“The destruction of the health system has been the main thrust of the [Israeli] military strategy.” This was the testimony of Dr. Ghassan Abu Sitta after spending six weeks working in various hospitals across the Gaza Strip during the ongoing genocidal war against the Palestinian people[1]. The same sentiment echoed through the conclusions drawn by the South African legal team charging Israel with genocide at the International Court of Justice: “Almost above all else, Israel’s military assault on Gaza has been an attack on Gaza’s medical healthcare system”[2].
The discourse and actions of the Israeli occupation forces leave no room to doubt these conclusions. As of February 9th, none of the hospitals in the Gaza Strip are fully operational; just 13 out of 36 are operating at partial capacity[3]. Only 17% of primary healthcare clinics are functional. The last healthcare facilities standing are completely overwhelmed. Many lives are being lost due to the destructive conditions imposed by the Israeli genocidal war – starvation, infections caused by overcrowding and unsanitary conditions due to Israel’s destruction of basic infrastructure, and complications arising from the interruption of time-sensitive treatments such as cancer care.
The Intent
The intent to erode the health sector in the Gaza Strip was evident from the onset of the war. On October 14th, just seven days into the war, the occupation army ordered the evacuation of 22 hospitals in the northern Gaza Strip. An Israeli airstrike on the cancer diagnostics center in al-Ahli Hospital that day, which injured four staff members, was understood as a threat of what was to come. Over the next three days, managers of the northern Gaza Strip hospitals, such as al-Shifa, al-Ahli, and al-Awda, received frequent phone calls from Israeli army commanders ordering the evacuation of the hospitals under threat of bombardment if they did not comply. Hospital staff quickly formed a consensus around a brave moral response: hospitals, as providers of critical services, will not evacuate.
These threats set the stage for the Israeli strike (as demonstrated by several investigations) on al-Ahli Hospital on October 17th, which killed 471 Gazans seeking shelter in the hospital courtyards and caused significant damage to the hospital[4]. Instead of holding Israel accountable for its heinous crimes, the world entertained Israel’s propaganda, debating the unfathomable claim that a failed rocket launch by a Palestinian resistance group caused the explosion at al-Ahli and ignoring the actions Israel was taking to dismantle the Gazan health system. The global community’s failure to condemn Israel emboldened it to unleash a more extensive offensive against healthcare institutions.
On October 27th, the Israeli army spokesperson declared to the world: “By now the truth is clear: Hamas wages war from hospitals, wages terror from hospitals.” Over the following days, these claims focused particularly on al-Shifa Hospital in Gaza City, which employs a quarter of all doctors and nurses in the Gaza Strip's hospital sector. By November 10th, following several days of continued incitement and drone strikes against hospitals, Israeli tanks were surrounding four hospitals in Gaza City; on November 11th, they also surrounded al-Shifa Hospital. Over the following days and weeks, Israeli forces systematically dismantled the healthcare infrastructure in the northern Gaza Strip, bombing hospitals, cutting off their energy and supplies, forcing patients and staff to evacuate at gunpoint, and shooting those working, seeking shelter, or receiving care in hospitals[5].
The motivations behind destroying the healthcare sector in Gaza were communicated extensively by Israeli officials from the start of the war. Israel had decided to make the Gaza Strip uninhabitable. On October 9th, the Israeli “defense” minister announced “a complete siege on Gaza. No electricity, no food, no water, no fuel. Everything is closed. We are fighting human animals and we must act accordingly.” In the same address, he stated: “Gaza won’t return to what it was before. We will eliminate everything. If it doesn’t take one day, it will take a week. It will take weeks or even months, we will reach all places.” On October 12th, after declaring, “It’s an entire nation out there that is responsible. It’s not true this rhetoric about civilians not aware not involved. It’s absolutely not true,” the Israeli president continued, “We will fight until we break their backbone.” He later added, “We will uproot evil so that there will be good for the entire region and the world.” On October 13th, the Israeli army ordered 1.1 million people living in the northern Gaza Strip to evacuate within 24 hours[6].
The aim to ethnically cleanse Gaza is a direct extension of Israel’s nature as a settler-colonial state, the formation of which was foundationally intertwined with Palestinian dispossession in the Nakba. Israeli officials frequently evoke the Nakba as punishment for Palestinian resistance, including in the current genocidal war, because they understand that the continuation of the settler colonial project, just like its foundation, is dependent on the continued dispossession of Palestinians.
Nowhere is Safe
Israel thus made it clear that it aimed to create conditions that would prevent life from continuing, especially in the northern Gaza Strip. Israel’s destruction of civilian infrastructure and the basics of life must, therefore, be termed correctly; they are calculated, deliberate, and strategic – not indiscriminate. This is evident from the cut-off of water, food, electricity, and fuel, and the repeated targeting of essential infrastructure, including hospital oxygen pipes and solar panels. The targeting of healthcare, especially the spectacle of its destruction, aimed to send a message that nowhere is safe, not even healthcare, which is granted special protections under international law. This message is directed not just to Gazans but also to international and foreign institutions, such as the International Committee of the Red Cross, the United Nations Relief and Works Agency, and Doctors Without Borders, whose facilities and teams have been targeted by Israel, even after prior coordination regarding their coordinates and movements.
The trend of targeting healthcare providers is replicated in different settings under Israeli control, demonstrating the systematic nature of this policy. According to testimonies by released Gazan prisoners, the Israeli army is singling out abducted healthcare personnel by subjecting them to degrading and dehumanizing treatment in detention[7]. Israel is also targeting healthcare in the West Bank. Since October 7th, Israel has killed ten people and injured 62 others in 364 attacks on healthcare in the West Bank alone[8]. It has become routine for the Israeli military to cut off the roads leading to hospitals during raids in Jenin and Tulkarm, and it has long prevented ambulances from reaching the injured and even targeted ambulances as they attempted to reach the injured. These attacks have escalated rapidly to raiding hospitals and culminated in the undercover assassination of three Palestinians in Ibn Sina Hospital in Jenin, including a disabled patient receiving treatment for injuries from an Israeli airstrike in October and two others who were visiting him[9].
The Impact of the Destruction of the Health Sector
The direct and indirect impacts of this destruction are devastating. The direct impacts include the loss of life and destruction caused directly by the targeting of healthcare infrastructure. The World Health Organization reported that 627 people were killed and 783 injured in 342 attacks on healthcare in Gaza[10]. These attacks also damaged 27 hospitals and 47 ambulances. As of January 23rd, Israel had killed 403 healthcare workers, abducted 215, and injured hundreds more[11]. Many victims were paramedics on duty, often with prior coordination with the Israeli army; one doctor was hit with a sniper bullet while working in the operating room; many healthcare workers’ homes were bombed as they returned from their hospital shifts.
The indirect impacts are due to the strain placed on the healthcare sector due to the vast majority of its services shutting down and the extreme increase in healthcare demand. The tens of thousands of injuries caused by Israeli bombardment already far exceed the capacity of the healthcare sector, especially as many of the injured arrive simultaneously, overwhelming facilities and preventing healthcare workers from attending to them promptly. Among the 70,000 injured Palestinians are at least 1,000 children who have had limbs amputated[12]. These are among thousands of others who have had life-altering injuries during the current war, previous aggressions, and the Great March of Return protests[13]. These people require complex specialist care including medical, surgical, physical rehabilitation, and psychological services.
The severe decrease in the capacity of the healthcare sector and the increased pressure on it are accompanied by increasing vulnerabilities and diseases in the population, due to the living conditions imposed by Israel. Israel has destroyed the vast majority of bakeries and fishing boats and a quarter of agricultural land, pushing every single person in the Gaza Strip into hunger[14]. There is extremely limited access to clean water due to Israel cutting off two out of the three main pipelines, bombing wells and desalination plants, and restricting aid truck deliveries[15]. Israel’s bombardment and siege have stopped all wastewater treatment and solid waste management, risking contamination of the remaining water sources. The constant bombardment of all but very small areas including the majority of homes, evacuation orders, and aid restrictions have squeezed the vast majority of the 2.3 million population of the Gaza Strip into tiny pockets of extreme overcrowding.
In addition to the immediate dangers posed by these conditions of hunger, thirst, and pollution, these factors significantly increase the vulnerability of the population to ill health on an individual and population level. There are already hundreds of thousands of infections, such as Hepatitis A, respiratory infections, and diarrhea. People are already dying due to hunger and thirst, but the medium- and long-term impacts of the war will likely kill far more than the war itself. Constant exposure to violence, dispossession, displacement, loss, insecurity, and precarity also causes severe distress among survivors of the war. This compounds existing distress due to never-ending cycles of violence that mental health services were already unable to handle in the absence of political solutions that definitively end the violence and achieve liberation and justice[16].
On top of this, the total siege Israel is imposing causes shortages and stock-outs of fuel, oxygen, equipment, and medications. These shortages are compounded by the fact that 70% of the medical aid that is allowed to enter is not usable[17]. In other words, much of the aid is illusory. These restrictions prevent healthcare workers from providing ideal treatment to the sick and injured, causing increased complications even for simple and routine conditions, which require more resources to address. From the early days of the war, hospitals began rationing dialysis services for kidney failure patients and resorting to home remedies to clean wounds. For several weeks, doctors in the Gaza Strip have reported that triage has been reduced to identifying whose lives can be saved and, sometimes, even making choices about who will survive, due to the sheer volume of demand and the accompanying critical shortage of resources.
The collapse of the healthcare sector is occurring despite its ability to adapt to working under extreme circumstances. The siege imposed by Israel on the Gaza Strip since 2007 included severe restrictions on the entry of medical supplies, classifying many as “dual [civilian and military] use”, causing significant delays and unavailability of many essential items. In 2021, healthcare facilities reported shortages in 45% of essential drugs, 31% of medical consumables, and 65% of laboratory products[18]. Despite this, healthcare workers in Gaza and visitors from outside consistently reported extraordinary adaptability and creativity within the healthcare sector to manage under such difficult circumstances.
The 17-year-long siege on the Gaza Strip, affecting the healthcare sector as well as all other aspects of life, demonstrates Israel’s longstanding aim to render the Gaza Strip uninhabitable. As early as 2017, the UN Coordinator for Humanitarian Aid and Development Activities in the Occupied Palestinian Territory remarked: “The ‘unliveability’ threshold has already been passed”[19].
Many impacts of the war are currently immeasurable. The destruction of healthcare facilities includes the destruction of medical records, preventing proper management of patients’ chronic conditions and the production of epidemiological data to support future service planning. It also includes significant destruction of equipment, requiring substantial investments to replace. When healthcare workers are killed, their relationships, impact within their communities, and combined decades of experience and expertise are lost and will take a generation to rebuild.
More broadly, the impact of Israel’s genocidal war on the natural environment is yet to be fully understood but is likely severe. The intensity of the bombardment and the use of chemical weapons will undoubtedly affect the soil and, in turn, local crops and may also linger in the air, which will affect all living things in the Gaza Strip. One telling sign is the dozens of Israeli soldiers reportedly contracting rare and serious infections while committing war crimes in the Gaza Strip. The prevalence of such infections likely results from previous wars and the long-term blockade against Gaza, as the environmental impacts of war can take a long time to manifest.
The Global Response
The world’s response to the atrocities Israel has committed over the past four months has once again exposed global complicity in the oppression of the Palestinian people. The International Committee of the Red Cross has thus far refused to denounce the Israeli army, even after it shot at Red Cross workers, bombed convoys coordinated by the Red Cross, and banned its workers from visiting Palestinian prisoners and detainees. The World Health Organization repeatedly issues partial statements and narrow demands despite documenting in detail Israel’s deliberate targeting of healthcare infrastructure. The United Nations Relief and Works Agency took little action as Israel killed 154 of its workers but fired nine of its workers as soon as Israel demanded it. Healthcare workers, especially in northern Gaza, report these organizations standing by even when requested to intervene.
The actions of these and other foreign and global organizations are the unsurprising result of the disproportionate influence of global north countries in these organizations. As Israel protects and furthers the interests of those countries, they consistently prevent organizations working with Palestinians from taking action to hold Israel accountable. This is why, while it is important to call out their hypocrisy, appealing to those organizations and countries to change their policies will undoubtedly be futile.
On the other hand, there have been incredible demonstrations of solidarity from all corners of the world, with overwhelming grassroots support for Palestine. The outpouring of support is no doubt a result of the sheer injustice witnessed through live streams, but it is important to pay tribute to the incredible spirit of the people in Gaza, which plays a significant role in inspiring such a response. While watching Israel’s devastating violence in Gaza, people around the world have also witnessed scenes and stories of healthcare workers tirelessly working under incomprehensibly difficult circumstances, Gazans sheltering strangers who have lost their homes, and people finding joy in sharing food and celebrating birthdays, births, and marriages amidst the rubble.
When the Egyptian Journalists Syndicate launched the “Global Conscience Convoy”, thousands of people from around the world volunteered to join, including healthcare workers, journalists, activists, and relief workers. More than 850 Jordanian doctors have volunteered to travel to the Gaza Strip to provide healthcare services. Healthcare workers have established collectives all around the world to pressure their colleagues, unions, workplaces, and governments to live up to their moral responsibility towards the Palestinian struggle. This is in addition to the strong bonds formed between medical and other missions that regularly visit the Gaza Strip, especially since the blockade started in 2007.
These collectives and coalitions are the ones pushing unequivocally for the necessary demands: ceasefire, arms embargos against Israel, and unconditional lifting of the blockade. To hold Israel accountable, they should extend these demands to reversing the destruction caused by Israel and thwarting its aim to make Gaza uninhabitable by also pushing for reparations and grassroots-led reconstruction. Fulfilling these demands is the only hope for bringing justice and reversing the destruction of Gaza.
[1] Al Jazeera English [@AJEnglish]. 2023. Dr. Ghassan Abu Sittah, who worked at both Gaza's Al-Shifa and Al-Alhi Baptist hospitals, tells Al Jazeera Israel's destruction of Gaza's health sector is part of a military strategy to wipe out Palestinians from the besieged enclave. X.
[2] International Court of Justice. 2023. Application Instituting Proceedings.
[3] OCHA oPt. 2024. Hostilities in the Gaza Strip and Israel | Flash Update #115.
[4] Forensic Architecture. 2024. Israeli Disinformation: Al-Ahli Hospital.
[5] Forensic Architecture. 2024. Destruction of Medical Infrastructure in Gaza.
[6] International Court of Justice. 2023. Application Instituting Proceedings.
[7] حكايا غزة. ٢٠٢٤. تفاصيل مرعبة حول ظروف اعتقال الدكتور محمد أبو سلمية.
[8] World Health Organization. 2024. oPt Emergency Situation Update: Issue 22.
[9] Al Mayadeen English. 2024. IOF assassinate 3 Palestinians inside Ibn Sina Hospital in Jenin.
[10] World Health Organization. 2024. oPt Emergency Situation Update: Issue 22.
[11] Healthcare Workers Watch – Palestine. 2024. 23.1.2024 HWW-Palestine Update: 403 healthcare workers (4 HCWs /day) were murdered by Israeli Occupation Forces in Palestine since 7th October 2023 including 136 doctors, 118 nurses, and 149 other healthcare workers. #NotATarget #CeaseFireNow #Palestine #Gaza #WarCrimes #GazaWar. X.
[12] Saada Allaw and Nour Kelzi. 2024. Ghassan Abu Sitta: Genocide in Gaza.
[13] OCHA oPt. 2020. Two years on: people injured and traumatized during the “Great March of Return” are still struggling.
[14] United Nations Office of the High Commissioner for Human Rights. 2024. Over one hundred days into the war, Israel destroying Gaza’s food system and weaponizing food, say UN human rights experts.
[15] OCHA oPt. 2024. Hostilities in the Gaza Strip and Israel | Flash Update #120
[16] Weeam Hammoudeh, Smaah Jabr, Maria Helbich and Cindy Sousa. 2020. On Mental Health Amid Covid-19. Journal of Palestine Studies.
[17] Quds News Network. 2024. Gaza Health Ministry Spokesperson Ashraf al-Qudra: "70% of the medical aid entering Gaza cannot be utilized." Telegram.
[18] ANERA. 2021. After the Conflict: Gaza Recovery and Medical Aid.
[19] United Nations Country Team in the occupied Palestinian territory. 2017. Gaza: Ten Years Later.