Updated November 7, 2023 at 12:07 PM ET

TEL AVIV, Israel — Hospitals in Gaza are facing dire conditions as much-needed fuel is running dry and staff try to operate amid overcrowding, disintegrating sanitation and threats from Israel.

Health officials in the Hamas-run Gaza Strip report 18 out of 35 hospitals are no longer operational, according to new numbers released Tuesday.

At least 71% of all primary care facilities across Gaza have been shut down due to damage or lack of fuel, the officials said.

The United Nations says an estimated 117,000 displaced people, in addition to patients and hospital staff, are in the hospitals still operational in Gaza City and northern Gaza. Israel has dropped leaflets and sent messages telling people to leave these areas as troops close in.

"It's a health catastrophe right now what is happening in Gaza," Tarik Jasarevic, a spokesperson for the World Health Organization, told NPR.

Strikes damage hospitals throughout Gaza

Over the past few days, several hospitals in Gaza have reported damage from Israeli airstrikes, according to witnesses on the ground and humanitarian aid groups.

The Palestinian Red Crescent Society said on Monday that an aircraft "targeted the vicinity of the Al-Quds Hospital with two rockets, approximately 50 meters from the hospital's gate."

The Rantissi Children's Hospital and the Nasser Hospital Complex also have been damaged through direct and indirect airstrikes, according to the Ministry of Health in Gaza and the United Nations.

Israel has also struck Al-Shifa Hospital, Gaza's largest medical facility and where thousands of sick, injured and others are being treated and sheltered, and the Indonesian Hospital. Some strikes have hit the hospitals' infrastructure directly; others struck in their vicinity, like an ambulance convoy outside Al-Shifa on Friday.

Health officials in Gaza said that on Nov. 6, Al-Shifa Hospital's fifth floor was hit by Israeli airstrikes, destroying the building's solar panels — the facility's last source for energy. The attack reportedly killed several people, including displaced individuals sheltering there for safety, the health officials said.

The constant bombardments are one thing, but these facilities are already struggling to meet the needs of their patients because of the lack of fuel, the WHO's Jasarevic said.

"Doctors need to have electricity in a hospital to be able to perform surgical operations, and they need surgical material. Now, both of those things are missing in most of hospitals. Fuel is running really low. It's the last the liters of fuel that is being used in hospitals and they have to ration it," Jasarevic said. "You have to run generators. You also need to have a light. You can't just do surgeries with the flash flashlight of your mobile phone."

Israel says it is targeting Hamas, not hospitals

The Israeli military says that it has not hit any hospitals. These facilities are on the radar of the military, however, because Israel says that it has intelligence that Hamas is hiding in tunnels underneath medical facilities in Gaza.

That includes in Gaza's Indonesian and Al-Shifa hospitals.

The military believes that there are Hamas tunnels in the vicinity of these medical facilities, Lt. Col. Richard Hecht, an Israeli military spokesperson, said on Monday.

Hecht said the Israeli military hasn't attacked hospitals, but rather that the military is considering how to deal with those sites to try "and minimize as much as we can the collateral damage."

Indonesia's Foreign Minister Retno Marsudi disputed Israel's claim and said in a statement that the Indonesian Hospital "is a facility built by the Indonesian people entirely for humanitarian purposes and to serve the medical needs of the Palestinian people in Gaza."

B'Tselem, an Israeli human rights group, urged Israel not to bomb Al-Shifa.

"According to Israel, Hamas has chosen to set up a military base underneath the hospital. If that is the case, Hamas is committing a war crime that is morally reprehensible and absolutely prohibited under international humanitarian law," the group said in a statement.

It continued: "Even if there is a military facility operating under the hospital, this does not allow Israel to bomb the site. Such an attack would result in unbearable, horrifying harm to civilians and constitute a war crime — violating the provisions of international humanitarian law that Israel has repeatedly declared its commitment to uphold."

Jaclyn Diaz reported from Tel Aviv. Aya Batrawy reported from Dubai.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

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