GRAPHIC PHOTO WARNING: This gallery contains news images from war that some viewers may find disturbing.

For a few hours every day or night, Dr. Suhaib Alhamss tries to sleep on a thin mattress in an operating room. He swings in and out of half-consciousness, both too tired to open his eyes and too tense to let go.

Thunderous shellfire often rattles the windows of the hospital he directs in the southern Gaza Strip.

But the worst sounds, Dr. Alhamss said, come from inside Kuwaiti Hospital: the cries of tiny children with no parents and enormous wounds.

The panicked screams of patients jolted awake to the realization that they had lost a limb.

The Israel-Hamas war, which started 100 days ago on January 14, has exposed him, his staff and the people of Gaza to a scale of violence and horror unlike anything they had seen before. It has rendered his hometown unrecognizable.

“This is a disaster that’s bigger than all of us,” Dr. Alhamss, 35, said by phone between surgeries.

His hospital, donated and funded by Kuwait’s government, is one of two in the city of Rafah. With just four intensive care beds before the war, it now receives some 1,500 wounded patients each day and at least 50 people dead on arrival — adults and children with shrapnel-shattered limbs and pulped bodies, bone-exposing wounds, and tattered flesh.

Over 23,400 Palestinians in Gaza have been killed in the war, according to the Health Ministry in Hamas-run Gaza. The count does not distinguish between civilians and militants.

Israel, which mounted its blistering air and ground campaign in response to the October 7 attack by Hamas on southern Israel, that saw 1,200 people killed and 250 others abducted, holds the group responsible for civilian deaths by embedding militants in buildings used by non-combatants.

To make room for the daily rush of war-wounded, Dr. Alhamss has crammed a few dozen extra beds into the intensive care unit. He cleared out the pharmacy, which was largely empty anyway since Israel’s siege has deprived the hospital of IV lines and most medicines. Still, patients sprawl on the floors.

“The situation is completely out of control,” he said.

A urologist by training and a father of three, Dr. Alhamss has watched aghast as his city and hospital have transformed over the course of the war.

With its low-rise concrete buildings and trash-strewn alleys teeming with unemployed men, Rafah, the strip’s southernmost city, long has been a squalid place straddling the Egyptian frontier. Notorious as a smuggling capital during the Israeli-Egyptian blockade, it contains Gaza’s only border crossing that doesn’t lead into Israel.

Now it is the flashpoint in one of the world’s worst humanitarian crises. Apartment towers have been blasted into flat, smoldering ruins. Israel’s evacuation orders and expanding offensive have swelled Rafah’s population from 280,000 to 1.4 million, leaving hundreds of thousands of displaced Palestinians jammed into flimsy tents smothering the streets.

Most people spend hours each day in search of food, waiting in motionless lines outside aid distribution centers and sometimes plodding kilometers (miles) on foot to carry back canned beans and rice.

The faces he sees around the city have changed, too, as Israel presses on with its goal of destroying Hamas. Fear and strain crease the features of his colleagues, Dr. Alhamss said. Blood and dust smear the faces of the incoming wounded, while waxy gray skin and eyes circled by darkening rings are marks of the dying.

“You can see the exhaustion, the nervousness, the hunger on everyone’s faces,” Dr. Alhamss said. “It’s a strange place now. It’s not the city I know.”

Aid trucks have trickled through the Rafah border crossing with Egypt. But it is nowhere near enough to meet the besieged enclave’s surging needs, humanitarian officials say. In the absence of vital equipment, medical staff have applied their ingenuity to new ends. Dr. Alhamss dresses patients’ wounds with burial shrouds.

“Each day I have people who die before my eyes because I don’t have medicine or burn ointment or supplies to help them,” he said.

He is too overwhelmed to dwell on all that he’s seen, but some images spring up unbidden: the vacuous stare of a young boy who survived a strike that killed his entire family, a newborn rescued from his dead mother’s womb.

“I think, how will they go on? They have no one left in this world,” Dr. Alhamss said. His thoughts turn to his own children, 12-year-old Jenna, 8-year-old Hala and 7-year-old Hudhayfa, sheltering at their grandmother’s Rafah apartment. He sees them once a week, on Thursdays, when they come to the hospital to give him a hug.

“I am terrified for them,” he said.

Dr. Alhamss knows fellow doctors and nurses who were killed in their homes or on the way to work by artillery, missiles, exploding drones — so many kinds of incoming fire. He has lost dozens of his medical students at the Islamic University of Gaza where he teaches, ambitious men and women “with so much life left to live,” he said.

But grief is a luxury he cannot afford. When asked how he felt, he answered with a simple “It’s God’s will.”

“We all will die in the end, why be afraid of it?” Dr. Alhamss asked. “We have no choice but to try to live in dignity, to help those we can.”

Isabel Debre and Najib Jobain

Associated Press

RAFAH, Gaza Strip

Adel Hana (AP), Ali Mahmoud (AP), Fatima Shbair (AP), Hatem Ali (AP), and Hatem Moussa (AP)