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Doctors in Gaza City faced with dwindling medical supplies performed surgery on hospital floors, often without anesthesia, in a desperate bid to save badly wounded victims of a massive blast that killed civilians sheltering in a nearby hospital amid Israeli bombings and a blockade of the territory. ... “We need equipment, we need medicine, we need beds, we need anesthesia, we need everything,” said hospital director Mohammed Abu Selmia. He warned that fuel for the hospital’s generators would run out within hours, forcing a complete shutdown, unless supplies enter the Gaza Strip. (Jobain, Kullab, Nessman and Lee, 10/18)

"This attack is unprecedented in scale," said Richard Peeperkorn, WHO Representative for the West Bank and Gaza. "We have seen consistent attacks on healthcare in the occupied Palestinian territory." Peeperkorn said there so far have been 51 attacks against healthcare facilities in Gaza, with 15 health workers killed and 27 injured. "The hospital was one of 20 in the north of the Gaza Strip facing evacuation orders from the Israeli military," he said. "The order for evacuation has been impossible to carry out given the current insecurity, critical condition of many patients, and lack of ambulances, staff, health system bed capacity, and alternative shelter for those displaced," he added. (Tetrault-Farber, 10/18)

Leonard Rubinstein, a John Hopkins University public health professor who has studied violence against medical facilities during wartime for 25 years, said the estimated death toll of at least 200 is the highest for a single incident involving a hospital that he is aware of. He added that “the number of attacks or instances of violence on health care facilities in this conflict are very significant.” Doctors Without Borders said on X that it was “horrified." “This is a massacre. It is absolutely unacceptable,” it said in a statement.  (Salam, Dunn and Lubbehusen, 10/17)

The al-Ahli Hospital in Gaza City — where authorities suspect an airstrike killed hundreds of people Tuesday — is owned and operated by a branch of the Anglican Communion, one of the largest Christian groups in the world. The 80-bed hospital normally sees about 3,500 outpatient visits a month, according to the website of the Diocese of Jerusalem, the local branch of the Anglican Communion that runs al-Ahli. It handles about 300 surgeries and roughly 600 radiological visits a month. (Boorstein and Brasch, 10/17)

U.S. President Joe Biden arrived in Israel on Wednesday pledging solidarity in its war against Hamas and backing its account that a blast that killed huge numbers of Palestinians at a Gaza hospital had been caused by militants. ... "But there's a lot of people out there not sure, so we’ve got a lot, we’ve got to overcome a lot of things," Biden added. "The world is looking. Israel has a value set like the United States does, and other democracies, and they are looking to see what we are going to do." (Al-Mughrabi and Holland, 10/18)

World leaders issued statements of condemnation and condolence on Tuesday after an explosion killed hundreds at a hospital in Gaza City, a staggering loss of civilian life in Israel’s 10-day-old war with Hamas that rapidly became enmeshed in competing assertions of blame. Virtually all stressed the horrific nature of the devastation. ... King Abdullah II of Jordan called the explosion “a heinous war crime that cannot be ignored." (Stack, 10/17)