The supply cupboard is almost bare at Gaza’s Shifa Hospital. There’s rarely a full complement of anything, not needles, breathing tubes, surgical thread nor sterile dressings.
There is no guaranteed source of anaesthetics, antibiotics, intravenous fluids, cancer drugs or even the most basic of painkillers.
Doctors are well into their emergency supplies of essential medicines and equipment, which they warn will only last another two days.
Meanwhile, there is death and chaos all around them.
Shifa Hospital is emblematic of a life lived close to the edge in Gaza, the coastal jewel of Palestine that was broken long before this latest round of hostilities.
With Operation Cast Lead in 2008-2009 (1400 Palestinians dead, including 300 children, as well as nine Israelis) and Operation Pillar of Defence in November 2012 (167 Palestinians died, along with four Israelis), Israel’s devastating military strikes on Gaza’s captive, mostly civilian population has left a trail of damaged infrastructure and shattered lives.
As the casualties pour in from this week’s Israeli air and naval strikes up and down the heavily-populated 42-kilometre-long strip, Shifa Hospital and the handful of others treating the injured and receiving the ripped, burned, dust-covered bodies into their morgues are overwhelmed by the might of Israel’s firepower.
The Palestinians of Gaza have nowhere to run. They have no bomb shelters or warning sirens, no state-of-the-art defence system that can shoot Israel’s missiles from the sky.
There are civilians and the armed militant groups who live amongst them, emerging from hiding to fire rockets and the occasional long-range missile at a traumatised Israeli population.
Israel may have withdrawn its army from Gaza and dismantled its settlements in 2005, but it has maintained strict control over the lives of the 1.7 million Palestinians trapped within the strip’s land, sea and air borders.
Gazans are also locked in by Egypt – its Rafah border crossing has barely been opened over the last year, severely restricting travel and leaving people to die as they wait for approval that never comes to travel to Cairo for medical treatment.
Already this week more than 85 Palestinians have been killed and 537 injured in the first three days of Israel’s bombardment, Palestinian medical officials say, the majority of them civilians, at least 22 of them children.
From the air and sea Israel has launched missiles and shells at more than 860 targets along the Gaza Strip, a Defence Ministry spokesman said.
“These targets consist of terror tunnels, weapons storage and manufacturing facilities, military compounds, concealed caches of rockets and launchers,” he said.
From Gaza, militants have been launching a relentless barrage of rockets, with at least 470 fired into Israel in the last three days, 350 of them landing while 87 – including several long-range missiles that made it as far as Jerusalem and Tel Aviv – were intercepted by the Iron Dome defence system.
For Israelis, particularly those living in the country’s southern centres of Ashkelon, Ashdod, Beersheba and Sderot, life has been punctuated by the wail of warning sirens, sending hundreds of thousands of people running terrified to bomb shelters or into stairwells seeking safety.
Communities and business in Israel have been paralysed by the rockets – they too want an end to the hostilities that are never far from the surface.
So far there have been no Israeli fatalities – no thanks to Hamas and the other militant groups sending rockets indiscriminately into Israel, says Mark Regev, a spokesman for Israeli Prime Minister Benjamin Netanyahu.
“We have invested billions in homeland defence, in concrete bunkers, sirens, building codes, in Iron Dome – whatever it takes to keep our people safe,” Mr Regev says.
“Hamas must understand that it is not in its interest to shoot rockets into Israeli civilians.”
As for the high civilian casualties on the Palestinian side, Mr Regev says Hamas and other militant groups chose to put civilians at risk by launching rockets at Israel from locations adjacent to civilian homes and concealing explosives in civilian homes.
“Ultimately our target isn’t Palestinian civilians in Gaza … the problem is that the Hamas terrorist machine is firing those rockets at Israel and at the same time it is embedding itself in the civilian population, using that population as a human shield.”
“If we know there are kids in the house we don’t bomb it – we are as surgical as is humanly possible in a very difficult situation. The [Israel Defence Force] has been ringing up houses telling people there is an attack about to happen … there is at least an effort to prevent civilians being caught in the cross fire.”
Descent into conflict
Any attempt to mark a starting point in the latest hostilities is a fraught process.
The collapse in April of the latest round of US-brokered peace talks between Israel and Palestine, in which the finger of blame was pointed firmly at Israel and its program of settlement expansion, provides a clear punctuation point.
So too does the decision of Palestinian Authority President Mahmoud Abbas to abandon the failed talks, finalise a unity deal with Hamas and form a government of technocrats – a move cautiously welcomed by the European Union and the United States but roundly condemned by Mr Netanyahu.
"Hamas is a terrorist organisation that calls for Israel's destruction, and the international community must not embrace it," he said.
Many Israelis believe it was the kidnapping of three Israeli teenagers in the occupied West Bank last month – 16-year-olds Naftali Fraenkel and Gil-Ad Shaer and 19-year-old Eyal Yifrah – who were found shot dead more than two weeks later, that tipped the two sides towards war.
The intense Israeli army campaign of house-to-house searches, mass arrests and ultimately, the demolition of the houses owned by the families of the two suspects Israel arrested in relation to the deaths sparked widespread fear and anger throughout the West Bank and East Jerusalem.
Mr Netanyahu was quick to blame Hamas for the kidnapping, although it had not claimed responsibility for the act, nor has any evidence been released pointing towards its involvement.
The situation deteriorated further with the revenge kidnap and murder of 16-year-old Palestinian Mohammed Abu Khedair. The news, via his autopsy, that he had been burnt to death by his captors triggered another wave of protests, violence and a harsh security crackdown.
But when asked where the conflict begins, Palestinians have an answer that is both simple and extremely complicated.
They say it is Israel’s decades-long military occupation, with its separation wall cutting off families from their loved ones, the settlements built on Palestinian land that are considered illegal under international law, the mass arrests, the night-time raids and the violent deaths of Palestinians at the hands of the IDF, that has lead us to this point.
In the United Nations on Thursday, Palestinian ambassador Riyad Mansour also raised Israel’s occupation as a major factor in the latest outbreak of violence.
“It is an occupation including armed force and terrorist settlers, that intentionally perpetrates the murder, burning and maiming of children,” Dr Mansour said, “as well as the killing and wounding of women, men and elderly persons, extrajudicial executions; the destruction of homes, the theft and colonisation of other people’s land, the forced displacement and dispossession of civilians, rendering them homeless and impoverished … and the abduction, imprisonment and detention of thousands of civilians, including children.”
Israel’s representative at the UN, Ron Prosor, used his iPhone to play the sound of the siren that warns Israelis they have only 15 seconds to get into bomb shelters before a rocket might strike.
He pointed out that during the speech of the UN Secretary General Ban Ki-moon “five rockets were fired from Gaza to Israel, and one hit a house".
'It burns inside of us'
In the mourning tent for Mohamed Abu Khedair, his quiet, grief-stricken father Hussein sits in the cool shade of the grape vine covering his family’s garden.
“He was a lovely child,” Hussein says. “He wanted to be an electrician, but just two months ago I visited his school and his teacher told me he should be an actor, a comedian, he had so much humour inside of him.”
Hussein and his wife Suha have six other children, aged from 12 to 23, and he says the younger ones are living in “constant fear of being kidnapped and killed”.
“The pain of Mohamed’s death is so extreme, it burns inside of us like it burned him,” he says.
Upstairs, Suha sits with family friends and relatives, including Mohamed’s kindergarten teacher, who has travelled from Nazareth to pay her respects.
The family wants justice for Mohamed, his mother says, quietly weeping, her eyes closed against the pain, but there are fears his death may be swept under the rug like so many others' before him.
And all the while, it is civilians, especially children, who are paying the price for this latest round of violence.
More than 6000 children in the West Bank are in need of urgent support following the Israeli military's operation to find the three kidnapped teenagers, says Bruce Grant, UNICEF’s head of child protection.
“For the majority of children in Gaza, this is the third major escalation in hostilities in the last six years,” he warns. ”War takes a terrible toll on the … wellbeing of children. It creates not only physical injury but psychological scars as well. These scars can run deep.”