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At a hospital in Rafah, American medical teams are reporting the worst

MARY LOUISE KELLY, HOST:

Israel's closure of the main border crossing with Gaza has trapped American medical teams in Rafah while aid officials report an ever worsening humanitarian crisis unfolding. As NPR Jane Arraf reports, seasoned medical volunteers are facing heartbreaking decisions. And a warning, this story contains references to disturbing injuries.

KELLY: Israel's closure of the main border crossing with Gaza has trapped American medical teams in Rafah while aid officials report an ever worsening humanitarian crisis unfolding. As NPR Jane Arraf reports, seasoned medical volunteers are facing heartbreaking decisions. And a warning, this story contains references to disturbing injuries.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: (Non-English language spoken).

JANE ARRAF, BYLINE: This is an intensive care unit at a hospital in Rafah today. It was recorded by Dr. Ammar Ghanem, one of more than a dozen American doctors and nurses who've worked nonstop since arriving nine days ago.

AMMAR GHANEM: The last two days, things all get much worse.

ARRAF: That's since Israel told people to evacuate because they were sending in ground forces to Rafah. They closed the nearby border crossing.

GHANEM: I estimate about two to three patients every day will die in this ICU because of lack of supplies or equipment or medical staff.

ARRAF: In the ICU, Dr. Ghanem, vice president of the Syrian American Medical Society, points out to a colleague an 18-year-old patient.

GHANEM: The most difficult case really is this patient here.

UNIDENTIFIED PERSON #2: How?

GHANEM: But she cannot be trached now.

UNIDENTIFIED PERSON #2: That case?

GHANEM: Yeah.

ARRAF: Like many of the patients, she was wounded by shrapnel.

GHANEM: She had a fracture of the skull with part of her brain material showing up through the skull fracture.

ARRAF: The sedatives they have are not strong enough.

GHANEM: 'Cause we are using a large dose, and she's still not sedated.

ARRAF: Israel says it needs restrictions on aid to be able to prevent weapons from entering. The shortages mean medical staff end up making agonizing choices, deciding which patients to stop treating to allow others a better chance to live.

GHANEM: Unfortunately - and I have to prioritize patient lives. So when I say, OK, prioritizing patient lives, I mean, I know that term, but I never used it before until I came here.

ARRAF: Experienced trauma staff have never seen anything like this.

(SOUNDBITE OF ARCHIVED RECORDING)

HELENA RANCHAL: I'm nurse. I have been doing this work for 20 years, and I never saw the situation that we have in Gaza, the magnitude, the severity of the people in the hospital. Many, many of them, they are children.

ARRAF: That's Helena Ranchal of Medicins du Monde, or Doctors of the World, at a press briefing on Wednesday. She says with a lack of basic supplies, patients are dying of preventable causes.

(SOUNDBITE OF ARCHIVED RECORDING)

RANCHAL: We are choosing people to say, OK, these injuries, they are so severe that you will need so many resources that we decide that you will wait your death.

ARRAF: Dr. Nick Maynard from Oxford University in England was evacuated from Gaza Monday. He says increasing malnutrition is contributing to patient deaths.

NICK MAYNARD: And I genuinely believe we're seeing the tip of the iceberg in terms of the impact on morbidity and mortality of malnutrition. I think it's going to get inestimably worse.

ARRAF: That's because malnourished patients with traumatic injuries are much less likely to recover.

MAYNARD: The many thousands of amputees, their wounds are breaking down. Their amputation stumps are breaking down. Their bones are exposed. They will then die of that if they're not treated.

MONICA JOHNSTON: OK. It's done. They're going to put in a new art line (ph).

ARRAF: At the hospital in Rafah today, Monica Johnston, a burn nurse from Portland, Ore., dizzy and nauseous from a gastrointestinal infection, was back in the ICU. One of her patients - a 7-year-old with burns over 80% of his body.

JOHNSTON: We're running out of pain medicine, running out of blood pressure medicine. So we cannot keep these people alive or comfortable. It's absolutely horrifying what we're seeing here.

ARRAF: She said everyone was desperately hoping for a cease-fire.

JOHNSTON: This will enable us to finish our mission, enable new help to come in, new supplies to come in.

ARRAF: And eventually, she said, enable the team's safe return home.

Jane Arraf, NPR News, Amman. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Jane Arraf covers Egypt, Iraq, and other parts of the Middle East for NPR News.