Since October 2023, the healthcare system in the Gaza Strip has been systematically dismantled. According to OCHA, out of 36 hospitals in Gaza, Palestine, only 17 remained partially functional by early December 2024, with the other 19 closed, while over 1,000 health workers have been killed.

Each medical centre or humanitarian delivery system has been or is being destroyed, to be replaced by less effective, improvised options. There is no telling what the indirect human cost in deaths and long-term injuries will be as a result of the denial of aid and treatment.

Staff and patients from Médecins Sans Frontières (MSF) have had to leave 17 different health structures and endured around 50 violent incidents from October 2023 to December 2024 in Gaza and the West Bank, which includes airstrikes damaging hospitals and/or their vicinity, tanks being fired at agreed deconflicted shelters, ground offensives into medical centres, and convoys fired upon. MSF has yet to receive accountability or admission of responsibility for the killing, maiming, or dehumanisation of our staff and patients. 

MSF has yet to receive accountability or admission of responsibility for the killing, maiming, or dehumanisation of our staff and patients.

While the past year has been devastating for communities in the Gaza Strip, the West Bank, and in Israel, from a medical humanitarian perspective, the problems faced by Palestinians in Gaza and the West Bank far pre-date 7 October 2023, and it is important to recall that there was already a humanitarian crisis in the Gaza Strip, caused by Israel’s 17-year blockade of the land.  

On 6 October 2023, MSF was running medical humanitarian activities in Palestine, specifically in Hebron, Jenin, Nablus, Masafer Yatta, and the Gaza Strip. On that day, our colleagues were attending to patients in Gaza wounded by so-called butterfly bullets, fired by Israeli snipers at people as they protested in the days and weeks prior to the war that engulfed the region on 7 October. We were also treating some 87 patients for long-term injuries (down from an original patient cohort of almost 900), sustained in the Great March of Return escalation in 2018 and 2019.  

MSF medical staff were also continuing to treat patients wounded in the war of 2021, sparked by the seizure and settlement of property in Sheikh Jarrah, east Jerusalem, and resulting in the gravest escalation since 2014 with thousands of Palestinians displaced, massive levels of destruction, and hundreds killed.  

The attacks of 7 October 2023, and the collective punishment that followed, represented a paradigm shift in the way MSF has been able to operate in the Occupied Palestinian Territories. Without operations in Israel, the first thing our colleagues witnessed on 7 October were Israeli airstrikes in Gaza, immediately following Hamas attacks estimated to have killed up to 1,200 people with the taking around 250 hostages. On 8 October 2023, MSF offered support to the Israeli Ministry of Health, which ultimately was not accepted.  

For MSF colleagues in Gaza who had been running projects focused on orthopaedic and reconstructive surgery, physiotherapy, burn care, psychological healthcare, and research and treatment for antimicrobial resistance in Gaza, it was not immediately clear what would become of our patients, how we could ensure their continuity of care, what we would be able to do for those wounded in this new escalation.  

However, what did become clear was that the increasing disrespect of medical humanitarian action and the destruction of health structures and staff shelters, along with the killing of colleagues and patients, made it nearly impossible for MSF to negotiate the protection we usually seek in conflict settings. Since 7 October 2023, to date, eight MSF colleagues have been killed.1

Below is a timeline of attacks on MSF or MSF-supported medical facilities, and MSF or MSF-supported staff2 in Palestine since 7 October 2023. It is important to note that we have attributed the responsibility of the attacks when we were able to verify it, yet for the other attacks, we were not able with certainty to attribute them.

The location of MSF or MSF-supported medical facilities, shelters and movements that have been hit or attacked had been communicated to the main parties to the conflict in Gaza prior to their attacks. Yet, these structures and movements have not been respected nor protected, and many civilians have been killed and injured. 

The location of MSF or MSF-supported medical facilities, shelters and movements that have been hit or attacked had been communicated to the main parties to the conflict in Gaza prior to their attacks.

Timeline of attacks

• 7 October 2023 – Immediately following Hamas’ attacks, Israeli forces struck Indonesian hospital and an ambulance in front of Nasser hospital, killing a nurse and an ambulance driver and injuring several others.  
• 10 October 2023 – MSF’s Gaza clinic was damaged by an Israeli airstrike; no staff or patients were injured.  
• 11 October 2023 – there was an airstrike close to Al-Awda hospital, where MSF has been operating since 2018 – some ceilings caved in as a result of the blast, but the structural integrity of the hospital was maintained, and the hospital continued to function.  
• 13 October 2023 - Israeli forces gave two hours to evacuate MSF-supported Al-Awda hospital. Our medical colleagues wheeled patients on gurneys into the street in an effort to get them to other hospitals, with little success. MSF condemned the evacuation order and highlighted the need to protect medical workers and patients. Eventually staff and patients remained in the hospital.  
• 17 October 2023 – In Gaza City, a strike hit the parking lot of Al Ahli Arab hospital where an MSF doctor was operating, reportedly killing hundreds. In the days leading up to the incident, the hospital director had received warnings from Israel. MSF condemned this strike and initially attributed responsibility to Israel. However, even today it remains uncertain who bears responsibility for this act. An independent investigation is the only way to determine the responsibility for this attack.
• 30 October 2023 - MSF-supported Turkish-Palestinian Friendship hospital in Gaza was hit by a projectile, causing damage to the building. The hospital stopped functioning when it ran out of fuel on 1 November.  
• 3 November 2023 - An ambulance convoy was hit and destroyed by an Israeli airstrike outside Al Shifa hospital, many people were killed. MSF unequivocally condemned this attack.  
• 10 November 2023 – Al Shifa hospital was shelled, while patients and staff were still trapped inside, leading to several casualties. Masher Sharif, a nurse at Al-Shifa told us: “I was heading to the hospital to work this morning when the facility was hit. All of us were horrified, some of us threw ourselves to the ground. I saw dead bodies, including women and children. This scene was horrific.”
• 14 November 2023 - Bullets were fired into one of three MSF premises located near Al-Shifa hospital and sheltering MSF staff and their families – over 100 people were sheltering there, including 65 children, who had run out of food and were waiting to be evacuated.  
• 15 November 2023 - Al Shifa hospital was stormed by Israeli ground troops. All remaining MSF staff had left the hospital about one week earlier.  
• 18 November 2023 - an MSF evacuation convoy seeking to evacuate staff and their families was fired upon, killing two people, including an MSF colleague. All elements point to the responsibility of the Israeli army for this attack. On 20 November 2023, the MSF cars from the convoy were destroyed by an Israeli bulldozer and heavy military vehicles in full view of our colleagues sheltering in the MSF guesthouse. The vehicles also damaged the MSF clinic by ramming its perimeter wall, which collapsed. Part of the clinic caught fire as a result.  
• 21 November 2023 - A strike on Al Awda hospital killed Dr Mahmoud Abu Nujaila and Dr Ahmad Al Sahar from MSF, and another doctor, Dr Ziad Al-Tatari. While we have spoken to all parties to the conflict, seeking accountability for these killings, none have been forthcoming, and it is not possible to say what happened with absolute certainty. An independent assessment should be conducted onsite to determine responsibility for this.
• 22 November 2023 – MSF convoy cars targeted by Israeli vehicles.  
• 24 November 2023 – MSF cars and a minibus sent from south Gaza to attempt another evacuation of MSF staff and their relatives in the north were destroyed by Israeli forces.
• 1 December 2023 - Hours after the truce ended, a blast damaged Al Awda hospital.  
• 5 December 2023 - MSF staff in Al Awda hospital reported that the hospital was facing a total siege. In the following days, two members of medical staff at the hospital (not MSF staff) were reportedly shot and killed by snipers outside.  
• 12 December 2023 - An MSF surgeon was injured inside Al-Awda hospital by a shot fired from the outside.  
• 14 December 2023 - In Khalil Suleiman hospital, Jenin, the West Bank, our colleagues supporting the hospital witnessed a teenage boy shot and killed by Israeli forces in the hospital compound, following the abuse of paramedics who were forced to strip and kneel in the street.  
• 17 December 2023 - Israeli forces took control of Al Awda hospital after a 12-day siege. Males over 16 years old were taken, stripped and interrogated – six MSF staff among them. After the interrogations, most of them were then sent back into the hospital and told not to move. The same day, the maternity ward of Nasser hospital was hit by Israeli tracer bullets. One patient was killed, others were wounded.  
• 6 January 2024 – MSF had to evacuate Al-Aqsa hospital as fighting between Israeli forces and Palestinian armed groups approached. A sniper bullet was fired through the intensive care unit wall on 5 January.  
• 8 January 2024 - MSF “Lotus” shelter in Khan Younis was struck by an Israeli tank shell, killing the 5-year-old daughter of a member of MSF staff and wounding three people. Over 125 MSF staff and their families were then relocated to Rafah.  
• 16 January 2024 - Israeli forces heavily bombed the area close to Nasser hospital with no prior evacuation order, causing patients and many of the thousands of displaced civilians, who had sought refuge in the facility, to flee in panic.
• 22 January 2024 - Nasser hospital in Khan Younis was surrounded by fighting, bombing, and subjected to evacuation orders. Airstrikes killed people as close as 150 meters from hospital entrance, according to MSF staff present.