, but not longer," he said. All hopes are pinned on the Rafah crossing, which is only open for the movement of people, not supply trucks.
"The crisis now is that the aid will take some time to deliver," said Shurrab.
In this situation, time lost equals lives lost.
"A delay means life," said Shurrab.
"It means that someone will suffer and maybe die. It’s a matter of life and death."
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