Tents are popping up in hospital corridors, parking lots and courtyards, as families seek safety in and around medical facilities — places that should be protected under international humanitarian law.

It is only the latest sign of the new reality as the Israel-Hamas war reaches its 29th day on Saturday, with growing fears of medical supply shortages and explosions disrupting the vital health services unfolding at hospitals and clinics.

With only cloth walls for privacy, families inside the tents are going about their daily routines, sleeping, eating and trying to reestablish a sense of normalcy.

These tents began to appear only days after the war broke out on October 7. Not only do they serve as temporary shelter for those escaping death and destruction in residential areas, but some also act as makeshift surgeries and emergency rooms as the Palestinian death toll soars past 9,000.

Women and children comprise a mass majority of the hospital inhabitants. Privacy is a distant memory, and the challenges of living in a hospital are manifold. Food, clean water and toilet facilities are severely rationed and available only sporadically: once or twice a day.

A seven-member family sheltering in a tent spoke anonymously to Al Jazeera about their hardship. They mentioned that they lack protection from the nearby shelling and the debris it raises, as well as from the biting cold at night.

“Overnight, from having everything, we now have nothing,” one of the family members said.

Families like theirs also face the heightened possibilities of infection and contact with toxic chemicals, as medical treatment continues in other tents nearby.

A lack of medical supplies

Health facilities across Gaza have reported shortages of medical supplies. According to the Palestinian Ministry of Health, the scarcity has become a grave problem for both medical personnel and patients, causing the quality of healthcare to deteriorate rapidly.

The shortage of anaesthesia has become glaringly apparent at the Al-Shifa Hospital, the biggest health facility in Gaza, established in 1946. Doctors there are reportedly forced to perform surgery on patients without medicine to dull their pain, causing them indescribable agony.

Intensive care units or ICUs, meanwhile, have too few beds to accommodate the hundreds of patients with severe injuries. According to the Palestinian Ministry of Health in Gaza, spaces for such cases have been exhausted since mid-October.

The Indonesian Hospital, serving over 150,000 residents in northern Gaza, is on the brink of ceasing its operations, raising alarm among health officials.

The Al-Shifa Hospital is also on the verge of a complete shutdown. The hospital, which provides critical health services to central Gaza, may soon be unable to admit more patients or treat injuries.

With only 546 beds, it is now treating over 1,000 injured people. The hospital has even resorted to conducting surgery in its yards, using the sun to light the medical procedures due to the lack of electricity and fuel.

“The hospital is expected to go completely dark within hours,” Ashraf al-Qudra, a spokesperson for the Health Ministry, warned on Wednesday.

An additional 50,000 to 60,000 people are taking shelter in the hospital’s yards.

Al-Qudra said that Gaza’s health sector faces catastrophe unless fuel and medical supplies reach the besieged enclave. He called on Egypt to facilitate the urgent delivery of medical aid to Gaza.

On October 21, 20 trucks with health supplies and other necessary goods crossed into Gaza from Egypt for the first time, beginning the flow of humanitarian assistance.

But aid has been slow to arrive, in part due to ongoing Israeli bombing in the border area.

The Palestinian Ministry of Health has said as well that the international aid allocated for Gaza’s health sector barely covers its essential operations and falls short of its most dire needs.

Health facilities facing bomb blasts

Attacks on or near medical facilities and workers have also dealt a severe blow to Gaza’s healthcare system since the war began.

Palestinian officials have blamed Israeli air strikes for explosions at several healthcare centres, including the Turkish-Palestinian Friendship Hospital in the south and the Al-Ahli Arab Hospital in central Gaza City, resulting in hundreds of deaths.

Israel’s military has also acknowledged striking ambulances, alleging that one of the vehicles in a medical convoy on Friday was “being used by a Hamas terrorist cell”. Al-Qudra said “a big number” of health workers were killed in the blast.

An estimated 25 ambulances have been hit, and 136 healthcare workers killed, since the start of the war.

The Health Ministry and Palestinian Red Crescent Society (PRCS) have called for medical facilities and first responders to be protected from the violence, in accordance with international law.

Article 18 of the Geneva Convention specifies that civilian hospitals should “in no circumstances be the object of attack”. Medical transport is likewise protected under humanitarian law.

Nevertheless, medical institutions in Gaza have continued to face fire. On October 29, PRCS said it received a notification from Israeli forces to evacuate the Al-Quds Hospital in the Tal al-Hawa area of Gaza City, ahead of a planned bombing there.

The hospital housed hundreds of patients and an estimated 12,000 displaced Palestinians.

The Government Media Office in Gaza and the Health Ministry have characterised such attacks as “war crimes”, calling for accountability.

Exhaustion among health workers

The continued violence has also increased concerns for the mental and physical wellbeing of healthcare workers, including doctors, nurses, administrative staff and rescue crews.

Working around the clock, some are facing extreme exhaustion. Others are suffering psychological fatigue from treating gruesome injuries or the frustration of lacking resources.

“Before the war, we would be responsible for alleviating the stress and trauma of the sick and injured, but now it is us who need an outlet for our exhausted bodies and spirits,” said nurse Huda Shokry from the Al-Daraj Medical Complex.

Still, Dr Ahmed Ghoul, an emergency room supervisor at Al-Daraj, told Al Jazeera that the professionals he works with are dedicated to caring for their patients.

“Despite the shortage of nearly everything necessary to effectively do our jobs, we do not leave our rooms, day or night, except for quick toilet breaks,” he said.

“We have lost track of the days of the week because we are more concerned with the thousands of injured individuals than over time.”

Doctors like Ghoul have no place to sleep even if they have the chance to. Their personal rooms have been converted into patient treatment areas, and their beds are used for surgery and emergency care.

Hospital kitchens, meanwhile, have largely stopped functioning. They lack the basic resources to prepare meals for staff or patients.

“We have grown weary of what we have been witnessing,” Shokry told Al Jazeera. “Being a doctor in the war in Gaza means losing one’s sense of fear and exhaustion.”

“It is impossible to maintain a normal psyche or even emotions.”