Israel’s ongoing military assault is on the brink of destroying Gaza’s healthcare system, threatening to create a public health disaster that will last long after the bombs stop falling and contribute to significantly more deaths.
Much of the international community has lined up to support the Israeli military’s response to Hamas’ heinous 7 October attacks. It must now also raise its voice to call for Israel to adhere to international humanitarian law in Gaza by shielding civilians, medical personnel, and healthcare facilities from airstrikes.
What we are witnessing now in Gaza seems no different from the horrific attacks by Russian and Syrian forces over the last 10 years against civilians and medical infrastructure in Syria, which have been repeatedly and widely condemned.
Gaza has become the most dangerous place on Earth to practise medicine. No one knows how long the hostilities will last, how much more damage will be done, or what the situation in Gaza will look like when they cease.
But healthcare workers have the right to be able to care for people without the fear of being killed, and the international community must start planning now to quickly rebuild Gaza’s health system as soon as the current fighting ends.
A healthcare system under attack
Since Israel began its response to the brutal attacks by Hamas on 7 October, at least 46 healthcare workers have been killed and 85 injured in deadly airstrikes, according to the Palestinian Ministry of Health.
These medics are among key Palestinian staff in much-needed subspecialties such as plastic surgery, urology, and gynaecology. Their deaths have not only had a devastating effect on healthcare service capacities right now but will also pose challenges for the future rebuilding of the health system.
For example, on 14 October, an Israeli airstrike killed Dr Midhat Saidam, along with 35 members of his family. Dr Saidam was a burns specialist and surgeon who had returned home to rest after seven days of continuous work at Al-Shifa Hospital in Gaza City. On 15 October, airstrikes also killed Professor Omar Firwana, a Palestinian gynaecologist and former Dean of the Faculty of Medicine at the Islamic University of Gaza, along with his wife, children, and grandchildren – 14 family members in total – in their home in Tel al-Hawa, West Gaza.
Some of us knew both Dr Saidam and Professor Firwana personally.
Israel has closed all borders with Gaza and prevented essential humanitarian aid from reaching the population. The small number of trucks that have been allowed to enter through the Rafah border crossing from Egypt with food, water, and medical supplies are a “drop in the ocean”, as the World Health Organisation has said.
The Palestinian Ministry of Health reports that the main blood bank in Gaza is almost depleted and, according to a medical colleague in Gaza, they have resorted to using vinegar to treat bacterial infections from wounds.
Prior to 7 October, more than 100 aid trucks entered Gaza every day. Home to roughly 2.3 million people, 73% of households in Gaza reported receiving humanitarian aid, and 81% said they struggled to meet their basic needs, including food, health, and utilities.
That was before the enclave was plunged into an even more acute crisis due to the current hostilities.
The mortality rates in Gaza due to bombardments are the highest of any previous conflict with Israel. In addition, blast and crush injuries pose severe challenges now and for future services. For every death, some seven to eight seriously injured adults and children will likely need long-term critical care and support, should they survive.
Hospitals across Gaza are now without stable electricity, fuel, medical supplies, and equipment. The Palestinian Ministry of Health reports that the main blood bank in Gaza is almost depleted and, according to a medical colleague in Gaza, they have resorted to using vinegar to treat bacterial infections from wounds. Hospital beds are in short supply, with facilities over capacity by 150%. Thousands of patients in need of critical care are lying in crowded hospital corridors.
With Gaza’s electricity supply from Israel cut, hospitals are being powered by back-up generators. Fuel reserves are running out, paralysing ambulance services. The small amount of aid allowed to enter Gaza so far has not included fuel to replenish the dwindling stock. If generators at Gaza’s hospitals run out of fuel, a lack of electricity will mean that intensive care and neonatal units will stop working.
Take the politics out of health
The international community must take urgent action to prevent the healthcare system in Gaza from collapsing as it struggles under impossible circumstances to try to keep pace with medical needs.
Gaza does not have the resources nor the infrastructure to provide for thousands of badly injured people – and those whose treatments have been disrupted – who will require long-term care and support. Before the current conflict, Gaza’s health and welfare system was already chronically underfunded and lacking capacity. Health and healthcare were highly politicised following 16 years of Israeli-administered blockade, widespread dependency on dwindling donor aid, and corruption in the Hamas-controlled Ministry of Health, during which time the enclave has undergone a process of de-development.
The international community, along with Israel, as the occupying power, retains the primary responsibility to respect, protect, and fulfil the right to health and livelihoods in the Occupied Palestinian Territories, including Gaza.
In oncology treatment and care, the politicisation of health was particularly visible. Those with financial means or with influential connections could seek specialist cancer care in Jordan. However, due to lengthy delays in gaining travel permits from Israeli authorities, even the fortunate patients who were able to leave Gaza for care would present with advanced cancer to the King Hussein Cancer Centre in Jordan.
Chronic conflict, political instability, and insecure working conditions have led to a youth unemployment rate of nearly 70% in Gaza and a brain drain amongst the human resources for health. The depletion of a trained healthcare workforce has been particularly detrimental, with hundreds of professionals leaving for Europe and the United States. Access to primary and secondary healthcare services has worsened over recent years.
There is a strong link between the health of a population and its economic potential. Investment in health and health systems helps to generate the conditions for stability, for a strong civil society, and for people to thrive and achieve their economic and political goals.
Conversely, an injured and traumatised population living under adverse conditions without enough support will not recover economically and will struggle to live full and fulfilling lives.
The international community, along with Israel, as the occupying power, retains the primary responsibility to respect, protect, and fulfil the right to health and livelihoods in the Occupied Palestinian Territories, including Gaza.
Yet, the health system and everyday public services, such as employment and housing, which can act as a stabilising force and agents of hope, have been neglected by international donors in recent years.
When the violence ends, people in Gaza will immediately turn to these services to begin to recover. If there is any hope to break the cycle of despair and conflict, the international community must ensure the centrality of protection; to guarantee that all rights and needs of those affected by the conflict are met.
The research of Dr Adam P. Coutts, Professor Richard Sullivan, and Professor Simon Deakin is funded by the UK Government’s Research and Innovation, Global Challenges Research Fund. Please see the Research for Health in Conflict website for more details.
Dr Coutts is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration, East of England (NIHR ARC EoE). The views expressed are those of the author and not those of the NIHR.
