It seems like a lifetime ago that attacking a hospital was a scandal.

After Gaza’s al-Ahli hospital was hit by a mysterious blast on October 17, killing numerous civilians, the Israeli government resorted to desperate efforts to deny responsibility for the attack and instead blame Hamas. A deliberate military attack on a hospital is as clear a war crime as they come, and Israeli officials seemed to understand that were they pinned for the blame, it would be devastating to Israel’s international standing and further turn global sentiment against its military campaign. (Several independent reports since have lent credence to Israeli claims that the culprit may have been a misfired Hamas rocket).

Fast forward a month and a half, and Israeli forces have now attacked and shut down Gaza’s largest hospital, bombed a convoy of ambulances, and besieged and bombed Indonesian Hospital, just a few cases out of the more than two-dozen Gazan hospitals that Israeli attacks have rendered nonfunctional. All of it has been done out in the open and, more often than not, alongside public justifications for the attacks — with devastating consequences for those trapped inside, and with a modicum of the outcry that once greeted al-Ahli’s bombing. This “unrelenting war” on the Gaza health sector, as one United Nations official has called it, continues as you read this, with Israeli forces turning their guns on al-Awda hospital in northern Gaza to little public attention.

At the time of writing, more than 240 people are trapped inside al-Awda, the last functioning hospital in northern Gaza providing maternity services, and currently in the ninth day of a siege that’s left several people dead and those inside struggling to survive. The increasingly dire situation has been provided to media in daily updates by Mohammed Salha, a monitoring manager at the hospital who has described to Jacobin the desperate conditions faced by the patients, medical staff, and families who have no way out of the facility.

Al-Awda is surrounded by snipers, according to Salha, making it impossible to move between hospital buildings, and leaving survivors corralled in a single building, sleeping far from windows and crawling on the floor to avoid being shot. Snipers have already killed two of Salha’s colleagues and a janitor who came too close to the windows, as well as a relative of a pregnant patient, who was shot in the street outside the hospital and whose body has been left to decompose, unable to be retrieved by those inside. Another, a sixteen-year-old, was also shot outside the hospital, but had his life saved by medical personnel.

As a result, hospital staff have been rationing the rapidly dwindling food, water, and medicine supplies, says Salha, with the more than two-hundred people trapped in the hospital subsisting on one meal per day of bread or rice. No food, water, or fuel is coming in, while Israeli forces bombed the facility’s water tanks on the fifth day of the siege. The presence of snipers means no one can leave to refill the generator powering the facility, nor travel between buildings to get more medication, putting patients under further risk. “We are living in a disaster here,” Salha told Jacobin.

Those patients include children and babies. On the eighth day of the siege, Salha says, medical staff had to amputate the leg of a four-year-old girl, risking infection. A video provided to Jacobin shows several sickly, ashen-faced young children sleeping in a hospital corridor.

According to Salha, no warning from Israeli forces preceded the siege and there has been no communication from Israeli forces as it’s gone on, while no one can leave the grounds for fear of being killed by snipers, making it impossible to know what the military goal of the attack is or how those trapped inside might evacuate. (The Israeli military did not respond to a request for comment.) Salha is calling for provisions of food, water, fuel, and medicine to be allowed inside the hospital and for public pressure on the Israeli government to end the siege. If not, the scene described suggests patients and staff are facing imminent starvation and dehydration, alongside medical complications from lack of medicine and unsanitary conditions.

This isn’t the first time the Israeli military has attacked al-Awda. In late November, Médecins Sans Frontières (MSF) had two of its doctors killed when Israeli forces struck the third and fourth floors of the hospital. According to MSF, it had regularly shared with the Israeli military information about al-Awda and the presence of its staff before the strike. At the start of this month, the organization blamed Israel for what it called a “deliberate attack against clearly identified MSF vehicles” that were part of an evacuation convoy, killing two family members of its staff.

An MSF spokesperson described conditions in al-Awda reported by colleagues in the hospital that matched Salha’s account, including a “total siege” imposed by Israeli forces since December 5 and snipers surrounding the hospital targeting those inside. Five hospital staff have been killed in various attacks since October 7 according to the organization, while one MSF-affiliated surgeon in the facility was injured by sniper fire on December 11.

“Reports coming out of al-Awda hospital are harrowing and we are gravely worried for safety of patients and staff inside,” said Renzo Fricke, MSF head of mission in the occupied Palestinian territories. “Let us be clear: al-Awda is a functioning hospital with medical staff and many patients in vulnerable condition. Targeting medical workers as they care for their patients is utterly reprehensible, utterly inhumane.”

Meanwhile, yesterday Israeli forces stormed Kamal Adwan Hospital, also in northern Gaza, after days of besieging and bombing it, mirroring the strategy it has taken to previous assaults on Gaza’s medical facilities, and providing a possible preview of what awaits those trapped in al-Awda. Previous raids on hospitals have led to civilian deaths and horrifying scenes of patients — including children and premature babies — being left behind to die and decompose by evacuating staff.

Top Israeli leadership has previously strongly condemned attacks on hospitals, as when it accused Hamas of causing the explosion at al-Ahli. Prime Minister Benjamin Netanyahu called the alleged perpetrators “barbaric terrorists,” while president Isaac Herzog said al-Ahli was “a place where lives should be saved” and laid “shame on the vile terrorists in Gaza who willfully spill the blood of the innocent.”

The ongoing siege of al-Awda is a reminder of the brutality of what has been an exceptionally savage military campaign by Israel, as well as the seemingly growing public tolerance for Israeli war crimes. Not even two months ago, the bombing of a hospital was a major outrage; now, when a public outcry is desperately needed to stop it, the siege of another hospital is just one more thread in a tapestry of violence. What crimes will become normal in another month or two?