GAZA (NYTIMES) - Until Monday (May 17) evening, the Al-Rimal health clinic in central Gaza City was a key cog in the Palestinian health system. Its eight doctors and 200 nurses administered hundreds of vaccinations, prescriptions and screenings a day.
But then, on Monday night, an Israeli airstrike hit the street outside, sending shrapnel into the clinic, shattering windows, shredding doors, furniture and computers - and wrecking the Gaza Strip's only coronavirus test laboratory.
"During times of war people need more treatment than usual," Mohammed Abu Samaan, a senior administrator at the clinic, said on Tuesday. "Now we can't give people medicine."
The wreckage at Al-Rimal is one of the most striking examples of the devastation wrought by the nine-day-old battle between Hamas militants and the Israeli military - creating a humanitarian catastrophe that is touching nearly every civilian living in Gaza, a coastal territory of about 2 million people.
Sewage systems have been destroyed, sending fetid wastewater into the streets of Gaza City. A critical desalination plant that helped provide fresh water to 250,000 people is offline, and water pipes serving at least 800,000 people have been damaged.
Landfills are closed, with trash piling up. And dozens of schools have been either damaged or ordered to close, forcing some 600,000 students to miss classes on Monday.
Even before the loss of the coronavirus testing centre, vaccine supplies headed to Gaza were indefinitely delayed by the fighting, and only a tiny fraction of Gazans had been vaccinated.
"All of this is happening in a situation where we know in Gaza, the humanitarian situation even before this latest round of fighting was not good, to say the least," Stéphane Dujarric, a spokesman for the United Nations, told reporters on Tuesday at UN headquarters in New York. "Access to vaccines was very challenging. So, this only makes things worse."
The level of destruction and loss of human life have underlined the challenge in Gaza, already overpacked with people and suffering under the weight of an indefinite blockade by Israel and Egypt even before the latest conflict.
US President Joe Biden added his voice to the growing chorus of international leaders calling for a cease-fire Monday night, but there was little indication that an end to the hostilities was near Tuesday morning.
Militants in Gaza aimed a barrage of around 100 rockets at southern Israel overnight, adding to the more than 3,300 fired in just over a week. And the Israeli bombardment showed no signs of letting up, with the sound of explosions once again rocking Gaza before dawn.
Gen Hidai Zilberman, a military spokesman, who spoke to the Israeli network Army Radio, said there was no plan to suspend operations.
"We have a bank of targets that is full, and we want to continue and to create pressure on Hamas," he said. "This morning, the chief of staff gave us the plans for the next 24 hours, the targets. We will hit anyone who belongs to Hamas, from the first to the last."
Hamas said it would not stop its assault, accusing "the criminal Zionist enemy" of "bombing of homes and residential apartments."
"We warn the enemy that if it did not stop that immediately, we would resume rocketing Tel Aviv," said the militant group's spokesman, Abu Ubaida, according to Reuters.
While Hamas fighters move through an extensive series of tunnels under Gaza, and as Israeli warplanes drop bombs aimed at destroying that network, it is the people caught between who suffer the most calamitous losses.
Schools in southern Israel within range of the rocket fire have been closed, and many families have left the border areas. The constant wailing of sirens warning of incoming rocket fire punctuate daily life, particularly in the south, sending Israelis repeatedly running to shelters.
At least 10 people in Israel have been killed in rocket attacks, Israeli authorities said.
The death toll in Gaza itself has surpassed 200, including at least 61 children, according to health authorities in the territory.
And the sprawling humanitarian crisis in Gaza - documented by both UN agencies and local authorities - is growing by the day, adding to pressure on political leaders to pause the hostilities so that relief can reach those in desperate need.
Palestinian activists across Israel took part in a general strike Tuesday to protest Israel's air campaign in Gaza and other measures targeting Palestinians.
Six hospitals and eight clinics have suffered bomb damage, according to the UN humanitarian affairs office, limiting medical treatment available for many people living in the region.
By Monday, Israeli bombs had destroyed 132 residential buildings and damaged 316 housing units so badly that they were uninhabitable, according to Gaza's housing ministry.
More than 40,000 people have been forced into shelters and thousands more have sought refuge with friends or relatives, according to the UN humanitarian affairs office.
"Until a cease-fire is reached, all parties must agree to a 'humanitarian pause,'" the office said in a statement.
"These measures would allow humanitarian agencies to carry out relief operations, and people to purchase food and water and seek medical care."