The Israeli Genocide in Gaza has led to an unprecedented health and humanitarian manufactured disaster, with an overwhelming number of injuries and amputations. The deliberate targeting of civilians and medical infrastructure has led to the collapse of Gaza's healthcare system, leaving tens of thousands without access to critical medical care. The immense number of injuries and amputations, described as the highest in the world,[1] has far-reaching consequences. It severely impacts Gaza's ability to heal and rebuild, undermines the resilience of its population, and ultimately threatens their survival.
Palestinian Health and Settler-Colonial Ideology: Background
Even before the Israeli genocide, Palestinians in Gaza faced severe violations of their right to health due to the Israeli siege and Israel's control over the social and political determinants of health.[2] Access to healthcare was systematically restricted as part of Israel's siege policy and practice, which included limitations on the movement of patients, medical personnel, and essential medical supplies. Many patients were forced to seek treatment outside the Strip due to the unavailability of specialized care—a direct result of restrictions on the entry of medical equipment, drugs, and the medical teams' ability to access updated medical knowledge.
These compounded restrictions, along with recurrent military attacks over the past 18 years, have led to the deliberate de-development[3] of Gaza's healthcare system, systematically eroding its capacity to provide essential and lifesaving treatment, including in fields related to rehabilitation and complex injuries and amputations. Israel's settler-colonial ideology is embedded in these policies, as the deliberate restriction of healthcare access is part of a broader system of domination and erasure. Health is inextricable from this ongoing project of dispossession, with Israel exerting control over every aspect of medical care—from the movement of patients and healthcare workers to the flow of pharmaceuticals and equipment.
Injured individuals requiring advanced surgeries and prosthetics were typically referred to the West Bank, Egypt, Jordan, or, in rare cases, during Israeli military offensives, granted permits to reach hospitals in the West Bank and East Jerusalem. By controlling all exits and entries between occupied areas, Israel not only fragments Palestinian access to healthcare but also ensures the dependency of the Palestinian medical system on Israeli approvals for every referral and development. The sheer volume of injuries from Israeli military assaults, such as those sustained during the 2018 Great March of Return (GMR), has pushed Gaza's already debilitated healthcare system beyond its capacity. In this context, attacks on healthcare infrastructure and the systematic obstruction of medical care serve as mechanisms of elimination, reinforcing Israel's settler-colonial project by degrading the conditions necessary for survival and recovery.
The Scope of Injuries and Amputations in Gaza in the Past 15 Months
Although these challenges are not new, the unprecedented scale of injuries, coupled with the systematic dismantling of healthcare,[4] has made the treatment of complex injuries nearly impossible. Israel has systematically dismantled even the most minimal efforts to provide care, including renewed attacks on hospitals that had partially reopened to offer basic aid.[5] The inability to treat both complex and even standard injuries—caused by the debilitation of the healthcare system's capacity and workforce—has led to an increase in amputations. This healthcare collapse has been compounded by the destruction of over 80 percent of water, sanitation, and hygiene (WASH) infrastructure,[6] alongside electricity cuts and the blockade of essential medical items such as alcohol, sterilizing equipment, and antibiotics—conditions that have made proper wound care nearly impossible, increasing the risk of infection.[7] Additionally, the severity of the attacks, the repeated bombings, and the massive destruction of infrastructure have resulted in severe injuries. Without adequate and timely treatment, these injuries have led to a rise in amputations and lifelong disabilities.
Reports from the World Health Organization (WHO), United Nations agencies, and the Gaza Ministry of Health indicate that as of July 23, 2024, over 50,000 Palestinians have been killed and 90,996 individuals have been injured, with at least 22,500 suffering life-altering injuries.[8] This was echoed by The Lancet, which has reported that as of June 2024, over 85,523 Palestinians have been wounded, with thousands suffering catastrophic injuries requiring amputations.[9]
According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA),[10] severe limb injuries—estimated to range between 13,455 and 17,550—are the primary driver of long-term rehabilitation needs. WHO also estimates that between 3,000 and 4,000 limb amputations have taken place, alongside approximately 2,000 cases of spinal cord injuries and severe traumatic brain injuries, as well as at least 2,000 major burns. According to Save the Children, the use of explosive weapons in Gaza in 2024 condemned an average of 475 children each month—or 15 children a day—to potentially lifelong disabilities, including severely injured limbs and hearing impairments. In the first 11 months of 2024, at least 5,230 children sustained injuries requiring significant rehabilitation support that is inaccessible due to attacks on hospitals and healthcare workers by Israeli forces and restrictions on entry of critical supplies, leaving them with a high likelihood of disability.[11]
The Israeli targeted attack on Gaza's healthcare system has left it in a state of devastation, acute rehabilitation services have been severely disrupted, and specialized care for complex injuries remains unavailable, putting patients' lives at serious risk. According to the WHO, the majority of Gaza's rehabilitation workforce has been displaced, and as of May 10, 2024, reports indicate that 39 physiotherapists have been killed. There are no in-patient rehabilitation or prosthetic services available, and even the most basic assistive devices, such as wheelchairs and crutches, are in short supply due to ongoing restrictions on aid entry.[12]
Palestinian Disabling and Healthcare Debilitation—A Deliberate Policy
The deliberate maiming of Palestinians predates the current genocide and was particularly evident during the 2018 GMR, when Israeli soldiers systematically targeted the limbs of protesters demonstrating against the siege and blockade near the colonial fence.[13] Similarly, attacks on healthcare—undermining the ability of Gaza's healthcare system to meet the population's needs, as well as targeting health providers and facilities—have been documented in the past.[14] Though these practices are not new, they have reached unprecedented levels in the last 15 months, this time with an undeniable and deliberate intent[15]—something that was more difficult to prove in the past. The systematic dismantling of the healthcare system, the recurrence of attacks, and other tactics such as starvation and cutting water supplies all point to the deliberate destruction of the population's ability to survive,[16] aligning with settler-colonial ideology. This ideology operates through the elimination of the native population, not only through direct violence but also by making survival untenable—eroding essential infrastructures, denying basic necessities, and rendering life itself unsustainable.
Amputation as a form of violence extends beyond the individual injury—it is a calculated strategy that fractures both the physical and political body of a population. In the context of Gaza, whether through the systematic targeting of limbs during the Great March of Return or the deliberate creation of conditions in which tens of thousands of injuries—resulting from Israel dropping tens of thousands of tons of explosives—cannot be treated, the goal is not only to incapacitate individuals, but to inflict mass disability as a strategy of national dismemberment, fracturing the population's ability to function and survive. This dual and simultaneous assault—bodily harm and the destruction of medical infrastructure—ensures that recovery is either impossible or painfully slow, transforming injury into a long-term tool of suppression.
When thousands are left with permanent disabilities or untreated injuries that have become debilitating, they are not only physically incapacitated but also unable to take part in efforts to rebuild, remain steadfast, or even sustain their survival. The destruction of bodies becomes an extension of the destruction of infrastructure—an intentional erosion that ensures that the wounded are left in a state of dependency. By understanding amputation and injuries within this broader framework, alongside the simultaneous incapacitation of the healthcare system, it becomes clear that injuries inflicted in Gaza are not incidental byproducts of war but rather a deliberate strategy in Israel's genocidal war.
The Inadequacy of Rights Frameworks amidst the Destruction of the Healthcare System
The right to health is enshrined in multiple international agreements, including the International Covenant on Economic, Social, and Cultural Rights (ICESCR), which guarantees “the highest attainable standard of physical and mental health.”[17] Israel's large-scale and systematic attacks on Gaza's healthcare system—including the deliberate targeting of hospitals, the blocking of medical aid, and restrictions on patient transfers—constitute not only violations of this right but also evidence of genocidal intent. Under Article II(b),(c) of the Genocide Convention, “Causing serious bodily or mental harm to members of the group” and “deliberately inflicting conditions of life calculated to bring about the physical destruction”[18] of a group includes preventing access to medical care, a key strategy in Israel's assault on Gaza.
The Fourth Geneva Convention prohibits the targeting of medical personnel and mandates access to humanitarian aid,[19] yet these protections have been systematically disregarded. The destruction of Gaza's healthcare infrastructure is not incidental; it is a strategic effort to dismantle Palestinians' ability to survive. The widespread damage to and destruction of life-sustaining infrastructure, including hospitals, water and sanitation systems, food supplies, and energy sources—has left civilians without essential services, further exacerbating fatalities.
UN Security Council Resolution 2286 (2016) condemns attacks on medical facilities and calls for accountability,[20] yet no meaningful enforcement mechanisms have been applied to Israel. Israel's actions extend beyond individual violations of international humanitarian law—they amount to the intentional collapse of Gaza's healthcare system, ensuring that even those who survive direct attacks face death from untreated injuries, disease, and starvation.
The International Court of Justice (ICJ) has acknowledged the plausibility of genocide in Gaza, reinforcing the urgent need to recognize that the destruction of healthcare is not merely a war crime but a tool of extermination. As humanitarian organizations and legal experts increasingly argue, the targeting of Gaza's healthcare system, alongside the systematic destruction of infrastructure essential for civilian survival, represents a coordinated strategy of annihilation.
How do we move forward in the face of such systematic and well-documented violations? When legal frameworks exist—enshrined in conventions, covenants, and international court rulings—yet prove unable to halt or deter the deliberate destruction of Gaza's healthcare system, what does that say about the tools available to protect the right to health? What avenues remain when hospitals become targets, medical workers are incarcerated and killed, and an entire population is denied access to care, all under the watch of international law?
International legal frameworks have the language, the principles, and the precedents to protect health under occupation and war. However, in the case of Palestine, they have been largely ineffective, not because they lack clarity but because they lack enforcement, are selectively applied, and are systematically undermined by political power dynamics.
Recommendations
Short-Term Recommendations
- Immediate Provision of Rehabilitation Equipment and Prosthetic Devices
Given the scale of traumatic injuries and amputations in Gaza, particularly among children, there is an urgent need to allow the entry of prosthetic limbs, mobility aids (e.g., crutches, wheelchairs), wound care materials, and rehabilitation equipment. International agencies should prioritize support for temporary field-based rehabilitation units inside Gaza, focusing on early physical therapy interventions to prevent complications. Special attention must be given to pediatric-specific prosthetics and care adapted to children's developmental needs. - Establishment of a Medical Evacuation and Referral Mechanism
A coordinated, independent medical evacuation mechanism must be established to enable the timely transfer of patients requiring advanced surgical and rehabilitation care. Crossings must be opened unconditionally, and international monitors should ensure safe passage. Dedicated Rehabilitation and Psychosocial Support Programs for Children with Amputations
Children who have experienced amputations face unique physical, developmental, and psychological challenges that require specialized, age-appropriate care. A dedicated system of pediatric rehabilitation should be established in Gaza, including access to child-sized prosthetics, physiotherapy, and ongoing mental health support.
Long-Term Recommendations
Restoration and Rebuilding of Healthcare Facilities in Gaza
All possible efforts should be made to facilitate the rapid rehabilitation and operational restoration of damaged and destroyed healthcare facilities in Gaza. This includes hospitals, primary care clinics and rehabilitation centers that have been rendered nonfunctional due to sustained Israeli attacks. Reconstruction must prioritize the re-establishment of essential medical services, such as trauma care, surgical units, intensive care and rehabilitation services for amputees and the chronically injured.International agencies, donors, and humanitarian actors must coordinate with local health authorities to assess damage, provide technical and financial support, and ensure that infrastructure meets both emergency and long-term care needs. Special attention should be given to rebuilding services for children with disabilities, many of whom have lost access to specialized care. Restoration efforts must also include the retraining and protection of Gaza's healthcare workforce and the safe and sustained entry of essential medical equipment and supplies.
- End the Siege and Lift All Restrictions on Medical Access and Movement
The ongoing blockade on Gaza must be lifted to allow the free and consistent flow of medical supplies, equipment, and personnel. The right of patients to seek treatment outside Gaza must be fully respected, including unimpeded access to hospitals in the West Bank, East Jerusalem, and abroad. These steps are essential to prevent further avoidable amputations and ensure timely, comprehensive medical care. - Ensure Comprehensive, Long-Term Aftercare for Amputees
Urgent efforts must be made to establish a functioning and accessible system of long-term aftercare for amputees in Gaza, including follow-up surgeries, access to high-quality prosthetics, physical rehabilitation, and psychological support. This requires sustained investment in medical infrastructure, human resources, and specialized training programs tailored to trauma recovery and the needs of those with disabilities. International cooperation should focus on building a comprehensive, sustainable system of rehabilitation and recovery that provides ongoing support to amputees.
[1] “Gaza Leads World in Child Amputees per Capita, UN Says,” Middle East Eye, December 2, 2024.
[2] United Nations Human Rights Council, “Report of the Special Rapporteur on the Situation of Human Rights in the Palestinian Territories Occupied Since 1967,” A/HRC/37/75, Thirty-seventh session, Agenda item 7, 26 February–23 March 2018, 15 March 2018; World Health Organization (WHO), Regional Office for the Eastern Mediterranean, “Right to Health: Barriers to Health and Attacks on Health Care in the Occupied Palestinian Territory, 2019 to 2021,” 2022.
[3] Yara Asi, “Palestinian Dependence on External Health Services: De-development as a Tool of Dispossession,” Middle East Law and Governance 14 (2022): 366–87.
[4] United Nations, “Gaza: ‘Systematic Dismantling of Healthcare Must End' says WHO,” UN News, April 6, 2024.
[5] World Health Organization (WHO), “Kamal Adwan Hospital Out of Service Following a Raid Today and Repeated Attacks Since October, 28,” December 2024.
[6] World Health Organization (WHO), “WHO's Response in the Occupied Palestinian Territory: April 2024–December 2024,”.
[7] Bilal Irfan et al., “Combating Infections Under Siege: Healthcare Challenges Amidst the Military Assault in Gaza,” World Medical & Health Policy (2024).
[8] United Nations Office for the Coordination of Humanitarian Affairs (OCHA), “Humanitarian Situation Update #218 | Gaza Strip [EN/AR/HE],” September 16, 2024.
[9] Ibid.
[10] Rasha Khatib, Martin McKee, and Salim Yusuf, “Counting the Dead in Gaza: Difficult but Essential,” The Lancet 404, no. 10449 (2024): 237–38.
[11] Save the Children, “Gaza: Explosive Weapons Left 15 Children a Day with Potentially Lifelong Disabilities in 2024,” January 14, 2025.
[12] World Health Organization (WHO), “WHO Analysis Highlights Vast Unmet Rehabilitation Needs in Gaza,” September 12, 2024.
[13] Jasbir K. Puar, “On Amputation,” Journal of Palestine Studies 54, no. 1 (2025): 14;
Ghada Majadli and Hadas Ziv, “Amputating the Body, Fragmenting the Nation: Palestinian Amputees in Gaza,” Health and Human Rights 24, no. 2 (2022): 281.
[14] Yara M. Asi et al., “Are There ‘Two Sides' to Attacks on Healthcare? Evidence from Palestine,” European Journal of Public Health 31, no. 5 (2021): 927–28;
Al Mezan Center for Human Rights, Lawyers for Palestinian Human Rights (LPHR), and Medical Aid for Palestinians (MAP), “Two Years On, Still No Accountability for Attacks on Gaza's Health Sector,” July 13, 2016.
[15] Fatima Al-Kassab, “A Top U.N. Court Says Gaza Genocide Is ‘Plausible' but Does Not Order Cease-Fire,” NPR News, January 26, 2024;
Amnesty International, “Amnesty International Investigation Concludes Israel Is Committing Genocide Against Palestinians in Gaza,” December 5, 2024.
[16] Oxfam, “Starvation as Weapon of War Being Used Against Gaza Civilians – Oxfam,” October 25, 2023.
[17] United Nations General Assembly, "International Covenant on Economic, Social and Cultural Rights," December 16, 1966, United Nations Treaty Series, vol. 993, 3.
[18] United Nations General Assembly, "Convention on the Prevention and Punishment of the Crime of Genocide," December 9, 1948, United Nations Treaty Series, vol. 78, 277, art. II(c).
[19] International Committee of the Red Cross (ICRC), Geneva Convention Relative to the Protection of Civilian Persons in Time of War (Fourth Geneva Convention), August 12, 1949, 75 U.N.T.S. 287, arts, 16-18, 23;
International Committee of the Red Cross (ICRC), Customary IHL: Rule 25. Medical Personnel, ICRC Customary IHL Database.
[20] United Nations Security Council, Resolution 2286 (2016), May 3, 2016, S/RES/2286.