When Dr Ammar Darwish went to Gaza in January 2024 as a volunteer medic, his team narrowly escaped an Israeli airstrike on their accommodation. By the time he returned in August, the level of destruction, the severity of patient injuries and the lack of essentials in the territory had significantly worsened.
"Gaza is one of the worst missions that I've done, especially this time around. It has affected me and affected the whole team," said Darwish, a general and major trauma surgeon from Manchester who has also worked in Syria, Yemen, Iraq, Libya and Ukraine.
"Saving one life is a good enough reason to go back," said Darwish, who returned from a volunteer mission with Medical Aid for Palestine (MAP) in Gaza last month.
Nearly a year into the war - which began after the 7 October assault by Hamas militants on southern Israel that killed 1,200 people, mostly civilians - the Guardian spoke to volunteer healthcare workers from the UK who had travelled to Gaza in recent months.
They called on the British government to evacuate patients, apply pressure for an immediate ceasefire, and push for the opening of aid corridors as essential supplies remain at the Egyptian border.
At overcrowded hospitals, medics report operating without essentials such as surgical gowns and gauze. Malnutrition is also a huge problem, according to doctors, along with worsening sanitation and the limited access to water. Polio vaccinations started last month but a brutal reality, Darwish said, is that some of the children being vaccinated will be seen as casualties in the evening.
"I really cannot imagine how things will become in two months' time," he said. "After what I've seen there, I would really ask our UK government, our prime minister, to push forward and put pressure on all sides to have an immediate permanent ceasefire [and] to allow medical aid.
"And also to protect civilians, and protect medics and medical facilities. They're unprotected, they're unsafe."
A Foreign, Commonwealth and Development Office spokesperson said: "A resolution to this conflict, the release of all hostages still cruelly detained by Hamas, better protection for civilians, aid and medical workers, and much more aid entering Gaza has been a priority since day one of this government."
Dr Ana Jeelani, a paediatric orthopaedic surgeon from Liverpool who travelled to Gaza's al-Aqsa hospital in March, says the government has failed to recognise the "actual concerns that we have as humanitarian aid workers".
Jeelani said the UK had failed to take a single patient from Gaza. The United Arab Emirates, Spain and the European Union have evacuated severely sick and injured patients, according to the World Health Organization (WHO). "I work in a trust that openly accepted Ukrainian refugees and provided them cancer care, NHS care, and we have been told that we cannot accept patients from Gaza because the government have not allowed this," she said. "How can we be a developed country and not allow a single patient into our hospitals when there is such a massive man-made catastrophe happening?"
Aid and health workers account for at least 765 of the more than 41,000 people killed in Israel's assault on Gaza, according to the WHO and the Palestinian health ministry. Of Gaza's 36 hospitals, 32 are damaged and 17 are partially functioning, according to the WHO.
Hospitals have been battlegrounds since the start of the Israeli offensive. The IDF, which has been approached for comment, previously said Hamas "systematically" uses hospitals and medical centres to conduct terror activities. Hamas denies the claims.
With trucks loaded with life-saving essentials in a backlog of lorries unable to enter from Egypt, aid groups have warned more than a million people in Gaza will not have enough food this month. In September, 1,386 humanitarian trucks entered Gaza according to Unrwa data, largely through the Erez crossing, compared with 3,096 trucks in August and 4,681 trucks in July.
Dr Yassar Qureshi, an oesophago-gastric cancer and general surgeon from London, who travelled to Gaza in April with MAP, said: "There were plenty of patients who simply died because we didn't have appropriate specialists or medications or equipment."
Working at al-Aqsa hospital, Qureshi described operating on patients who would days later return to the operating theatre with worsened conditions as a result of malnutrition.
"You go in with high hopes of helping people and saving lives, but the reality is that actually, we're just prolonging the misery. It was the first time in my life, as a doctor, as a surgeon, that you actually sometimes wish that a patient wouldn't survive or wouldn't make it," he said.
"It was more merciful if they just died. And it's a horrible thing to say, but that's the stark reality."
Dr Khaled Dawas, a consultant surgeon and associate professor at University College London Hospitals, said nearly half of the patients he operated on during his recent visit to al-Aqsa hospital in April died within a week.
"Forgetting the fact that you're a human, as a professional it's very difficult to get over that and accept that you've failed 50% of the time. It's a staggering number," he said.
Dawas, who has been to Gaza twice since December, said there were more than 20 patients in the emergency department, including children, with bullet wounds to the head.
"What needs to be done is for this war to stop," said Dawas. "It's a catastrophe ... the scale of it is just beyond the human understanding."
Dr Nizam Mamode, a general, vascular and transplant surgeon who retired from the NHS in 2022, travelled into the territory with MAP in August. He said the territory looked "postapocalyptic" upon entering, and the level of casualties and conditions were "unlike anything I'd seen anywhere else".
"You felt insecure in a way that I've never felt in any other conflict area, because I think there's always been a feeling that aid workers and journalists are not deliberate targets," said Mamode. "But in Gaza, it feels as if they are. And so there's always a degree of insecurity, and for that reason, we never left the hospital."
What shocked him most was the number of intensive care hospital beds taken up by children.
"We saw children with single bullet wounds to the head, which you have to conclude is deliberate targeting. We saw children who gave very clear descriptions of drone attacks. Again, deliberate. The drone comes down, hovers above them, fires," he said.
"What everyone agrees is we need a ceasefire, and I think that was urgent a long time ago," said Mamode, who plans to return. "A ceasefire in which the hostages are released and the bombing stops is going to be good for everybody."