Editor's note: This story contains graphic descriptions of injuries.
AMMAN, Jordan — When Zain Abu Obeid died on Sunday at the last functioning hospital in Rafah, there was no one to collect the 7-year-old boy's body from the morgue. He had been injured in an Israeli airstrike that killed his entire family, according to members of a U.S. medical team trapped at the European Hospital following Israel's closure of the nearby border crossing.
Conditions are so dire that the hospital staff are operating without light due to fuel shortages.
"You can see how everything is dark. The only light is coming from outside," Dr. Ammar Ghanem, vice chair of the Syrian American Medical Society, said in a video that he filmed on Monday and sent to NPR. The video showed doctors and nurses in the intensive care unit working in what little daylight was coming through the small windows.
Israel seized the Rafah crossing with Egypt last week as part of an assault on the nearby city of the same name, aimed at rooting out Hamas militants after a Hamas attack last October killed almost 1,200 Israeli civilians and security forces, according to Israeli government figures. Gaza's health ministry says more than 35,000 Palestinians, most of them women and children, have been killed in seven months of war.
Israel has told civilians to evacuate Rafah — where 1.3 million people who've fled fighting in other parts of Gaza have been crammed up against the Egyptian border. But tens of thousands have nowhere to go. And the 16-person team of American and U.S.-trained doctors and nurses are among international aid workers now trapped in Gaza as well.
"Yesterday, they changed their minds and said it's not safe and we're not going to evacuate anyone yet," said Ghanem, after receiving the decision to stay put from the mission's leadership.
The United Nations said Monday that a member of a U.N. security team had been killed and another wounded while their vehicle was struck as it traveled to the European Hospital, the same hospital where the U.S. medical mission is working, on Monday morning. The U.N. statement provided no further details on the incident. The U.N. secretary-general called for a full investigation into the attack and renewed calls for an immediate cease-fire.
Israel says it is rejecting a sustained cease-fire because it says it needs to eliminate Hamas' military capability.
Before the border closure, Israel allowed fuel trucks in through the Rafah crossing. According to the World Bank and the U.N., seven months of fighting has destroyed most of Gaza's infrastructure and the imported fuel runs everything from hospital ventilators to bakery ovens.
The European Hospital's emergency generator was powering the hospital ventilators and other essential equipment. But the hospital had been running out of basic medical supplies long before the medical mission, organized by the Palestinian American Medical Association, arrived on May 1. There is not enough pain medication, antibiotics or even bandages, say doctors and nurses in the mission.
'I just want to help ... but we have no tools'
Monica Johnston, a burn nurse from Portland, Ore., had been treating Zain, the 7-year-old patient, since he was admitted last Wednesday with blast injuries that left 90% of his body burned. He never regained consciousness and died early Sunday morning.
"When they took him to the morgue to prep his body all his burns were infested with maggots," she said. ' I just want to help. We all just want to help. But we have no tools to do it."
Johnston sent NPR a photo taken by one of her colleagues. In the picture, Johnston points out to a Palestinian nurse a burn wound down to the bone in the boy's painfully thin leg.
Johnston, in a phone interview from the hospital, talked of flies infesting the operating room and the intensive care unit.
"Usually two days before a patient dies there is an increase of flies swarming around them," she said.
"I came thinking we could do some good, despite our webinars and preparation explaining how dire the situation was here," said Johnston, a nurse with 20 years of experience.
"But as time goes on we're all feeling absolutely useless and helpless and hopeless. It feels like everyone we see in the ICU ends up dying."
Last week, after Israel ordered residents to evacuate Rafah, local doctors and nurses at the hospital tried to relocate their own families. Many of the staff were unable to come to work. Johnston said that evening a patient died in the ICU and wasn't discovered until rigor mortis had set in.
Most of the American medical staff are experienced conflict zone volunteers. This was Johnston's first mission. She said she came because her skills as a burn nurse were needed — but nothing prepared her for the things she would have to do.
She said after changing dressings for Zain, the 7-year-old, she decided not to continue the extremely painful process.
"You know, I think the local staff understood because I think they've seen that pattern of death. But some of my teammates were taken aback," said Johnston, 44. "It was so hard to get across that it's not that I'm giving up on him. But if I do his dressings as often as they need to, to stay clean, I will deplete our entire wound care resources just on him.
"We should not be making these choices," she said. "So he passed away ... and there's just so much indignity to that. And then the feeling of 'I could have helped prevent that.' "
Ghanem said the evacuation plan had been for two members of the team to leave each day. But on Monday, when the first were due to leave, they were told by their aid agencies that they were coordinating with Israeli forces and it was not safe to travel.
At her home in Portland, Johnston, who is a dual Canadian and American citizen, has a 14-year-old son and a 16-year-old daughter.
Until Sunday, when the internet went down, she had been able to text and talk to them regularly.
She said her son doesn't want to know details. "Every time I text he just texts back and says 'stay safe. I love you.' "
Her daughter asks about her day and the things she's seeing.
"She texted the other day saying that she signed up for a blood drive," Johnston said. "She is terrified of needles. But at the end of the text, she said, 'you know, you're doing something that is scary for you. So I felt I needed to do that too.'"
The American volunteers, like residents of Gaza, say they wake up to the sound of explosions. Worse, though, said Johnston, is the silence in the aftermath. Many of the casualties are buried in rubble. Those who survive are increasingly unable to make it to hospital.
"We hear bombs," she said, "and before my thought used to be 'what patients are we going to meet tomorrow?' And now we hear bombs and no one comes."
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