RAFAH, Gaza Strip (AP) — The roads are so ravaged that the dead and wounded arrive by donkey cart. Desperate relatives rush bloodied and dust-covered people, many of them children, to the hospital.

Naseem Hassan, a 48-year-old Palestinian medic in the Gaza Strip’s southern town of Khan Younis, said it had become impossible to walk through Nasser Hospital, with people spread out everywhere. Some patients, terrified or semiconscious, tugged at his sleeve when he squeezed through the halls. They groaned, slept and died on those bloodstained floors, he said.

His skeletal staff at the 350-bed hospital has struggled to cope with an influx of over 1,000 patients. Without fresh bandages and gauze, Doctors Without Borders said, patients’ wounds have become seriously infected, in many cases septic.

“When I think about it for a moment, I start to cry,” Hassan said by phone, struggling to be heard over the shouts of the doctors and nurses who remained. “It’s a good thing I’m too tired to think.”

On Dec. 7, United Nations monitors said the hospital received its first delivery of supplies since Nov. 29. The World Health Organization delivered trauma and emergency care supplies to the area for about 4,500 patients.

In recent days, Israeli tanks have rumbled into southern Gaza, starting with Khan Younis. It’s the opening of a grim new chapter in a war that has already killed over 17,000 Palestinians, according to Gaza’s Health Ministry, and displaced what the United Nations estimates to be 1.9 million people. The war — which erupted when Hamas militants rampaged through southern Israel on Oct. 7, killing about 1,200 people and abducting more than 240 others — has severely damaged or destroyed as much as 36% of all the buildings across the entire enclave, according to analysis of publicly available satellite imagery from the European Earth observation program Copernicus taken Wednesday.

Those who took refuge in southern Gaza from the military campaign that reduced the north to rubble over the past two months now find themselves stuck in a cramped, desperate patch of ever-shrinking land as Israel expands its invasion.

“The suffering is really apocalyptic,” said Khaled Abu Shaban, 38, an aid worker near Khan Younis. Israel’s intensive shelling has forced agonizing choices, he said. Should he venture out to the supermarket or search for well water, at risk of being killed? Or should he let his young daughters go to sleep hungry and thirsty?

His 7-year-old cheered Wednesday, he said, when he brought home a tomato. “It is unacceptable that we are searching for water and anything that we can chew in the 21st century.”

The pitched street battles and heavy bombardment have blocked aid groups from delivering vital supplies in Khan Younis, the U.N. said, where hungry families are sometimes streets away from warehouses full of food.

On Tuesday, desperate mobs stormed a warehouse where two days’ worth of food aid had piled up before distribution, the U.N. Palestinian refugee agency, known as UNRWA, said, lamenting the dangers that stalled delivery. People snatched whatever they could and ran off with sacks of flour.

“The hunger war has started,” said Nawras Abu Libdeh, a worker in Khan Younis with the humanitarian organization Medical Aid for Palestinians. “And this is the worst of all wars.”

In central Gaza, which has been so far spared Israel’s ground invasion, residents said thousands of jostling Palestinians pounce on aid trucks the moment they arrive, screaming for food and ripping into packages.

“There are 8,000 people in this shelter, and any vegetables disappear before I see them because people seize everything so fast,” said Mazen Junaid, a father of six who fled to the central city of Deir al-Balah from northern Gaza. The swelling crowds, he said, make it difficult to breathe and move.

The prices of staple foods have ballooned out of reach, residents said, with a bag of flour now some 450 shekels ($121). Sugar, emptied from supermarkets, goes for about 40 shekels ($10) on the black market. Rare wartime luxuries savored over the past few weeks — coffee, eggs, biscuits — have vanished. Without cooking gas, Palestinians chop down whatever trees they find for firewood.

“There is hunger, there is nothing: There is no flour, no water,” said Etimad Hassan, who sleeps pressed together with 21 family members in a small tent in Deir al-Balah. Her voice trembled with rage. “We are not animals. Why do they put us in tents like dogs? At least guarantee us a place for shelter.”

Adding to the misery, there is little to no treatment available for the 14% of Gaza’s population suffering from diabetes, high blood pressure and other chronic heart conditions, said the World Health Organization.

“Asthmatics do not find inhalers. Diabetics do not find insulin,” said Ebraheem Matar, a doctor at Al-Aqsa Martyrs Hospital in Deir al-Balah. “Hypertensive patients do not find receptor blockers.”

Hassan said her husband abruptly stopped taking his blood pressure medication when he ran out, a withdrawal doctors warned would increase his risk of heart attack. “I’m worried it will kill him,” she said.

Junaid said he spends his days begging for food in the streets and scouring pharmacies and health clinics for any anti-inflammatory medication to blunt his throbbing headaches. He checked five pharmacies Thursday and returned home empty-handed.

“We didn’t start this war,” he said. “What will I do, leave my daughters to die in it?”

Tens of thousands of Palestinians in Gaza, many of whom already fled fighting two or three times, have set off for the southern city of Rafah on the Egyptian border. The Israeli military air-dropped fliers and called and texted evacuation warnings to thousands of civilians across Khan Younis while pressing deeper into the city.

Misery spans the horizon in the southern border town. Thousands of people sleep in the cold outside. Others crowd together wherever they find space.

“You find displaced people in the streets, in schools, in mosques, in hospitals,” said Hamza Abu Mustafa, a schoolteacher in Rafah. “You find displaced families everywhere.”

Chaotic scenes of sickness and filth unfold at the U.N. shelters in Rafah, bursting at the seams. The U.N. humanitarian office said Wednesday that poor sanitation has led to rampant cases of scabies, lice and diarrhea, raising fears that more serious diseases may soon spread. Aid workers have reported outbreaks of the liver disease hepatitis A.

In Nasser Hospital, the walls thrum with the thunder of battles raging nearby. Hassan, the medic, said his wife, four young daughters and son pleaded with him to join their flight to Rafah.

But Hassan has refused, vowing to persist through the grim routine that drains and haunts him more each day.

“My patients come here because they put their faith in international law. They come to hospitals for care and safety,” he said. “I won’t leave them even if tanks tear down this hospital.”

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DeBre reported from Jerusalem and Magdy from Cairo.