RAFAH, Egypt — Gaza’s hospital system is collapsing in the face of continuous Israeli bombardment, yet there is no letup in the wounded – more than 21,000, according to the latest count from Gaza’s Health Ministry. Exhausted doctors are operating on patients in corridors and on floors, often without anesthesia and other critical supplies.

Across the border in Egypt, hundreds of beds prepared for injured Palestinians lie empty. The continued closure of the Rafah crossing, save for a daily trickle of aid trucks, has meant no one can leave Gaza.

While the Egyptian government has made clear that it refuses to accept large numbers of Palestinian refugees from Gaza, fearful of the political and security repercussions, it has ordered hospitals in northern Sinai and elsewhere to prepare to take in wounded patients from the enclave – as they have during past rounds of fighting.

“This border is open to take in any injured,” said Diaa Rashwan, head of Egypt’s State Information Service, at a news conference in front of the Rafah crossing Tuesday. He added that the World Health Organization has inspected “all the hospitals and medical facilities” but that “the occupying forces prevent the crossing from the Palestinian side” – a reference to Israel.

Egypt, Israel, Hamas and the United States have given conflicting explanations for why no one has been able to cross from Gaza to Egypt since the war began – even civilians with grievous injuries. National security adviser Jake Sullivan said Sunday that Hamas was preventing people from leaving unless certain conditions were met, but he did not specify the conditions. Egypt has blamed Israel for not providing guarantees that it will not bomb the crossing or its vicinity if people try to leave.

The Hamas border authority said late Tuesday that Egypt had agreed to take in 81 injured people from Gaza on Wednesday, echoing reports in Egyptian state media. There was no immediate confirmation from Israel or Washington. Similar deals, involving the departure of foreign nationals, have fallen through at the last minute.

In Arish, a city some 30 miles from the Gaza border, health authorities are preparing to receive patients at the main hospital.

A makeshift hospital is also being set up in the Bedouin city of Sheikh Zuweid in northern Sinai to accommodate 300 patients to start, and maybe more later, officials told Sada El-Balad News, a government-affiliated news outlet.

One hundred and fifty ambulances stand ready to transport Palestinian patients to health facilities in Sinai and – if more serious injuries require it – to better-equipped hospitals elsewhere in Egypt, the North Sinai regional government announced last week.

The Turkish ambassador to Cairo toured northern Sinai and pledged that his country would open its own field hospital to assist in the effort.

More than 2,000 Egyptian health workers have registered to treat injured Gazans, Khaled Amin, assistant secretary general of the Egyptian doctors syndicate, told The Washington Post. Thousands more have expressed interest in volunteering, he said, including surgeons, pharmacists, and gynecology and obstetrics specialists.

“People truly want to help,” Amin said. They “are telling us, ‘Just open the road for us and we will cross over. …We won’t hold any entity accountable for our safety, not even Israel.'”

Border negotiations have focused largely on the entry of humanitarian aid to Gaza and the exit of foreign nationals, as well as the release of more than 200 hostages taken by Hamas militants from southern Israel on Oct. 7.

But as casualties pile up in Gaza, and the situation in hospitals grows more desperate, the issue of medical evacuations has taken on greater urgency. More than 8,500 people have been killed since the start of the war, according to the Gaza Health Ministry, including 3,324 children; 21,543 people have been injured.

Twelve hospitals and 32 primary care centers are out of service because of damage from Israeli strikes or a lack of power, Gaza Health Ministry spokesman Ashraf al-Qudra said Sunday. Al-Shifa, the largest hospital in Gaza, said Tuesday it had less than 24 hours’ worth of fuel to power its generators.

Surgeons in Gaza are “totally exhausted, burned out; some of them are crying – they cannot even manage,” said Mohammed Abu Mughaisib, deputy medical coordinator for Doctors Without Borders in Gaza.

The bed occupancy rate stood at more than 170 percent, he added, describing the environment inside hospitals – where tens of thousands of displaced Gazans have sought refuge – as “super chaotic.”

“It would at least relieve the bed occupancy [issue],” he said of medical evacuations to Egypt.

A high-level delegation from the World Health Organization and UNICEF, the U.N. children’s agency, visited hospitals in Arish last week.

“We were quite impressed with the Ministry of Health’s preparations in this regard. They’ve got a plan,” said Jeremy Hopkins, UNICEF’s representative in Egypt. “They’ve of course requested support to implement, but they are ready to receive the initial medevacs.”

During past rounds of violence in Gaza, Egypt has treated a limited number of wounded Palestinians in hospitals throughout the country – most recently during Israel’s two-week bombing campaign on the Gaza Strip in May 2021.

While U.S. officials have primarily blamed Hamas for the stalemate at the border, they have also alluded more generally to the complexity of talks involving so many parties, each with their own interests.

Evacuating the injured has been “held up by the inability to date to reach agreement on the opening of the Rafah corridor,” a senior U.S. official said Sunday, speaking on the condition of anonymity to discuss sensitive negotiations. Egyptian authorities will also want to vet who is crossing the border for treatment, the official added.

Egypt says Palestinian border employees are afraid to show up for work because of Israeli airstrikes.

“It is impossible unless there is a cease-fire,” said a doctor at al-Najjar Hospital in the Gazan city of Rafah, speaking on the condition of anonymity because of safety concerns.

Abu Mughaisib, of Doctors Without Borders, said the bombardment of southern Gaza makes it difficult to walk a quarter of a mile to buy bread for his family. It was impossible, he said, to imagine moving wounded patients across an active battlefield.

“You need safe corridors, a humanitarian cease-fire; you need the borders to be opened,” he said. But “the call is really to stop the war. We need to stop the war.”

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