At Al-Wafa rehabilitation hospital near Gaza City, a handful of doctors and nurses hover over paralysed patients, wondering how to protect them from more air strikes as threatened by Israel.

The patients lie mostly inert in beds lined up in the hospital's reception, where staff moved them after an Israeli rocket crashed into the fourth floor.

The staff have appealed to international agencies for protection, and say the hospital is known to the Israeli army.

But it was hit again on Tuesday night.

Shortly afterwards, the Israeli army contacted the hospital three times, saying everyone should be evacuated by morning as the air force was planning to intensify its air strikes.

Director Basman Alashi explained that the 14 patients in the facility, many of them paralysed or in a coma, are in no position to be moved.

And even if they were, he said, there is no place to take them.

"There is no place safe in Gaza! If a hospital is not safe, where is?

"We cannot leave our patients, they are helpless. They cannot move, they cannot walk, they cannot eat, they cannot even scratch their heads by themselves," he said.

Even as he spoke, the sound of shelling rattled the hospital windows.

- 'Hospital shaking' -

More than 200 people have been killed in Gaza since the latest confrontation between Israel and Hamas militants erupted in the early hours of July 8.

After an Egyptian truce effort failed to get off the ground on Tuesday, there appears to be no end in sight.

Mercifully, said staff doctor Hassan Sarsur, many of the patients are unconscious and unaware of what is happening.

But for others, the situation is terrifying.

"Several of our female patients are paralysed but conscious, and during the night they were crying with fear and clutching our hands," Sarsur said.

Aya Abdeen, one of eight women in the facility, is paralysed from the waist down because of a tumour in her spinal cord.

"Yesterday, when they said that we have to evacuate and with all the shelling, of course I was afraid," she told AFP.

"There was shelling all around and the hospital was shaking. And I am as you see, I can't move," she said.

"We are sick people, in a hospital!"

Karam Shublaq suffered a gunshot wound to his spinal cord in 2006 and is also paralysed from the waist down.

He is being treated for pressure sores and is fitted with a colostomy bag.

"We wake up to shelling and we go to sleep to shelling," he said.

"We can't even move and they hit the fourth floor of the building several times, so they moved us down here."

To care for the patients, the staff are working 24-hour shifts, battling fatigue but also fear.

"We are human beings, of course we are scared," said Sarsur.

"We don't know what to do to protect the patients. We'd already evacuated the fourth floor and now we've evacuated all the floors except the reception."

Several patients have been sent back to their families, but others require medical care that relatives can't provide.

- Watching over brother -

Sixteen-year-old Nur Okasha has been sleeping at the hospital for a week to keep watch over his 13-year-old brother Mohammed who has been in a coma for several months after nearly drowning.

He lies motionless on the bed, his eyes half open as Nur flicks away flies.

"We wanted to take him home, but the tube in his trachea requires a suction machine, and we don't always have electricity at home," the teenager explained.

He keeps vigil at Mohammed's side, putting in his eyedrops and talking to him.

"I want to make him feel like someone is always here. I tell him that his friends miss him. I talk to him about anything except the war," he said.

Doctors at the hospital have reached out to international agencies in a bid to secure Israeli assurances that the facility won't be hit again.

And a group of foreign activists are staying at the hospital in the hope that their presence might deter further attacks.

"The Israelis told the (international) agencies that the hospital was not the target, only the area around it. But they have already hit us directly," Sarsur said.

"We are helpless, the war comes to us and there is nothing we can do to stop it."