At least 178 Lebanese emergency workers have been killed in Israeli attacks since last October. Three-quarters of the deaths have occurred in the past six weeks.

The Israeli surveillance drone sank in the sky over this embattled city in southern Lebanon, a signal to rescue workers that a strike might be near.

“We can’t stay here long,” said Hussein Jaber, a member of Lebanon’s national civil defense force, standing in the courtyard of the team’s headquarters in Nabatiyeh. As the aircraft’s oppressive hum grew louder, he glanced upward. “It shouldn’t be that low,” he said.

With the death toll from Israel’s military campaign against Hezbollah soaring, and airstrikes expanding across the country, the rescue workers who are dispatched to pull casualties from the rubble are increasingly in the crosshairs.

At least 178 paramedics and other first responders have been killed and 279 injured in Israeli airstrikes and artillery attacks since Israel and Hezbollah began exchanging fire more than a year ago, according to Lebanon’s Health Ministry, accounting for about 6 percent of the total death toll. Three-quarters of the deaths have occurred in the past six weeks, as Israel ramped up airstrikes ahead of a ground invasion on Oct. 1.

Civil defense crews say the attacks — including strikes on or near ambulances, fire trucks, paramedic stations and hospitals — have hampered search and rescue efforts, particularly in the south, forcing some teams to abandon their missions and leave casualties in the rubble. Emergency services affiliated with Hezbollah and its allies have been hit the hardest, according to a health ministry tally, but teams from the Lebanese Red Cross and government-run civil defense have also come under fire.

“The protection of civilians and healthcare is a legal and moral imperative that must be upheld,” Hanan Balkhy, regional director for the World Health Organization in the Eastern Mediterranean, said in a statement last month. “Attacks on health care cannot continue to be one of the defining marks of conflict in this region.”

Hussein Fakih, who leads the government’s civil defense force in Nabatiyeh, was one of seven first responders wounded in an Israeli airstrike last month while responding to an attack on the city’s municipality building. “There are signs that mark us as civilians ... as paramedics and fire fighters,” Fakih said from his hospital bed, where he is still recovering. “It’s international protocol not to target them.”

Deliberate strikes on rescue workers and medical personnel, even those affiliated with armed groups, is a war crime under international law unless they are taking part in the hostilities. The Israel Defense Forces did not respond to questions about the specific attacks detailed in this story, instead sharing links to previous statements in which it has accused Hezbollah of using ambulances to transport weapons and fighters. The army has yet to publicly provide evidence that the emergency vehicles it targeted were being used for military purposes.

In Nabatiyeh, which sits just eight miles from the border with Israel, Jaber tries to ignore the accusations, and to block out the risks, “because it will affect my work, and my job is to rescue people, to bring them back,” he said.

Much of the region he works in is now abandoned, after residents fled most parts of southern Lebanon — some out of fear in the early days of the war, others later after evacuation orders from the Israeli military. Among those who stayed behind are the elderly, the infirm and those who lack the funds to leave, local health workers and residents said.

Since the conflict escalated in September, seven members of the government’s civil defense force have been killed by Israeli attacks in the Nabatiyeh area. In at least three instances described by Jaber’s team, the strikes resembled what are known as “double taps,” a tactic that involves striking a location and then attacking again when first responders arrive.

The strikes so far have killed three members of Jaber’s 30-man crew and wounded 13 others, including Jaber himself, making the arduous job of pulling survivors from the rubble even more difficult. Some of their vehicles have been smashed beyond repair, leaving them with fewer ambulances to ferry the wounded.

On Thursday, Jaber’s team responded to strikes that killed two first responders and injured four from the Islamic Health Committee in several locations around Nabatiyeh. Fifteen miles away, in the town of Dardghaya, another four paramedics were killed.

Decades of corruption and mismanagement have hollowed out many Lebanese institutions, sapping funds for services like the civil defense, where rescue workers are often forced to pay for their own equipment. An array of political groups and nongovernment agencies have stepped in to fill the gaps.

Among them is the Hezbollah-affiliated Islamic Health Committee, a civilian force whose duties include providing emergency services. Another is the Risala Scout Association, a rescue force linked to the Amal movement, a Shiite Muslim political party allied with Hezbollah.

On Oct. 4, the Israeli military struck an Islamic Health Committee ambulance near the entrance of Marjayoun Hospital, east of Nabatiyeh, killing seven paramedics and forcing the facility to evacuate staff and close its doors. The IDF did not comment on the target of the attack.

That same day, it also hit Salah Ghandour Hospital in the town of Bint Jbeil, after Israel ordered the facility to evacuate. The hospital said in a statement that most of its medical staff left, but that a number of workers stayed behind to safeguard the property. Nine hospital workers were injured, according to director Mohammed Suleiman, and two remain in a critical condition.

The Israeli military said the following day it had targeted a Hezbollah command center in a mosque outside the hospital building. Suleiman said the strikes hit a mosque, a laboratory, a patients room and a pharmacy. Satellite imagery reviewed by Human Rights Watch showed extensive damage to the main hospital building.

In the immediate chaos of a strike site, response time can be the difference between life and death; casualties can bleed out, suffocate or be crushed by a mountain of rubble. The faster the wounded reach the hospital, the better their chances of survival. Yet as fears of double tap strikes sharpen, rescue crews across southern Lebanon say they are forced to wait longer before scrambling to the scene.

In the coastal city of Tyre, where Israeli airstrikes escalated last week, civil defense volunteers said they often wait up to 20 minutes before heading out to a strike site. Further north, in the city of Sidon, first responders have been sleeping by their vehicles under a lime tree, fearing their headquarters will be targeted while they wait for calls.

At the Hammoud Hospital University Medical Center in Sidon, Samer Saadi, the facility’s chairman of emergency medicine, said that Red Cross teams responding to strikes have often called to say that bombed-out roads are preventing them from reaching the hospital.

As of late October, his team had been unable to save a single child who arrived at the hospital with grievous wounds, he said. “Most of the children die. Emotionally, it’s not easy,” he said, trailing off.

In Nabatiyeh, Oct. 16 was the deadliest day of the war: Israeli strikes killed 16 people and wounded 52 others, among them rescue workers and the civilians they were trying to save. The bombardment was so heavy, it jolted the municipality building from its foundations. The city’s mayor, Ahmad Kahil, was killed as he readied humanitarian aid, the prime minister later said.

Residents described cowering in their homes that day as the force of the blasts shook the walls. Veteran civil defense worker Naji Fahs was killed when an Israeli strike hit a building near his base. Fakih’s crew was wounded in another attack. Then a third injured two more rescue workers as they approached the rubble.

In October, Israeli strikes hit or wounded Red Cross teams on at least five different days, according to the organization. Sixteen of its volunteers have been wounded, the group says.

Fakih said his team had not felt threatened when the conflict first started last October, after Hezbollah began launching rockets at northern Israel in solidarity with Hamas in Gaza, forcing tens of thousands of Israelis from their homes. Israeli airstrikes were mostly limited to bushy areas along the border, and follow-up attacks took place only after government rescue crews had left.

The first direct attack on his fleet came on Sept. 7 when an Israeli airstrike hit their fire truck in the town of Froun, killing three people and leaving another worker so wounded that he is still in the ICU.

“That truck was marked with the civil defense symbol that is recognized by 173 countries,” Fakih said quietly from Nabatiyeh’s public hospital, still visibly weakened by his injuries.

Outside the hospital, the whine of the surveillance drone was eclipsed by the roar of jets, and explosions soon followed. Another paramedic, Ali Hamed, said that his cousins, including children and babies, were killed days earlier in Darwaniyeh, a village nearby.

“We’ve never faced a period like this,” Hamed said. “Never.”