GAZA — Even without a full-scale Israeli ground invasion, Rafah's medical facilities have been overwhelmed.

Medics say more than a million people sheltering in the southern Gaza city are at risk of being deprived of healthcare after the Israeli military began a "limited" operation against Hamas on its eastern outskirts on Monday.

The largest of the city's three partially functioning hospitals, Abu Youssef al-Najjar, had to be hastily abandoned the following day after staff received an evacuation order and there was fighting nearby.

The hospital's dialysis department had been the only surviving one in Gaza, a lifeline for patients suffering kidney failure.

The Israeli advance has also cut off access to the nearby European Gaza Hospital in Khan Younis, where critical patients were being referred for surgery, as well as the nearby Rafah and Kerem Shalom border crossings.

With the Emirati maternity hospital in Rafah busy delivering dozens of babies each day, the Kuwaiti Specialist hospital is struggling to cope with a surge of emergency cases despite a lack of capacity, staff and equipment.

One doctor at the hospital, which before the war had only four intensive care beds, said the situation there was "catastrophic in every sense of the word".

"Unfortunately, the Kuwaiti hospital is a small hospital that does not have diagnostic capabilities," Dr Jamal al-Hams, its director, told BBC Arabic's Gaza Lifeline program. "Even the X-ray machine is disabled due to the Israeli shelling and there are no spare parts for it, as the crossings are closed."

"And the CBC analysis device has stopped due to being overloaded," he added, referring to the complete blood count test used to diagnose and monitor numerous diseases.

Dr Hams said he and his colleagues were nevertheless having to treat people with complex trauma wounds, burns, fractures and crushed limbs.

"We have received some cases of torn abdomen and intestines, and cases of skull fractures with parts of the brain outside the skull," he recalled. "Some cases have lost major parts of the buttocks, in addition to cases of amputation of the lower limbs at the foot area.

"These are unusual injuries caused by unusual weapons. I lived through all previous wars [in Gaza]... where injuries were always in a certain area and dealt with by one specialist. But now each case needs several specialists."

He also expressed anger at how doctors at al-Najjar hospital had been forced to evacuate both the facility and their family homes at such short notice.

The Israeli military told all residents of a number of eastern areas of Rafah to leave for their own safety on Monday and head towards an "expanded humanitarian area" stretching from nearby al-Mawasi to the central town of Deir al-Balah, where it said there would be field hospitals, tents and aid.

"Where should they go? Tents and other supplies were supposed to be provided in other safe areas. This has not been done," Dr Hams said.

Dr Youssef Abu al-Rish, undersecretary of the Hamas-run health ministry in Gaza, told Gaza Lifeline that Rafah's remaining medical facilities would no longer able to save the lives of many seriously wounded or ill patients.

"Rafah governorate does not have real medical services after the Abu Youssef al-Najjar hospital went out of service and people were unable to reach the European Gaza Hospital," he said.

"There are many field hospitals, but they cannot provide all these services as they do not have the necessary infrastructure or capabilities... For instance, they do not have dialysis services, oxygen-generating stations, intensive care departments or blood banks."

He added: "The Kuwaiti Hospital is a small non-governmental hospital that cannot provide emergency services. But we are trying to enhance its capabilities."

Medical aid group Project Hope said on Thursday that all of its clinics and mobile medical points in Rafah were closed, and that almost all of its staff had been evacuated, with many fleeing to Khan Younis and Deir al-Balah.

"Most aid services were based in Rafah. Now that people are further north, there is nearly no help. As long as the violence continues and the Rafah border crossing remains closed, more and more people will die from preventable causes," said Moses Kondowe, its Gaza team lead in Rafah.

Mr Kondowe said he expected to see malnutrition, pregnancy complications and other health conditions like Hepatitis A and cholera increase.

Hundreds of thousands of children sheltering in Rafah are already injured, sick, malnourished, traumatized or living with disabilities.

Médecins Sans Frontières said on Wednesday that its teams had begun to discharge patients from Rafah Indonesian Field Hospital, where they helped provide post-operative care, and had suspended activities at its clinic in al-Shaboura - a move it described as "catastrophic".

The medical group also said it was handing over its activities at the Emirati maternity hospital to the Gaza health ministry.

Dr Abu al-Rish said the closure of the Rafah crossing with Egypt, which Israeli troops seized on Tuesday, meant patients who had been due to be sent abroad for medical treatment were now stranded.

Haitham, a teenage boy who has already had three operations for a bullet wound that punctured his lung, is one of those waiting to leave.

"I feel helpless," he said. "The world is powerless to open the border. The hospitals here can no longer help me."

Zeina, a nine-year-old girl who has epilepsy, was also scheduled to be transferred abroad by the end of this week.

"She went to the hospital for hepatitis and her liver function tests where very high and she fell into a coma," her mother told Gaza Lifeline.

"After 14 days, Zeina woke up and her nerve cells had been affected and she couldn't... walk or move or hold anything. Her hands were often shaking so they started giving her medication and then put her up for transfer."

Israeli military spokesman Rear Admiral Daniel Hagari said on Thursday night that its troops were continuing to operate against "terror targets and the smuggling of weapons in the area of eastern Rafah".

"This activity supports the intelligence we had [that] Hamas used the area of the Rafah Crossing for terrorism," he added.

"We found several terrorist tunnel shafts in the area, which we are currently investigating and scanning, and so far, our forces have eliminated approximately 50 terrorists in this area during encounters and air strikes, and also during scans in the area."

The Israeli military also said it had reopened the nearby Kerem Shalom goods crossing for humanitarian aid on Wednesday, but the UN has said the fighting has made it impossible for it to pick up supplies there.

And unless they receive deliveries of fuel in the next few days, the World Health Organization has said all hospitals in Rafah and elsewhere in southern Gaza may soon have to halt services. — BBC