In a statement the following day, the United Nations Office for the Coordination of Humanitarian Affairs (Ocha) also says al-Awda “was struck, putting scores of patients and medical staff at risk”.

The nearby Indonesian Hospital is declared out of service by Gaza’s Hamas-run health ministry, following what the UN later describes as “repeated Israeli attacks and sustained structural damage”. The IDF says it was fighting “terrorist infrastructure sites” in the area.

Israel does not allow international journalists access to Gaza, and the situation around the hospitals in the far north of the strip makes it too dangerous for the trusted freelancers the BBC works with to go there.

Al-Awda fills its oxygen cylinders at the Indonesian, Salha says, so if it runs out of oxygen now it will become “impossible to work”. Al-Awda also relies on the Indonesian for its intensive care unit.

“If we have ICU cases now we’ll have to refer them to Gaza City and we don’t know if it’ll be possible to go because the situation outside is dangerous to move between hospitals,” he says.

Another nearby hospital, Kamal Adwan, is also classified as out of service, though tents have been erected there to offer some care.

Salha fears what might happen if al-Awda has to shut – especially because of its maternity services. “If there is no al-Awda hospital… women will give birth in the street.”

At this point, al-Awda is considered the last functioning hospital in Gaza’s northern governorate, which does not include Gaza City.

Despite being declared out of service several times during the war, staff say it continued to operate at some level throughout, including after its previous director was detained by Israeli forces in December 2023.

The IDF told the BBC it was unable to confirm details of his detention or any charges unless his ID number was supplied. The WHO says 300 health workers have been detained in Gaza since October 2023.

Asked after al-Awda’s eventual closure if there was any evidence of Hamas or other groups’ activity there, the IDF said Hamas had a strategy of using hospitals for “terror-related activities”, including holding hostages, storing explosives and sheltering senior operatives, referring to allegations related to several other hospitals across Gaza.

Last month, the Israeli military killed Mohammed Sinwar, Hamas’ military leader, later saying his body was discovered in a tunnel underneath the European Hospital in southern Gaza.

Asked twice more if there was any evidence of armed groups operating in al-Awda, the IDF gave no comment.