As Israeli bombs fell, wounded children overwhelmed this Gaza hospital. Dozens died

CAIRO (AP) — When the first explosions in Gaza this week started around 1:30 a.m., a visiting British doctor went to the balcony of a hospital in Khan Younis and watched the streaks of missiles light up the night before pounding the city. A Palestinian surgeon next to him gasped, “Oh no. Oh no.”

After two months of ceasefire, the horror of Israeli bombardment was back. The veteran surgeon told the visiting doctor, Sakib Rokadiya, they’d better head to the emergency ward.

Torn bodies soon streamed in, carried by ambulances, donkey carts or in the arms of terrified relatives. What stunned doctors was the number of children.

“Just child after child, young patient after young patient,” Rokadiya said. “The vast, vast majority were women, children, the elderly.”

This was the start of a chaotic 24 hours at Nasser Hospital, the largest hospital in southern Gaza. Israel shattered the ceasefire in place since mid-January with a surprise barrage that began early Tuesday and was meant to pressure Hamas into releasing more hostages and accepting changes in the truce’s terms. It turned into one of the deadliest days in the 17-month war.

The aerial attacks killed 409 people across Gaza, including 173 children and 88 women, and hundreds more were wounded, according to the territory’s Health Ministry, whose count does not differentiate between militants and civilians.

More than 300 casualties flooded into Nasser Hospital. Like other medical facilities around Gaza, it had been damaged by Israeli raids and strikes throughout the war, leaving it without key equipment. It was also running short on antibiotics and other essentials. On March 2, when the first, six-week phase of the ceasefire technically expired, Israel blocked entry of medicine, food and other supplies to Gaza.

Nasser Hospital's emergency ward filled with wounded, in a scene described to The Associated Press by Rokadiya and Tanya Haj-Hassan, an American pediatrician — both volunteers with the charity Medical Aid for Palestinians. Wounded came from a tent camp sheltering displaced that missiles set ablaze and from homes struck in Khan Younis and Rafah, further south.

One nurse was trying to resuscitate a boy sprawled on the floor with shrapnel in his heart. A young man with most of his arm gone sat nearby, shivering. A barefoot boy carried in his younger brother, around 4 years old, whose foot had been blown off. Blood was everywhere on the floor, with bits of bone and tissue.

“I was overwhelmed, running from corner to corner, trying to find out who to prioritize, who to send to the operating room, who to declare a case that’s not salvageable,” said Haj-Hassan.

“It’s a very difficult decision, and we had to make it multiple times,” she said in a voice message.

Wounds could be easy to miss. One little girl seemed OK – it just hurt a bit when she breathed, she told Haj-Hassan -- but when they undressed her they determined she was bleeding into her lungs. Looking through the curly hair of another girl, Haj-Hassan discovered she had shrapnel in her brain.

Two or three wounded at a time were squeezed onto gurneys and sped off to surgery, Rokadiya said.

He scrawled notes on slips of paper or directly on the patient’s skin – this one to surgery, this one for a scan. He wrote names when he could, but many kids were brought in by strangers, their parents dead, wounded or lost in the mayhem. So he often wrote, “UNKNOWN.”

Dr. Feroze Sidhwa, an American trauma surgeon from California with the medical charity MedGlobal, rushed immediately to the area where the hospital put the worst-off patients still deemed possible to save.

But the very first little girl he saw -- 3 or 4 years old -- was too far gone. Her face was mangled by shrapnel. “She was technically still alive,” Sidhwa said, but with so many other casualties “there was nothing we could do.”

He told the girl’s father she was going to die. Sidhwa went on to do some 15 operations, one after another.

Khaled Alserr, a Palestinian surgeon, and an Irish volunteer surgeon were doing the same. There was a 29-year-old woman whose pelvis was smashed, the webbing of veins around the bones was bleeding heavily. They did what they could in surgery, but she died 10 hours later in the intensive care unit.

There was a 6-year-old boy with two holes in his heart, two in his colon and three more in his stomach, Sidhwa said. They repaired the holes and restarted his heart after he went into cardiac arrest.

He, too, died hours later.

“They died because the ICU simply does not have the capacity to care for them,” Sidhwa said.

Ahmed al-Farra, head of the pediatric and obstetrics department, said that was in part because the ICU lacks strong antibiotics.

Sidhwa recalled how he was at Boston Medical Center when the 2013 Boston Marathon bombing happened, killing three people and sending some 260 wounded to area hospitals.

Boston Medical “couldn’t handle this influx of cases” seen at Nasser Hospital, he said.

Rokadiya marveled at how the hospital staff took care of each other under duress. Workers circulated with water to give sips to doctors and nurses. Cleaners whisked away the bloody clothes, blankets, tissues and medical debris accumulating on the floors.

At the same time, some staff had their own family members killed in the strikes.

Alserr, the Palestinian surgeon, had to go to the morgue to identify the bodies of his wife’s father and brother.

“The only thing I saw was like a packet of meat and bones, melted and fractured,” he said in a voice message, without giving details on the circumstances their deaths.

Another staffer lost his wife and kids. An anesthesiologist -- whose mother and 21 other relatives were killed earlier in the war -- later learned his father, his brother and a cousin were killed, Haj-Hassan said.

Around 85 people died at Nasser Hospital on Tuesday, including around 40 children from ages 1 to 17, al-Farra said.

Strikes continued throughout the week, killing several dozen more people. At least six prominent Hamas figures were among those killed Tuesday.

Israel says it will keep targeting Hamas, demanding it release more hostages, even though Israel has ignored ceasefire requirements for it to first negotiate a long-term end to the war. Israel says it does not target civilians and blames Hamas for their deaths because it operates among the population.

With Tuesday’s bombardment, Prime Minister Benjamin Netanyahu also secured the return to his government of a right-wing party that had demanded a resumption of the war, solidifying his coalition ahead of a crucial budget vote that could have brought him down.

Haj-Hassan keeps checking in on children in Nasser's ICU. The girl with shrapnel in her brain still can’t move her right side. Her mother came to see her, limping from her own wounds, and told Haj-Hassan that the little girl’s sisters had been killed.

“I cannot process or comprehend the scale of mass killing and massacre of families in their sleep that we are seeing here,” Haj-Hassan said. “This can’t be the world we’re living in.”

Associated Press writers Julia Frankel in Jerusalem, Fatma Khaled in Cairo, and Sarah El Deeb in Beirut contributed to this report.

FILE - A man mourns over the body of a child in a hospital morgue following Israeli airstrikes in Khan Younis, southern Gaza Strip, Tuesday, March 18, 2025. (AP Photo/Mohammad Jahjouh, File)

FILE - Two people mourn over the body of a man in a hospital morgue following Israeli airstrikes in Khan Younis, southern Gaza Strip, Tuesday, March 18, 2025. (AP Photo/Mohammad Jahjouh, File)

EDS NOTE: GRAPHIC CONTENT - FILE - The body of a child is placed on the floor in a hospital morgue following Israeli army airstrikes in Khan Younis, southern Gaza Strip, Tuesday, March 18, 2025. (AP Photo/Mohammad Jahjouh, File)

FILE - An injured man waits for treatment on the floor of a hospital following Israeli airstrikes in Khan Younis, southern Gaza Strip, Tuesday, March 18, 2025. (AP Photo/Mohammad Jahjouh, File)

Injured Palestinians wait for treatment at the hospital following Israeli army airstrikes in Khan Younis, southern Gaza Strip, Tuesday, March 18, 2025. (AP Photo/Mohammad Jahjouh)

An explosion erupts in the northern Gaza Strip, as seen from southern Israel, on Tuesday, March 18, 2025. (AP Photo/Leo Correa)

EDS NOTE: GRAPHIC CONTENT - FILE - Eyad Abu Jazar holds the body of a child he believes to be his nephew, who was killed in Israeli army airstrikes, at Nasser Hospital morgue in Khan Younis, southern Gaza Strip, March 18, 2025. (AP Photo/Mohammad Jahjouh, File)

WASHINGTON (AP) — As President Donald Trump and his adviser Elon Musk work to overhaul the federal government, they’re forcing out thousands of workers with insider knowledge and connections who now need a job.

For Russia, China and other adversaries, the upheaval in Washington as Musk's Department of Government Efficiency guts government agencies presents an unprecedented opportunity to recruit informants, national security and intelligence experts say.

Every former federal worker with knowledge of or access to sensitive information or systems could be a target. When thousands of them leave their jobs at the same time, that creates a lot of targets, as well as a counterespionage challenge for the United States.

“This information is highly valuable, and it shouldn’t be surprising that Russia and China and other organizations — criminal syndicates for instance — would be aggressively recruiting government employees,” said Theresa Payton, a former White House chief information officer under President George W. Bush, who now runs her own cybersecurity firm.

Each year an average of more than 100,000 federal workers leave their jobs. Some retire; others move to the private sector. This year, in three months, the number is already many times higher.

It's not just intelligence officers who present potential security risks. Many departments and agencies oversee vast amounts of data that include personal information on Americans as well as sensitive information about national security and government operations. Exiting employees could also give away helpful security secrets that would allow someone to penetrate government databases or physical offices.

The Office of the U.S. Trade Representative, for instance, maintains information on trade negotiations that could help an adversary undercut the United States. Federal records house data on clandestine intelligence operations and agents. Pentagon databases contain reams of sensitive information on U.S. military capabilities. The Department of Energy oversees many of the nation's most closely guarded nuclear secrets.

“This happens even in good times — someone in the intelligence community who for personal financial or other reasons walks into an embassy to sell America out — but DOGE is taking it to a whole new level,” said John Schindler, a former counterintelligence official.

“Someone is going to go rogue,” he said. “It’s just a question of how bad it will be.”

Only a tiny fraction of the many millions of Americans who have worked for the federal government have ever been accused of espionage. The overwhelming number are conscientious patriots who would never sell out their country, Payton said.

Background checks, employee training and exit interviews are all designed to prevent informants or moles — and to remind departing federal employees of their duty to preserve national secrets even after leaving federal service.

It takes only one or two misguided or disgruntled workers to cause a national security crisis. Former FBI agent Robert Hanssen and former CIA officer Aldrich Ames, who both spied for Russia, show just how damaging a single informant can be.

Hanssen divulged sweeping information about American intelligence-gathering, including details that authorities said were partly responsible for the outing of U.S. informants in Russia who were later executed for working on America's behalf.

The odds that one angry former employee reaches out to a foreign power go up as many federal employees find themselves without a job, experts said. What's not in doubt is that foreign adversaries are looking for any former employees they can flip. They're hunting for that one informant who could deliver a big advantage for their nation.

“It's a numbers game,” said Schindler.

Frank Montoya Jr., a retired senior FBI official and former top U.S. government counterintelligence executive, said he was less concerned about well-trained intelligence community employees betraying their oaths and selling out to American adversaries. But he noted the many workers in other realms of government who could be targeted by Russia or China,

“When it comes to the theft of intellectual property, when it comes to the theft of sensitive technology, when it comes to access to power grids or to financial systems, an IRS guy or a Social Service guy who’s really upset about what DOGE is doing, they actually are the bigger risk,” Montoya said.

Once military and intelligence officials were the primary targets of foreign spies looking to turn an informant. But now, thanks to the massive amount of information held at many agencies, and the competitive edge it could give China or Russia, that's no longer the case.

“We have seen over the last generation, the last 20–25 years, the Chinese and the Russians increasingly have been targeting non-national defense and non-classified information, because it helps them modernize their military, it helps them modernize their infrastructure," Montoya said.

The internet has made it far easier for foreign nations to identify and recruit potential informants.

Once, Soviet intelligence officers had to wait for an embittered agent to make contact, or go through the time-consuming process of identifying which recently separated federal employees could be pliable. Now, all you need is a LinkedIn subscription and you can quickly find former federal officials in search of work.

“You go on LinkedIn, you see someone who was ‘formerly at Department of Defense now looking for work’ and it’s like, 'Bingo,’" Schindler said.

A foreign spy service or scammer looking to exploit a recently laid-off federal worker could bring in potential recruits by posting a fake job ad online.

One particularly novel concern involves the fear that a foreign agent could set up a fake job interview and hire former federal officials as “consultants” to a fake company. The former federal workers would be paid for their expertise without even knowing they were supplying information to an enemy. Russia has paid unwitting Americans to do its business before.

Payton's advice for former federal employees looking for work? It's the same as her guidance for federal counterespionage officials, she said: "Be on high alert."

The Office of the Director of National Intelligence did not respond to questions about the risks that a former federal worker or contractor could sell out the country. Director of National Intelligence Tulsi Gabbard recently announced plans to investigate leaks within the intelligence community, though her announcement was focused not on counterespionage concerns but on employees who pass information to the press or the public.

In a statement, the office said it would investigate any claims that a member of the intelligence community was improperly releasing information.

“There are many patriots in the IC that have reached out to DNI Gabbard and her team directly, explaining that they have raised concerns on these issues in the past but they have been ignored," the office said. “That will no longer be the case.”

FILE - Demonstrators rally in support of federal workers outside of the Department of Health and Human Services, Feb. 14, 2025, in Washington. (AP Photo/Mark Schiefelbein, File)