Health officials in the Hamas-run territory said 40 patients, including three babies, have died since the emergency generator in al-Shifa ran out of fuel on Saturday. They say 36 babies are still at risk as there is no power to run incubators. The beds used for the babies have been lined with aluminium foil to try and keep the them warm.
The babies, who weigh less than 1.5 kg (3.3 pounds), with some as small as 700 to 800 grammes, were now lying side-by-side on ordinary beds, exposing them to infection and without any individual adjustments to humidity levels and temperatures, staff said.
"Luckily they are still 36, we didn't lose any of them overnight," Dr Ahmed El Mokhatallali, a surgeon, told Reuters from al-Shifa. "But still the risks are really high... We have still the risk of losing them."
Dr Medhat Abbas, a director of al-Shifa and a top official in the health ministry in Gaza, previously told The Independent: "Now, because of the shortage of electricity, our doctors have gathered them in these ordinary beds and put aluminium foil around to keep them warm. It’s becoming colder here in Gaza; for that reason, without proper temperature control, some of them could die."
Israeli forces have surrounded al-Shifa, which they say sits atop an underground headquarters of Hamas, but the military denies that it is under siege. The military said it started an effort to transfer incubators to the hospital but it was not clear if they had been delivered. Israel said that it was offering portable, battery-powered incubators so the babies could be moved. The military also posted a video showing Shani Sasson, a spokesperson from an Israeli Defence Ministry liaison office that deals with Palestinian civilian affairs, standing in front of incubators and saying a formal offer of help had been made.
"Extensive efforts are underway to ensure that these incubators right here behind me can reach the babies in Gaza without delay," she said in the video. But officials from the Gaza health ministry said that no mechanism had been suggested to achieve an evacuation safely.
"We have no objection to have the babies being moved to any hospital, in Egypt, the West Bank or even to [Israeli] hospitals. What we care most about is the wellbeing and the lives of those babies," Ashraf Al-Qidra, spokesman for the health ministry in the Hamas-run Strip, said. "So far there is no clear mechanism."
Dr Mokhatallali told Reuters that he was aware of efforts to rescue the babies, but that he do not know details. "Someone asked us to get the names of the babies and how many there are. But no actual steps on the ground. So we don't know how serious these efforts are to evacuate these babies," he said.
Christian Lindmeier, a spokesman for the World Health Organisation (WHO), said that the babies need to moved outside the Strip as "nowhere is safe in Gaza right now." He said an evacuation would require specialised equipment and a ceasefire along the route.
The UN Office for the Coordination of Humanitarian Affairs (OCHA) said on Tuesday that only one hospital in the northern half of the blockaded Gaza Strip – al-Awda – still had electricity and was able to receive patients
In a separate briefing, the WHO praised staff at Gaza's al-Shifa hospital for doing "everything they can" to care for patients.
"We know there's not enough food, that the staff are struggling to get any clean water because their water tanks were destroyed, but they are still doing everything they can to keep providing medical care for the desperately ill patients they have," WHO spokesperson Margaret Harris said in Geneva. "We actually still describe al-Shifa as a functioning hospital because of the heroic efforts the staff are making."
Ms Harris said al-Shifa now had 700 patients, more than 400 health staff and around 3,000 internally displaced people. She said 20 inpatient deaths had been reported in the last 48 hours although the situation could be much worse.
"Everyone in that hospital is in a really, really dire situation," she said. "We, as the world, have to find a way to help them. The best way would be to stop the hostilities right now. Focus on saving lives, not taking lives."
Ashraf Al-Qidra, spokesman for the health ministry in the Hamas-run Strip, said that with no means of keeping dozens of corpses from decomposing, a mass grave was being dug on the hospital grounds.
Hebrew-language media reported on Tuesday that both Israeli and Palestinian officials were trying to make arrangements for unconscious patients and those requiring dialysis and cancer treatment to be evacuated from al-Shifa to appropriate facilities in the southern half of the Strip, but it is unclear exactly how this would take place. Civilians have said that heavy gunfire can still be heard around the hospital compound. Israel says its forces allow routes for those inside to exit.
The Israeli military also posted an audio recording of what it said was a conversation between a senior officer from Israel's Coordination and Liaison Administration and the director-general of al-Shifa Hospital, speaking in Arabic, subtitled in English.
In it, the official talks about depositing an incubator at the hospital gate, without giving details of how or when that would happen. The director-general says that would help, adding that four respirators for children are also needed. The official says he will see what he can do to help. The director-general responds that all the wards and staff inside the hospital need help.
Israel has vowed to wipe out Hamas after it launched an attack inside Israel on 7 October during which 1,200 people were killed and around 240 were dragged back to Gaza as hostages. The territory has faced near-constant aerial bombardment and a blockade, leaving a severe shortage of fuel, water, food and medical supplies. The UN and aid agencies have said that the amount of help reaching Gaza is insufficient and international calls have been growing for "humanitarian pauses" to let aid in.
"My hope and expectation is that there will be less intrusive action relative to hospitals and we remain in contact with the Israelis... but hospitals must be protected" US President Joe Biden said late on Monday.
Another 200,000 people have fled northern Gaza in the past 10 days, the UN has said, with area the centre of Israel's military campaign against Hamas. They join the estimated 1.5 million people – three-quarters of the blockaded territory’s population – who have already fled their homes, with israel calling on people to move southwards. The UN said: “Hundreds of thousands of people, who are either unwilling or unable to move to the south remain in the north, amid intensified hostilities. They are struggling to secure the minimum amount of water and food for survival.”
A senior far-right member of Israeli Prime Minister Benjamin Netanyahu's government claimed on that Tuesday Gaza could not survive as an independent entity and it would be better for Palestinians there to leave for other countries. Finance Minister Bezalel Smotrich, who heads one of the religious nationalist parties in Mr Netanyahu's coalition, said he supported a call by two members of the Israeli parliament who wrote in a piece for the Wall Street Journal that Western countries should accept Gazan families who expressed a desire to relocate.
The comments underscore fears in much of the Arab world that Palestinians will be driven out of land where they want to build a future state, repeating the mass dispossession of Palestinians when Israel was created in 1948. "I welcome the initiative of the voluntary emigration of Gaza Arabs to countries around the world," Mr Smotrich said in a statement. "This is the right humanitarian solution for the residents of Gaza and the entire region after 75 years of refugees, poverty and danger."
Israel's military has also released video and photos of what it said were weapons Hamas had stored in the basement of another hospital, Rantissi, that specialises in cancer treatment for children. Hamas rejected the allegation. The military also confirmed confirmed the death of Noa Marciano, a soldier seen in a hostage video posted by Hamas on Monday. The military said: “Our hearts go out to the Marciano family, whose daughter, Noa, was brutally kidnapped by the Hamas terrorist organisation. We are using all means, both intelligence and operational, to bring the hostages home.”