Lives in Gaza "hang by thread" as hospital and humanitarian systems collapse

• That includes al-Shifa hospital, the enclave's largest, where hundreds of patients, health workers and displaced Palestinians remain, according to the Ministry of Health in Hamas-run Gaza.
• Hospitals across Gaza have relied on fuel to run generators since Israel imposed a "complete siege" on the enclave and cut electricity early in the war. That fuel has now run out, health officials, the UN and other aid groups say.

What they're saying: "Lives in Gaza are hanging by a thread due to depleting fuel and medical supplies. We hear that patients are already dying," Andrea De Domenico, the head of the UN humanitarian office (OCHA) in the occupied Palestinian territory, told reporters Monday.

• De Domenico said that in general, the UN's operational conditions are "deteriorating by the hour."
• "We have no fuel, no [communications], and no guarantee of respecting UN premises ..., which is reducing progressively our ability to operate," he added.

What's happening: Fighting between Israeli ground forces and Hamas militants continues to intensify in northern Gaza, particularly around al-Shifa hospital.

• Israel has focused on the hospital because it claims Hamas houses its headquarters and tunnels under the facility — a claim the militant group denies.
• More than 30 patients, including three newborn babies, have died at al-Shifa in recent days due to the heavy fighting or lack of power, per Reuters, citing the Gaza Ministry of Health. Dozens of other premature babies at the hospital were relocated "to an operating room without their incubators, with health workers trying to heat the room," the UN said on Monday.
• "We don't have electricity. There's no water in the hospital. There's no food. People will die in a few hours without functioning ventilators," a surgeon with Doctors Without Borders (MSF) who works in Al-Shifa hospital told the organization on Monday. "The situation is very bad, it is inhuman."

The Israeli military claimed on Sunday it had attempted to deliver 300 liters (79.25 gallons) of fuel to power generators al-Shifa and that Hamas rejected the offer — a claim the militant group denied.

• Hamas also said that amount would only be enough to power generators for 30 minutes, per Reuters.
• Health officials have also reported damage from Israeli attacks to part of al-Shifa and other hospitals in recent days.

Zoom in: Fuel shortages across Gaza are also impacting sanitation and water supplies, according to the UN Palestinian refugee agency (UNRWA), which reported that two of its water distribution contractors stopped work.

• "A tough decision – fuel for a hospital or fuel to produce drinking water – both save lives. Unfortunately, this is not a hypothetical," UNRWA's Thomas White wrote on X.
• "No fuel means no pumping of sewage or waste removal. [T]his is a serious threat to public health. [D]isease outbreak will become a reality," he added.

Zoom out: More than 11,100 Palestinians, including at least 4,600 children, in Gaza have been killed since the war began in early October following Hamas' attack on Israel, according to the Ministry of Health.

• The death toll includes at least 101 UN workers — the highest number of deaths for UN staff in any single conflict. UN agencies on Monday held a moment of silence and lowered flags to half-staff to remember those killed.
• "They will never be forgotten," UN Secretary-General António Guterres said.

What to watch: OCHA's De Domenico said that beginning on Tuesday, the UN will be unable to unload any aid trucks that are allowed into Gaza because they "don't have the fuel for the forklift and we do not have the fuel for the trucks that are distributing that assistance out to where the people in need are."

• "We are running out of time before a major disaster," De Domenico warned.

Go deeper: "Survival feels uncertain," Palestinian in Gaza say