As he sleeps, Nooh al-Shaghnobi, a rescuer in Gaza, is haunted by the cries of those he could not save.
Memories of the past 14 months come flooding back, nightmares of collapsed buildings with no equipment to dig out survivors.
“We hear the voices of people under the rubble,” he said in an interview between rescue calls. “Imagine that there are people under the rubble that we know are alive, but we cannot save them. We have to let them die.”
It has been Gaza for more than a year lifeguardsParamedics and ambulance drivers worked hard to front lines of the war, rushing to the sites of countless Israeli airstrikes to try to rescue those who survived and recover the bodies of those who didn’t. Only in the first seven weeks of the war, Israel fired almost 30,000 rounds of ammunition into Gazalaunching one of the most intense bombing campaigns in modern warfare.
The International Committee of the Red Cross said rescuers in Gaza were facing dangerous conditions without enough equipment, vehicles or fuel. They were mostly left to use their hands and rudimentary tools to dig out survivors from under tons of broken stone, concrete and twisted metal.
The carnage took a heavy physical, mental and emotional toll on rescuers, with Israeli strikes killing at least 118 during the conflict, according to local rescue officials.
“First responders suffer untold levels of stress, anxiety and frustration,” said Hisham Mhanna, spokesman for the Red Cross in Gaza. “We heard them describe their feelings of helplessness towards the victims they could not save and the immense pain of losing their colleagues in the line of duty.”
Since the beginning of the war — which began after Hamas attacked Israel on October 7, 2023 — they have been saviors struggling to keep up with the pace of airstrikes. In the first year of the war, the Israeli military said it hit more than 40,000 targets in an area the size of Detroit with approximately 60,000 bombs and other munitions.
Residents and aid officials say this war has been like no other Gazans have lived through, with no safe place to shelter and no goal. Israel’s military said it was taking “feasible precautions to mitigate harm to civilians.”
Despite the trauma, Mr al-Shaghnobi, 23, said he was driven to persevere in his rescue work with the Gaza Civil Defense, the emergency services agency, knowing he could save at least some lives.
He said he regularly shares videos and pictures on social media to draw attention to the suffering in Gaza.
In one video released in October in the Zeitoun neighborhood of Gaza City, calls out to a boy whose muffled cries can be heard under the rubble.
“Don’t be afraid,” Mr. al-Shagnobi shouts, issuing a series of quick instructions: “Rashid, don’t bother. Don’t speak. Don’t lose consciousness.”
Illuminated by a headlamp, the rescuer crawls between the collapsed floors to reach Rashid’s partially exposed head, the rest buried in crushed cement and stone. After three hours, Rashid was pulled alive from the rubble.
“Every day is harder than the last,” Mr al-Shaghnobi said. “My soul is weary of this war.”
The Red Cross, which provided rescuers with masks, boots, protective uniforms and body bags, also offered limited mental health counseling. But given the extreme trauma of the situation, the sessions were not enough, said Mr Mhanna, the Red Cross spokesman.
Amir Ahmed, a paramedic, said a few months ago his nightmares became too much for him and he quit his job with the Palestine Red Crescent Rescue Service.
“You get to a point where you can’t go on with this anymore,” he said recently.
Mr Ahmed said he worked in antiquities protection before the war and also volunteered with the Red Crescent during many of the conflicts in Gaza as he was trained as an emergency medical technician. He said he was called to duty on the second day of the war.
As the conflict progressed, he said, he realized he was falling deeper into depression. At home with his wife and three children, he became increasingly tense and angry.
Some days he tried to avoid talking to anyone and wanted to spend all his time sleeping, even when they were housed in tents or crammed into one-room apartments.
“I would dream of people who were in the pieces I picked up with my own hands,” he said, lowering his voice.
The smell of blood lingered on his hands for days after one rescue and recovery, he said, adding that there was almost no psychological support or mental health help.
Although he feels guilty about leaving the lifeguard job, he said he has no regrets about his decision.
Some rescuers accuse Israel of targeting them, accusations echoed by the Red Crescent and the Gaza Civil Defense.
The Israeli army said it had never targeted rescuers and would never do so on purpose. “The Israel Defense Forces also recognize the importance of the special protection afforded to medical teams under international humanitarian law and are taking measures to prevent their harm,” the military said in a statement.
They lost contact with Red Crescent dispatchers shortly after arriving on the scene and were found nearly two weeks later dead in their burned ambulances. Hind was also found dead in her family’s vehicle.
The Red Crescent accused Israeli forces of bombing the ambulance as it arrived “despite prior coordination” between the organization and the Israeli army. The Israeli army did not comment on the attack despite repeated requests.
At the beginning of the war, Mr. al-Shaghnobi said, he and his fellow rescuers would say goodbye to each other every night, unsure how long they would survive the Israeli attack.
He said that in November 2023, he was with his colleagues at the site of a seven-story building that had been demolished by an Israeli airstrike a few days earlier, trying retrieve the bodies of the family.
As rescuers combed through the rubble, another Israeli airstrike took place, killing two rescuers and two surviving family members, according to a relative at the time and Mr. al-Shaghnobi.
He recorded immediately after the strike on the video.
“Why does this happen to us who only save people?” he said recently. “We have nothing to do with weapons or resistance. All our work is humanitarian. Why are the Israelis targeting us?”
Naseem Hassan, a paramedic and ambulance driver, said his brother was killed almost a year ago at Al Amal Hospital while working for the Red Crescent. He was killed in an airstrike after climbing onto the roof of a hospital to turn on a generator, his surviving brother said. The Israeli military said it was “not aware of the incident”.
Mr Hassan, 47, said he was exhausted from the strain and exhaustion of rescuing the war wounded.
When the conflict began, he said, he weighed 190 kilograms. Now, after living mostly on tinned food and bug-infested bread and physically exhausting days spent digging through rubble, he’s down to about 150 pounds.
“We are mentally patient and determined, because we have to be,” he said. “If we were to have a nervous breakdown, who else is going to save people? Who will retrieve the bodies? Who will bury them?”
Patrick Kingsley contributed reporting.
