The human cost: 'We cannot treat them here – but we have no ambulances'

The surgery was taking place against a backdrop of steady artillery fire. Curtains had been taken down to let in the maximum amount of light through the windows to make up for the lack of electricity. There was no oxygen available either, and the doctors monitored the elderly patient's heartbeat with anxiety.

The hospital at Ajdabiya had been treating the tide of injured from the battles in the eastern front even before the war came to the city itself and its residents began to be ferried in. Resources, human and material, already acutely stretched have now dwindled even further. And the continuous fighting has prevented any new supplies from getting through.

The possibility of that changing soon is fading. The rebels were yesterday pushed further back from the city, having failed to take advantage after Western air strikes which destroyed Muammar Gaddafi's tanks and armour on the eastern front, and drove his troops into a terrified retreat.

The absence of any coherent operational plans by the revolutionary forces and their reluctance to take on their opponents makes any tangible military gains unlikely in the short term, raising the prospect of a long-term commitment from the West in a mission which is already proving contentious and divisive.

Meanwhile, there is a lack of political leadership in Benghazi, with the opposition's provisional government engaging in a round of infighting sparked by the de facto recognition by the international community. "They are fighting over who gets to appoint ambassadors to where," said a disgruntled official.

Commanders of the rebel fighters, the Shabaab, outside Ajdabiya yesterday blamed their failure to progress on the scaling down of air strikes by the US, Britain and France in the eastern areas over the last 24 hours. Elsewhere, regime forces were said to have launched an assault on Zintan and Mistrata, an opposition stronghold near the capital, Tripoli, in which up to 40 people were reported to have been killed.

In contrast to the Shabaab outside the gates of Ajdabiya, there is a resilient resistance inside the city which had driven the regime's forces from some of the areas. They had protected the hospital from raiding parties on a number of occasions, the firefights evident by the damage to the building.

The few remaining doctors and nurses – down to under 20 from 350 a few weeks ago – were keen to hear about the latest developments. Limited power from a generator has to be preserved for medical emergencies rather than news on a television set gathering dust in the staff meeting room.

But they soon had to return to immediate concerns. The shortages have meant that serious cases have to be transferred to Benghazi and Tobruk for treatment during lull in the fighting. But Milad Mussa's age and fragility has necessitated emergency care before he can be moved on. The 72-year-old retired driver was walking home after praying at his local mosque when regime troops opened fire with a heavy machine gun and he was injured in the leg. Dr Muswa Al-Majberi, said: "We did not think he would survive, there was trauma, a lot of blood lost, and the bones had shattered. I do not think we can save that leg. The main worry now is infection, we cannot treat that here, we need to send him somewhere they have the drugs. The problem is we have no ambulances at the moment." Three ambulances sat outside, windscreens and tyres shot out, by Gaddafi's troops, claimed the staff.

Mr Mussa's son, Jalad, was desperate to drive his father to Benghazi for treatment in his own car, but he was unable to do so because there was little petrol left in the city. Abdul Karem, on a makeshift stretcher, asked Jalad Mussa if there was any chance of taking him as well. "I had four days of waiting when every hour I thought it was the end," he said. "They have done everything they can for me here, they cannot do any more and I need to go somewhere else for an operation."

Mr Karem was in his room attached to a garage where he worked when a tank of the regime forces opened fire blasting a hole in the wall and leaving him with shrapnel wounds to the stomach and legs. The roof collapsed in the room next to his, killing three of his colleagues. The 36-year-old mechanic lay on the floor, without food or water, until he was rescued four days later. "I was falling unconscious," he remembered. "When I awoke I could see the outside through the hole, I was very afraid they would come inside and kill me."

It was not just the regime's forces who filled Mr Karem with dread. He comes from Chad and a climate of paranoia whipped up by tales of Colonel Gaddafi recruiting mercenaries from sub-Saharan Africa had led to lynchings of innocent migrant workers from that region. "I was lucky, the people who found me knew who I was," he said. "They said I had to be taken to the hospital quickly, not just because of my injuries, but before other more suspicious people found me."

Friends of Mr Karem appeared at the hospital and said they would arrange for him to be moved to Tobruk. Jalad Mussa set off with his father after siphoning some petrol from the car used by The Independent. We saw him a little later on one of the dirt tracks through the desert used to avoid the main road which remains under regime control.

"You cannot go there, there are Gaddafi men ahead, they are searching, we have to take another route," said Jalad. in the distance there was firing by the Shabaab. They were not coming after the enemy, but loosing rounds into the air in celebration of an imaginary victory as they retreated yet again.

A hard-fought day of little progress for the rebels

* Gaddafi loyalists intensify their attacks on Misrata and Zintan, cities in the west that remain in rebel hands. Shelling on Misrata has reportedly killed at least 40 in heavy fighting on Monday and four children hit by aerial bombardment, although this is impossible to verify.

* State-run television in Libya shows what it says is live footage of Tripoli under bombardment in the evening. The sound of anti-aircraft fire can be heard in the footage. Meanwhile, the government claims that the public will let off fireworks as a symbol of how international relations ought to be conducted.

* Rebels attempting to retake Ajdabiya have so far failed to drive loyalists from the city despite Western air strikes crippling tanks and armour. But a hardcore of rebels remains in the city.

* Aircraft promised by Qatar, so far the only Arab country to publicly pledge a contribution to the military operation, arrive in Cyprus. The two Mirage 200 jets and one C-17 cargo aircraft are due to be stationed in Crete but had to stop to refuel. Saudi Arabia has also indicated that it is behind the operation in a visit by Foreign Minister Prince Saud to London, where he met with David Cameron.

* The US says that the coalition will step up attacks on ground forces loyal to Gaddafi following early operations largely focused on disabling air defences. Admiral Samuel J Locklear said that the increasing capabilities of the coalition in the region would allow more intensive sorties against those attacking the country's rebels.

* Libyan authorities announce that they now plan to release three journalists missing in Libya: two working for AFP and one for Getty. The Committee to Protect Journalists meanwhile says there have been 50 attacks on journalists since the unrest began.