AFP - Hospital masks and anti-bacterial hand gel vanished from shelves in the Gaza Strip as fear gripped the besieged Hamas-ruled territory after the first deaths of swine flu.

A well-known surgeon, Dr. Mahmud al-Haddad, 35, was the fourth in two days to die of the A(H1N1) virus after the first cases were confirmed on Sunday, according to a Gaza medical official who spoke on condition of anonymity.

Medics have so far confirmed 19 out of 40 suspected cases of the disease, the official said. Haddad was among four patients who were transferred to Israel for treatment on Monday.

"The health situation is in a state of emergency in medical centres and hospitals in Gaza, and our doctors are working around the clock despite the strict siege and the lack of medical necessities," the official said.

Gazans have been anxiously following reports of the outbreak, their fears stoked by a flurry of rumours, including that Hamas is concealing the spread of the disease ahead of the group's 22nd anniversary on December 14, when it traditionally holds a mass rally attracting tens of thousands of people.

The government has meanwhile been largely silent about the disease, with the health ministry appointing a special spokesman to field media inquiries.

Meanwhile pharmacies across Gaza were sold out of protective masks and hand gels as teachers in government and UN-run schools urged students to purchase them to protect themselves.

"We ran out yesterday because everyone was asking for them," said Manar al-Bilbasi, a pharmacist in Gaza who had just turned away three university students. "There aren't any left in the whole country."

Israel has sealed Gaza off from all but vital humanitarian aid since the Islamist Hamas movement, which is sworn to the destruction of the Jewish state, seized power in June 2007. Egypt has only rarely opened the one border crossing that bypasses the Jewish state.

Israel's military coordinator for aid to Gaza said it had transferred 10,000 doses of swine flu vaccine to Gaza and was working with the Western-backed Palestinian Authority in the occupied West Bank to try to contain the outbreak.

Israel itself has had 67 people die from the disease out of 8,539 confirmed A(H1N1) cases, and many in Gaza feared that local medics would not have the supplies or the equipment to prevent the spread of the illness.

"In other places they have the equipment to test people. Here if you go to the doctor with a fever you might have it and they won't know," said Mohammed Darwish, 19, a nursing student. "Everyone has to depend on himself."

Since it was first uncovered in April, swine flu has been recorded in 207 countries and has resulted in the deaths of at least 8,768 people, according to World Health Organisation figures.

Many had hoped that Gaza's 1.5 million mostly impoverished residents, 80 percent of whom rely on international aid, would be spared from the global pandemic because of the blockade.

"We were expecting this moment for a few months," Mahmud Daher, the head of the WHO's Gaza office, told AFP. "Gaza is probably the last place in the world to have its first confirmed case."