Warning: This story contains graphic and distressing content throughout.

Doctors and hospitals that were already barely functioning in Gaza have been thrown back into chaos, with Palestinian casualties rapidly climbing as a result of what local health officials say is now the deadliest bombing campaign of Israel’s 17-month offensive.

Israeli Prime Minister Benjamin Netanyahu ordered the slew of airstrikes across Gaza early Tuesday, shattering the fragile ceasefire agreement with Hamas that began two months ago. The strikes killed more than 400 Palestinians overnight, at least 180 of whom were children, according to the Gaza Health Ministry.

“We received many bodies and body parts, most of them children and women,” Dr. Mohammed Qishta, who was at Nasser Hospital in Khan Younis, said in a recording to Doctors Without Borders, or MSF. “The bodies were everywhere in the emergency room, with complete confusion.”

Qishta is among the many doctors — both Gazan and foreign — who recounted to HuffPost, aid groups and on social media the mass-casualty nightmare they faced this week.

Israel and Hamas agreed to a ceasefire deal in January that included exchanging hostages from both sides over three phases, as well as the withdrawal of Israeli soldiers from Gaza. Despite sporadic attacks that mostly consisted of Israeli gunfire, displaced Palestinians had a chance to return to what little was left of home — retrieving loved ones’ bodies for burial and even beginning to rebuild.

But amid the truce, Dr. Feroze Sidhwa told HuffPost he had still been treating injuries that ultimately stemmed from the initial shootings and explosions, including buildings that collapsed after Israeli strikes rendered them structurally unsound.

“The first trauma operation I did here was for a 24-year-old guy who was trying to retrieve his dad’s dead body from inside their apartment,” said the surgeon, who entered Gaza with a MedGlobal team on March 6. “It had been bombed months before, and while he was doing that the apartment collapsed on him and tore his left kidney off of his aorta. He almost bled to death from this.”

The Israeli military killed at least 150 people during the ceasefire in Gaza, according to Euro-Med Monitor. The human rights group’s field team said Palestinians were usually targeted when they tried to return to their homes near the border.

Dr. Sabrina Das arrived in Gaza for the first time last week as part of a training mission to help doctors in the territory learn specific obstetrics tools. Before Tuesday’s bombardment, Das was at a United Nations clinic teaching doctors how to use handheld ultrasound devices on pregnant women — 50,000 of whom are currently trapped in Gaza, according to UNFPA, the U.N. agency focused on global reproductive health.

On March 2, Israel cut off all aid from entering Gaza, leaving Palestinians without access to food, water, fuel, shelter, medicine and other basic supplies. Dozens of ultrasound devices, some of which could save the lives of these women and their unborn children, have been stalled at the border for weeks now, says UNFPA, and Das said the blockade means pregnant women have no reliable access to pain relief.

“We have a lot of NGOs that are carrying basic infant nutrition, basic medicines,” the OB-GYN said. “And when you don’t allow them to come in, then you have bare shelves in the pharmacy, and you have bare shelves in the hospital.”

In the middle of the night, Israel began raining bombs across the entire Palestinian territory, killing hundreds of people in a matter of hours. Netanyahu said the attack was “only the beginning,” blaming Hamas for refusing to free half the remaining hostages as a precondition of extending the ceasefire, despite it not being what either party had initially agreed to.

Das was asleep in southern Gaza’s Al-Mawasi area when the strikes began. She recalled the bombs hitting so close to her that the doors shook with every explosion, describing her reaction as “an out-of-body experience” where “your brain knows what’s happening but you don’t want to believe it.”

Before Tuesday, Sidhwa had not heard a single bomb since his arrival — so when the door to the medical team’s living quarters at Nasser Hospital smashed open, the surgeon leaped out of bed.

“I jumped up and all of a sudden it was, I couldn’t tell you how many, but it was a lot of explosions in very rapid succession, and it continued all night long,” he said. “I kind of expected this to happen while I was here, but at the same time I don’t wanna pretend it’s not frightening to be in a place that’s being bombed to smithereens.”

Sidhwa and his colleagues ran downstairs to Nasser’s emergency room, an area he described as initially well-prepared ahead of the incoming flood of mass casualty patients.

Normally the first wave of people coming into the hospital for care aren’t in the most desperate need, he explained, since they were likely able to transport themselves. It’s the patients who are brought in by emergency personnel who usually need hospital resources the most.

But as the sheer number of casualties climbed, hospitals began struggling to keep up.

“The situation was very tense, and the doctors in the emergency room fell down and collapsed,” Qishta said. “They were crying due to the intensity and the difficulty of the situation.”

Hospitals across Gaza — most of which are only partially functioning, at most — became quickly overwhelmed. The situation is even worse due to the continued aid blockade and the Israeli military’s latest ground invasion, which has resulted in Gaza’s north and south again being cut off from each other.

Below are graphic details of some of the cases these doctors encountered.

“We’ve run out of ketamine, we’ve run out of propofol, we’ve run out of all painkillers,” Dr. Mohammed Mustafa said in a video he recorded from a hospital in the north and shared on Instagram. “We can’t sedate anyone, we can’t give them any analgesia. When we intubate people, they wake up and they’re choking because we have no sedation.”

The Gaza Health Ministry says most of the casualties from this week’s bombardment have been children and women, including the pregnant people Das and other OB-GYNs were hoping they could help.

An OB-GYN who has chosen to be publicly identified only as “Dr. Yacoub” for their security recalled a 30-year-old woman who was 22 weeks pregnant when she came to Kuwaiti Hospital with a head injury, only to be pronounced dead. Upon examination, Yacoub found that the baby was also dead.

At Nasser, Sidhwa and fellow trauma surgeon Dr. Morgan McMonagle went to what they called the “red area,” where patients are at the most immediate risk of death. Sidhwa himself worked on at least seven cases within seven hours, including a 29-year-old woman who had a hole in her sacrum, a rectum torn in half, and a wounded vagina, bladder and colon.

At the time he spoke to HuffPost, the surgeon said that the woman had died about a half hour earlier — and that she was the sister of another physician there.

“Almost every health care worker in Gaza has had somebody from their own family, either immediate or extended, come into the hospital while they were working in the ER, dead,” he said.

McMonagle also operated on startling cases, including a 6-year-old child with shrapnel wounds all over his chest and abdomen. The boy had two holes in his heart; a laceration in his left lung; his liver’s right side split in half; two holes in his colon; three holes in his stomach; and five holes in his small bowel. He did not survive.

Mustafa said that many of the people his hospital received were women and children “burned head to toe,” with limbs and sometimes heads missing from their bodies. Seven girls were getting their legs amputated without anesthesia, he added.

“I don’t know what to tell you. I was here in June – nothing to this intensity. This is unbelievable, and the bombing is still going on. The rooms are still shaking. The screams are everywhere. It’s insane,” he said.

“I need to just take 15 minutes or even an hour, just to rest to go back in there and go back down again,” he continued. “I feel awful to leave but I’ve been there all night and I haven’t stopped, and my legs are shaking. And I feel dizzy and lightheaded. The smell of burnt flesh is still in my nose.”

The carnage from Tuesday’s barrage of Israeli airstrikes is hardly over, with local health officials saying the military killed at least 85 more Palestinians over Wednesday night into Thursday. The victims were targeted in southern Gaza’s Khan Younis and Rafah, as well as northern Gaza’s Beit Lahiya.

Nasser Hospital received the bodies of several people killed in the new attack. Sidhwa said he operated on a young patient who needed a splenectomy, a left kidney repair, and a repair of holes in his transverse colon — all from shrapnel. He also had to break up a fight between a doctor and a patient’s husband, and “everybody said before the war that kind of thing would never have happened.”

Das is now helping at Nasser’s maternity ward, along with extra residents from the now-destroyed Al-Shifa Hospital. On Wednesday, she saw 110 people in the outpatient department, where droves of pregnant women are coming for scans due to their anxiety and the illusion that it’s safer to walk in the daytime. Cleanliness also remains an issue, she added.

“The stories are heartbreaking — like I said, the long-term impact of war on women — the nurse I was working with has 4 children and has to leave them alone to come to work,” Das updated HuffPost in a Thursday message. “Her husband was a teacher and was captured by the Israelis. Her 16 year old daughter is the same age as my daughter. Has to look after her siblings.”

Meanwhile, Israel’s aid blockade on Gaza has entered its 18th day and led to the closure of community kitchens and water desalination plants in the territory. Hospitals have either run out of supplies or are dangerously close to doing so.

“If this continues, we will absolutely be out of supplies, and quickly. I couldn’t tell you the number of hours or days, but it would not be very many,” Sidhwa said. “I cannot imagine we would have enough supplies that I would be able to operate competently to any kind of standard … for even another week.”

Humanitarians have accused Israel this week of violating international law, including in the killing of a U.N. staffer the agency called “no accident.” A slew of countries, human rights organizations, the U.N. and others in the international community have already accused Israel of committing genocide against the Palestinian people.

The U.S. has so far continued to support Israel, with President Donald Trump openly pushing to “take over” the territory and forcibly resettle residents. The White House admitted to signing off on Tuesday’s attack.

Israel has come under particular scrutiny for its targeting of Gaza’s health care system, laying siege to multiple hospitals and either killing doctors or taking them captive. On Thursday, Human Rights Watch released a report that claimed Israel had committed war crimes by causing deaths and unnecessary suffering while occupying Gaza’s hospitals.

Sidhwa recalled speaking with several doctors who were interested in helping Palestinians in Gaza, stressing to potential volunteers what they must consider before doing so.

“Look, if you want to, that’s good and you should. I wish more people did,” the surgeon said. “But you have to accept if you come here, that if the Israelis want to kill you they will, and nothing will happen to them for doing it. The U.S. won’t care, your own congressman won’t care, your president won’t care – whether it’s Biden or Trump, doesn’t matter.”

“And that’s just what it is,” he continued. “Don’t have any illusions about you being safe when you’re here.”