Almost 10 months since the start of the Israeli genocide in Gaza, the official death toll has now exceeded 40,000. While this number is shocking enough, it does not take into account the various forms of death Palestinians face that are not directly caused by an Israeli bullet or bomb.

In the Gaza ghetto where Palestinians live, which even United States President Joe Biden described as “sheer hell”, Palestinians die from heat, thirst, hunger and diseases caused by the debilitating siege on the strip.

Among these uncounted dead is Inshirah, a grand Badrasawi woman and a member of my extended family. She was married to my father’s cousin, Abdelfattah, and was an integral part of the community of refugees from Beit Daras (Badrasawi means coming from Beit Daras) – a Palestinian village located 32km northeast of Gaza, which Zionist militias destroyed in 1948.

Inshirah was not just any woman; she was a pillar of strength, courage and kindness in Khan Younis refugee camp and al-Qarara neighbourhood. After Abdelfattah passed away from a heart attack at a young age, she single-handedly raised six orphans: five boys and one girl. Known for her great social skills and sense of humour, Inshirah was the smiling face of the camp.

During the first Intifada, she risked her life on several occasions to rescue children from the Israeli army, often getting beaten for her bravery. One time, when my 11-year-old brother Anwar was arrested on his way back home from school, Inshirah courageously stormed the group of soldiers who were hitting him with their batons. She hugged him tightly, shielding him from the painful blows, and cried out with her loudest voice, “He is my son, he is my son!” Her screams alerted the women of the camp, who quickly came to help. Though my brother was saved, Inshirah was left with a broken arm and many bruises from the beating.

Once her children grew up and secured jobs, Inshirah moved from the refugee camp to a piece of land in al-Qarara, east of Khan Younis, where she built a home.

Anwar continued visiting her regularly after she moved. With her sharp wit, she would often remind him of the time she saved his life, saying, “This visit is part of the debt you owe me for saving your life.” Her teasing always made everyone laugh.

This was one of the many stories she shared when we last visited her in July 2023. Despite the severe kidney disease she was suffering from and the toll her biweekly dialysis treatments took on her, she remained humorous and generous of spirit, sharing memories and cracking jokes at the dinner table. Her laughter, as always, filled the room with warmth.

In Arabic, the word “inshirah” means joy and our Inshirah very much lived up to her name.

Al-Qarara was one of the first places invaded and destroyed by the Israeli army. Her home suffered substantial damage from the bombings, but she and the families of her four adult children who lived with her managed to escape in time. They sought refuge in Khan Younis camp near Nasser Hospital, the largest medical complex in Gaza, after al-Shifa.

When the Israeli army laid siege to the hospital compound in February, she was forced to flee again, this time close to Khan Younis’s al-Amal Hospital, which the Israelis had raided and ransacked earlier. Her children always wanted to be as close as possible to any health facility.

At that point, we lost contact with Inshirah and her children. I was overwhelmed with fear and anxiety, imagining her being ill amid genocide and the dire lack of resources. The memories of losing my parents due to the Israeli blockade of Gaza preventing proper medical care amplified my anguish. The endless pain we have endured made the thought of her and her children’s plight even more unbearable.

It was not until four months later that we found out what had happened. My nephew met one of Ishirah’s daughters-in-law near Nasser Hospital and found out that she was very ill. A few days later, my family in Gaza heard about her passing. At the funeral, Inshirah’s sons shared their harrowing story.

As the Israeli attacks on Khan Younis were raging, taking countless Palestinian lives, Inshirah’s family decided to move to Rafah. They made it to the Tal as-Sultan neighbourhood in Rafah, trying to stay near Abu Youssef al-Najjar Hospital.

Inshirah’s condition rapidly worsened, requiring three dialysis sessions a week, but transportation to the hospital became a nightmare. Ambulance services were scarce and dangerous, so her children resorted to private transport: cars, donkey carts and even a wheelchair running through the torn-up streets.

Tears streamed down her son Iyad’s face as he recounted to my brothers how he once had to surrender the rented donkey cart that was transporting his mother to carry the bodies of a family killed by the IOF. It was an impossible choice between preserving life and respecting the martyrs.

Inshirah continued her arduous journey in a wheelchair over rough and destroyed roads, which took a toll on her already fragile health.

The May invasion of Rafah sent Inshirah’s family on the move again. They fled to al-Mawasi in Khan Younis, a former recreation area turned into a zone of horror and despair. Inshirah’s suffering intensified as she struggled to access dialysis, this time at Al-Aqsa Martyrs Hospital in Deir el-Balah.

Eventually, the family returned to the partially rehabilitated Nasser Hospital as the trips to Deir el-Balah proved too much. Resources were scarce in the hospital, with medication and equipment often unavailable or inoperable due to the continuous Israeli shelling of Khan Younis.

Inshirah was not receiving the medical care she needed, despite the best efforts of her children. Her condition continued to deteriorate. It did not help that she had learned of the brutal killing of our relative Mohammad, his wife Manar and seven young children in their house in al-Qarara, next door to her own damaged home.

On the eve of Eid al-Adha, Inshirah entered the overwhelmed intensive care unit of Nasser Hospital, where inadequate medical supplies and support led to her passing.

At her funeral, Inshirah’s children spoke in detail of the unbearable conditions their mum had faced in the tents – extreme heat, lack of food and clean water, no nutritional supplements and a complete absence of required hygiene, oxygen and electricity. They remained by her side, offering care and prayers, but the systemic destruction of Gaza’s healthcare system left them powerless to offer much more.

Inshirah is just one victim among countless others amid Israel’s deliberate targeting of Gaza’s medical sector. The Israeli army has repeatedly raided and destroyed hospitals and clinics. Israeli soldiers have filmed themselves delightedly destroying medical equipment and supplies.

According to the Gaza Government Media Office, 34 of 36 hospitals have been put out of service by Israeli attacks. In total, 161 medical facilities have been targeted. More than 500 medical workers have been killed, including highly specialised doctors. The organisation, Physicians for Human Rights, has documented more than 1,000 Israeli attacks on doctors, patients, clinics and health infrastructure, which in their words, “have fuelled a public health catastrophe”.

The destruction of Gaza’s medical infrastructure and the killing of medical personnel is another deadly driver of the Israeli genocide. It has resulted in unspeakable horror and suffering for patients and their families and led to many preventable deaths.

At the beginning of Israel’s genocidal war, Gaza had some 350,000 residents with chronic diseases like Inshirah. How many have survived 10 months of “sheer hell” is unknown, but one estimate by doctors who visited Gaza puts the true death toll at 92,000; another by scientists puts it at 186,000.

Israel’s devastation of the medical sector, along with the destruction of sanitation infrastructure and the imposition of starvation, are producing thousands more chronically ill Palestinians, as people contract debilitating diseases. It is believed that some 100,000 people have already been infected with hepatitis A and most do not have access to treatment.

There are also more than 90,000 injured by Israeli attacks, 10,000 of whom urgently need to travel outside Gaza for medical care. They cannot leave because after Israel seized control of the Rafah crossing into Egypt, it has been blocking most medical evacuations.

Despite the desperate cries of civilians and the condemnation of Israel’s actions by United Nations agencies, the World Health Organization and medical organisations like Doctors Without Borders (MSF), the US and its allies have continued to supply Israel with weapons and turn a blind eye to its genocide and destruction of Gaza’s medical facilities.

It is grotesque to see President Biden claim to want to end the war and then do absolutely nothing to that effect. As he nears the end of his presidency, he looks set to leave behind a genocidal legacy, having been the principal sponsor and enabler of Israel’s wholesale destruction of Gaza and the extermination of its people.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.