ROCHESTER HILLS, Mich. (AP) — Each time Dr. Emad Shehada’s phone rings, the suburban Detroit pulmonologist worries that it could be more bad news about loved ones in Gaza.

He said that so far, 20 cousins and other relatives have been killed since the start of Israel’s campaign against Hamas following the militant group’s deadly Oct. 7 incursion into southern Israel that set off the war.

More than 11,000 Palestinians, two-thirds of them women and minors, have been killed since the war began, according to the Health Ministry in Gaza, which does not differentiate between civilian and militant deaths. About 2,700 people have been reported missing.

More than 1,200 people in Israel died, most of them in the Hamas attack, and about 240 hostages were taken from Israel into Gaza by Palestinian militants.

Among those Shehada grieves are his cousin, Mohammad Khrais, three of Khrais’ children and 19-year-old Mayar, who was pregnant.

“When you hear about these conflicts, your heart is broken for all these people that they die,” Shehada told WXYZ-TV for a story Thursday. “But when it hits somebody you know, it’s totally different.”

“It’s been horrible,” he added. “A hell of a month. I mean, it’s a nightmare that does not want to end.”

Shehada, whose medical practice is north of Detroit in Rochester Hills, was born in Kuwait and lived in Syria before moving to the United States about two decades ago. He studied at Wayne State University in Detroit.

Both his parents were born in a village outside Gaza. They now live in the United States. Shehada, 47, also has one sister in the U.S., but another remains in Gaza, he said.

The two communicate via text messages because listening to her tear-filled voice as the war rages is difficult, Shehada said.

“The house next to my sister was struck by a missile where I had 12 relatives living there,” he said. “That house was only 10 meters (32 feet) from my sister’s house.”