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JERUSALEM — The nurse in the besieged hospital was caring for five fragile babies. Infants, born premature, their parents’ whereabouts after a month of war unknown. Now he faced the most difficult decision of his life.

It was the height of Israel’s assault on northern Gaza last month, and al-Nasr Children’s Hospital was a war zone. The day before, airstrikes had cut off the Gaza City facility’s oxygen supplies. Israeli tanks had surrounded the hospital complex, and the Israel Defense Forces were calling and texting the doctors, urging them to leave.

But ambulances couldn’t safely reach al-Nasr to transport the wounded, and doctors refused to leave the facility without their patients.

The five premature babies were particularly vulnerable. They needed oxygen, and medication administered at regular intervals. There were no portable respirators or incubators to transport them. Without life support, the nurse feared, they wouldn’t survive an evacuation.

Then the IDF delivered an ultimatum, al-Nasr director Bakr Qaoud told The Washington Post: Get out or be bombarded. An Israeli official, meanwhile, provided an assurance that ambulances would be arranged to retrieve the patients.

The nurse, a Palestinian man who works with Paris-based Doctors Without Borders, saw no choice. He assessed his charges and picked up the strongest one — the baby he thought likeliest to bear a temporary cut to his oxygen supply. He left the other four on their breathing machines, reluctantly, and with his wife, their children and the one baby, headed south.

“I felt like I was leaving my own children behind,” said the nurse, who spoke on the condition of anonymity to protect his privacy. “If we had the ability to take them, we would have, [but] if we took them off the oxygen they would have died.”

Israel is reviewing the next steps of its <a href="https://www.washingtonpost.com/israel-hamas-war/" target=_blank>war against Hamas</a> following warnings by President Biden that the United States will <a href="https://www.washingtonpost.com/politics/2024/05/08/biden-threatens-suspension-military-aid-israel/?itid=lk_inline_manual_2" target=_blank>cut off offensive weapons shipments</a> if the Israeli military advances into Rafah.

Two weeks later, the pause in hostilities allowed a Gazan journalist to venture into the hospital. In the neonatal intensive care unit, Mohammed Balousha made the awful discovery.

The decomposing bodies of the four babies. Eaten by worms. Blackened by mold. Mauled, Balousha said, by stray dogs.

“A terrible and horrific scene,” he told The Post.<b> </b>He took video.

The grim discovery was a reminder of the harrowing civilian toll of Israel’s war to eradicate Hamas, a campaign that has spared neither hospitals nor children. Thousands have been killed.

The current hostilities erupted on Oct. 7, when  Hamas and allied fighters streamed out of Gaza to attack Israeli communities near the enclave, killed around 1,200 Israelis and kidnapped 240 more. Israel responded with a full siege, airstrikes and ground operations that have killed more than 15,200 Palestinians, according to the Gaza health ministry, including thousands of children.

Israel has long accused Hamas of hiding command-and-control centers in hospitals; the Biden administration has backed the claim. Hamas and Gaza medical staff deny it.

Still, Israeli commanders have made the territory’s health care infrastructure a focus of the military campaign. A month into the war, that included al-Nasr.

It was Nov. 10 when Israeli forces told al-Nasr’s staff they had to leave, according to Qaoud, the hospital director. “They sent us a map for a safe route,” he told The Post in a WhatsApp message. “They gave us half an hour to go out. Otherwise, they will bombard the hospital.”

An official at the adjacent al-Rantisi pediatric cancer center seemed to receive an assurance that ambulances would retrieve patients from both al-Rantisi and al-Nasr. In a telephone conversation with the Coordinator of Government Activities in the Territories, an arm of Israel’s defense ministry, the al-Rantisi official requested ambulances. In a <a href="https://t.me/idfofficial/5131" target=_blank>recording of that call released by the Israel Defense </a>Forces, a senior COGAT officer responds in Arabic: “No problem.”

The senior COGAT officer tells the al-Rantisi official that he will “arrange coordination” for ambulances. He gives the precise route that medical staff should take out of the complex.

The al-Rantisi official reminds COGAT that staff will also be evacuating al-Nasr. The COGAT officer acknowledges the reminder.

Qaoud, too, said there was “coordination with the Red Cross and Israeli army that we will go out and then these cases will be later evacuated to another hospital that was safe.”

COGAT spokeswoman Shani Sasson told The Post that Israeli forces neither directed al-Nasr’s staff to evacuate nor operated inside the facility. She declined to answer whether COGAT or the Israeli military had been told about the babies or taken any action to care for them.

On Saturday, IDF Spokeswoman Doron Spielman appeared to cast doubt on the story during <a href="https://twitter.com/i/spaces/1BRJjPOzoYaKw?s=20" target=_blank>a live conversation on X, formerly Twitter: </a>“There were no premature babies that decomposed because of the IDF; there were probably no babies that decomposed whatsoever,” he said.

Sarah Davies, a spokeswoman for the International Committee of the Red Cross in Jerusalem, said the agency made no guarantees and could not safely reach the hospital.

The evacuation was painful. There was no way to reach the babies’ families, the nurse said. He had no contact information, and communications in much of Gaza were down. Their parents had been “displaced people,” he surmised, “who knew their children were in the hospital and didn’t think the hospital would be hit or raided by the occupation.

“They thought they left them in safety.”

It was time to leave. The nurse gathered up the strongest baby, made sure the others’ respirators were working, and, still wearing his scrubs, walked with his family out of the hospital to begin the 18-mile journey, much of it on foot, south to Khan Younis.

On the road, the nurse found an ambulance to take the baby in his arms to al-Shifa Hospital, Gaza’s largest. Israeli forces would raid that facility days later. The World Health Organization eventually evacuated 31 premature babies from al-Shifa. By then, several others had died.

On Nov. 24, after nearly seven weeks of fighting, Israel and Hamas began a week-long pause to exchange captives and allow more aid into Gaza.

Balousha, a journalist with the Dubai-based Al-Mashhad channel, took advantage of the relative calm to venture into Gaza City and report on corpses left out. On Nabil Tammos Street, he found two bodies, a man and a woman. Someone had covered them in a blanket.

“People [were] telling me that the strongest story is found in al-Nasr Hospital,” Balousha said. “They told me that premature babies were left in intensive care and that they were supposed to be rescued,” but with the fighting, “no one took them out.”

During the pause, Israeli forces remained near the hospital, cutting off civilian access. Balousha, undeterred, “jumped from wall to wall” through broken buildings to reach the medical complex.

As he approached the neonatal intensive care unit, he said, he “started to smell a foul odor.” He turned his camera on.

When Al-Mashhad <a href="https://www.youtube.com/watch?v=fl2BkqcZIHA" target=_blank>aired the report</a>, it blurred the remains. The channel gave an unaltered copy of the video to The Post, which verified that it was recorded inside al-Nasr’s neonatal intensive care unit by comparing it with images of the facility from before the war.

The remains, still hooked up to respirators, bear little resemblance to bodies. They appear as piles of rotting flesh, bones protruding, body parts difficult to make out. Soiled-looking diapers remain wrapped around their middles.

Balousha described the scene on camera and hurried out of the unit.

The nurse, who reviewed the video, said the corpses were found where he had left the babies. No one had come for them.

Qaoud, the al-Nasr director, said the Israeli military “was informed there were cases” left inside the hospital, but “was determined to evacuate.”

Davies, the Red Cross spokeswoman, said the organization “received several requests to evacuate hospitals in the north of Gaza, but due to this security situation, we were not involved in any operations of evacuations, nor did teams commit to doing so.”

No one has emerged to claim the bodies. There has been no indication, the nurse said, that the parents know their children are dead.

He remains haunted by the event. He believes he needs psychiatric treatment.

Of what, he asks, were the babies guilty?

“Were they fighters?” he asked. “Were they holding weapons? Were they firing rockets?

“Why does the army hit the oxygen and electricity? Why did the army target them?”

<i>Heba Farouk Mahfouz in Cairo contributed to this report.</i>

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Miriam Berger, a staff writer writer on The Post's international news desk in Washington, has since Oct. 7 been on assignment in Jerusalem, where she covers Israel, the Palestinian territories and the war in Gaza. Before joining The Post, she was based in Jerusalem and Cairo and was a freelance reporter.

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