RAMALLAH, West Bank — From their home in the Israeli-occupied West Bank, Rana, 46, and her 54-year-old husband Ala'a try to reach their family in Gaza.

"Now, when I want to call, I dial each family member one by one, calling them four or five times to see who connects," Rana says.

"Just tell me you're fine, and that's it. I don't need more."

But most times, it's futile. It may take days before she even gets a text message from someone, she says.

The family did not want to use their full names out of fear of reprisals from Israeli authorities.

According to Netblocks, a company that tracks disruption to internet services in conflict zones, there have been about 10 telecom blackouts in Gaza since the beginning of the war, as recently as a few weeks ago.

"When they cut off communications, we cried and wailed — that's it, they've killed them all," Rana says.

For people living in the Gaza Strip, connecting with the outside world during the war has been extremely difficult. Blackouts, destruction of telecommunications infrastructure, and alleged cyberattacks have left many Palestinians unable to make calls to ambulances or to keep family members up to date on how they are, as well as hindered aid organizations from providing lifesaving services.

The war has destroyed critical infrastructure

At the headquarters of the Palestinian Telecommunications Co., or Paltel, in Ramallah, West Bank, there are about a dozen monitors mounted on the walls in the network operations center. Some show numbers and graphs, others maps of Gaza. Paltel is one of only two internet and cell service providers for the Gaza Strip. (The other network is Ooredo, a Qatari-owned company.)

Hamzah Naseef, Paltel's head of operations, points to a map of Gaza with dozens of little red flags up and down the territory, and a smattering of green ones.

The red flags mark sites that are destroyed or otherwise out of service. The far fewer green ones are still functioning. The war has had "a major impact on our network," Naseef says.

Paltel has more than 500 cell towers in Gaza, and 80% of them have been destroyed during the war, Naseef says. The Israeli military did not reply to multiple requests for comment on this claim.

The complex challenges predate the war

"Working in this part of the world is very difficult," says Mamoon Fares, who is based in Ramallah and has been in charge of Paltel's emergency response in Gaza since the beginning of the war.

Even in peacetime, Fares says running telecommunications for Palestinians is complicated by the Israeli government since it controls the borders of Palestinian territories, as well as imports and exports, making it difficult to bring in supplies.

Paltel has to get permission from the Israeli army to go into Gaza to fix fiber cables or deliver diesel needed for power generators. That process can take days.

The company is also regulated by Hamas in Gaza, and the Palestinian Authority in the West Bank.

On top of that, one of the conditions of the Oslo Accords signed by Israel and the Palestine Liberation Organization in 1993 and 1995 was that Israel control all cellular communications and technology built by Palestinians.

In fact, because of Israeli government restrictions, Gaza has only ever operated on 2G cellular service — an outdated system that has been shut down in many countries.

More than just a telecom provider

During the Israel-Hamas war, Paltel's customer service agents have acted as emergency call centers, trying to connect missing family members to each other, or calling ambulances.

Ramallah-based contact center manager Mahmoud Assaf says the company has instructed customer service workers to give free minutes to anyone who calls in with a Gaza phone number.

He says his employees have been affected emotionally while working during the war.

"Imagine someone is calling you about a loved one who is about to die," Assaf says. "And as a customer agent you can't help physically."

Fares, Paltel's head of corporate support, says the company is used to working in times of war, but this one is unprecedented.

"The scale of destruction got worse and worse," he says. "Our main office building was bombed — that was a first for us. And later on, our exchange offices and data centers got bombed one by one."

Fares says Israel has sabotaged communications in Gaza twice by deliberately disconnecting cables that run through Israel.

The Israeli military did not respond to NPR's multiple requests for comment on these claims.

When this happens, Fares says, Paltel tries to fix the issue by appealing to the International Telecommunication Union, or the American government to mediate with the Israelis. If that doesn't work, they appeal to humanitarian organizations like the United Nations or the Red Cross. Then they wait to see if anyone can put pressure on the Israeli military to end the blackout, Fares says.

The rest of the blackouts, he says, are due to Israel's destruction of Gaza's wider infrastructure.

Fiber networks run along streets that have been bulldozed, and radio sites have been destroyed.

Blackouts and other technical difficulties have also affected aid organizations. A few weeks ago, Fares says, the Red Cross wanted to set up internet service for one of its offices.

"We told them we don't have the 200 meters of cable to connect to your office," Fares recalls.

And the communications outages have hindered the ability for aid groups to do their job.

"For aid operations and to coordinate the delivery of assistance, it's extremely difficult not to have a phone line," Juliette Touma, director of communications for the United Nations agency that delivers aid to Gaza, told NPR in January.

"If we are destined to die, we prefer to die doing something useful"

It's also hard to get in touch with Paltel workers on the ground.

Paltel has about 1,000 employees in Gaza, Fares says, but he doesn't know the whereabouts of about 20% of them.

"Are they alive, are they killed, are they arrested? We don't know," he says.

Paltel workers are among the war's death toll, Fares says.

"We lost two of our people while doing maintenance, they were hit," he says. "And there were maybe five or six incidents where our teams were attacked by the Israeli army, sometimes they say by mistake."

The Israeli military did not reply to multiple requests from NPR for comment on these claims.

And yet, Paltel employees keep on working, Fares says.

"They tell me, if we are destined to die, we prefer to die doing something useful," he says.

Back in their Ramallah home, Rana and Ala'a are drinking tea when the phone suddenly rings.

Ala'a picks up.

It's Rana's brother-in-law calling from Gaza — from the Red Crescent hospital in Khan Younis where he is sheltering.

It's a rare moment when they get an update.

The hospital is besieged. He can't get out, but they are fine.

And then, the call drops.