Live updates: Follow the latest on Israel-Gaza
An Israeli air strike on Nasser Hospital in southern Gaza killed five patients and caused extensive damage in the men's surgical ward on Sunday, but the death toll would have been six if a doctor treating one of the victims had not been delayed by a colleague's request for help.
Israel's military said the strike targeted Ismail Barhoum, the finance chief of Hamas's political bureau, who was being treated in the ward on the second floor for injuries suffered in an earlier Israeli attempt on his life. The air strike also killed Mr Barhoum's nephew Ibrahim, 17, who was receiving treatment for injuries to his abdomen from Israel air strikes a few days earlier.
Dr Feroze Sidhwa, an American trauma surgeon from California, told The National he was on the fourth floor of the hospital and making his way to the ward to change Ibrahim's dressings just before the Israeli strike.
As he passed the Intensive Care Unit, one of the doctors there asked him to take a look at a patient who seemed to be bleeding internally. Dr Sidhwa spent 10 minutes checking his colleague's patient and confirmed he was bleeding into his abdomen. Just as the doctors were deciding to move the patient to the operating room, the hospital shook from the blast of the Israeli strike and filled with smoke.
The hospital was put in lockdown for an hour afterwards. Once staff were permitted to resume their work, Dr Sidhwa saw a person wrapped in a blanket being placed on a stretcher. The first thing that he noticed was the person's abdomen, which he immediately recognised.
"I knew it was Ibrahim. And when I looked up at his face, his pupils didn’t react to light any more. He didn’t have a pulse, he was dead. He had been dead for an hour," he said.
Dr Sidhwa recounted his experience in a post on X later that night.
"One of my patients, a 17-year-old boy, was killed. He would have gone home tomorrow. If I had been changing his dressings, as I planned to this evening, I probably would have been killed too," he wrote.
The affected area, which consisted of about 12 rooms with a capacity for 26 beds, was "ripped in half and left completely unusable", Dr Sidhwa said. However, the electrical and water systems were still working and the surgical department was able to continue operations.
Nasser Hospital, the largest in southern Gaza, had been overwhelmed just days earlier when Israel carried out heavy bombardment across Palestinian enclave, killing more than 400 Palestinians and injuring hundreds more. The attack in the early hours of March 18 ended nearly two months of a fragile ceasefire between Israel and Hamas, and came nearly three weeks after Israel imposed a ban on the entry of humanitarian aid into the territory amid a standoff over the future terms of the truce.
"The night of the 18th was definitely the biggest mass casualty event I have ever been part of," Dr Sidhwa said.
Nasser Hospital alone received about 250 victims of the attack, with between one third to half of them severely injured children. About 40 to 50 were "black-tagged", or declared dead before they even entered the emergency room.
"I performed six haemorrhage-control operations that morning. That's about the same amount of operating that I do in three weeks in the US as a trauma surgeon," Dr Sidhwa said. He also performed more operations on children as young as four on that day than he typically does in an entire year as a trauma surgeon in the US, he said.
Coping with such events is made more difficult by the damage suffered by Gaza's hospitals in attacks by the Israeli military since the war began in October 2023, as well as the lack of medical supplies because of the Israeli blockade. Nasser Hospital and its staff were subjected to a siege, shelling, military raids last year, and the loss of supplies when its stores were set on fire by Israeli forces.
Despite some of the hospital's departments being rehabilitated, Dr Sidhwa warned of an impending shortage of basic medical supplies, especially since doctors were unable to bring along their own supplies to the enclave.
"We haven’t got to the point of reusing gauze yet, but we are reusing more advanced things like surgical staplers, which are a one-time use," he said.
Dr Sidhwa compared the March 18 mass casualties to those from Boston Marathon bombings in 2013, where six trauma centres with hundreds of surgeons and operating rooms and thousands of patient beds worked together to treat 129 patients, which was considered to be an overwhelming number.
"They ran a better mass casualty event here than anywhere else I've ever seen, especially given how extreme the event was," he said.