Israel’s war on Gaza has so far killed more than 45,000 Palestinians, wounded more than 107,000, and displaced approximately 1.9 million people—90 percent of the population—according to Gaza’s Ministry of Health. In response to the horrific attacks carried out by Hamas and other armed groups on October 7, 2023, in which 1,200 people were killed and 251 taken hostage, Israeli forces are crushing an entire population under bombs and rubble.
Doctors Without Borders/Médecins Sans Frontières (MSF) has witnessed 14 months of repeated attacks on civilians, the dismantling of essential civilian infrastructure including health care facilities, and a systematic denial of humanitarian assistance, seemingly underpinning Israel’s campaign to unravel the very fabric of society in Gaza. In the first 12 months of hostilities, MSF staff themselves endured 41 attacks and violent incidents, including airstrikes, shelling, and violent incursions into health facilities; direct fire on its shelters and convoys; and arbitrary detention by Israeli forces. Eight MSF colleagues and many of their family members have been killed; many more have been injured. Medical personnel and patients alike have been forced to urgently evacuate health facilities on 17 separate occasions, often literally running for their lives. MSF has only been able to restart activities in three facilities.
"I woke up under the rubble, screaming. They carried me onto a tuk-tuk and took me to the hospital. The tuk-tuk kept shaking because the roads are uneven. Honestly, if my leg wasn’t already broken, it would have broken from all the shaking as we drove. When we arrived at Nasser Hospital, they just threw me on the ground because there were so many injuries, and dead bodies.”
Throughout the offensive, Israeli forces have blocked essential items such as food, water, and medical supplies from entering the Strip. They have either denied, delayed, or instrumentalized humanitarian assistance, allowing insignificant quantities of aid into Gaza with a complete disregard for the actual needs and the level of suffering of the population.
Gaza’s last remaining oncological hospital had to shut down as it ran out of fuel on November 1, 2023. MSF teams have had to carry out surgery without sufficient anesthesia. The consequences of these impediments are made even more harmful due to the uniqueness of a war being waged on a besieged area from which nobody can escape.
“[On July 24] I walked in behind a curtain, and there was a little girl alone, dying by herself. And that’s the outcome of a collapsed health system: a little 8-year-old girl, dying alone on a trolley in the emergency room. In a functioning health system, she would have been saved.”
The violence unleashed by Israeli forces has caused physical and mental damage on a scale that would overwhelm any functioning health system, let alone one already decimated by a crushing offensive and a 17-year-long blockade. As of mid-October, only 17 of Gaza’s 36 hospitals are partially functioning, though the unabated fighting often puts them out of reach for those who need them. The other 19 hospitals are out of service.
Seeking care outside of Gaza is made extremely difficult by the Israeli authorities. Between the closure of the Rafah crossing in early May 2024 and September 2024, only 229 patients were authorized to be evacuated—this amounts to 1.6 percent of those who needed it at the time.
“My son has a weak immune system. Even the smallest cut affects him. The conditions we’re living in—the cold, the polluted environment—are making his condition worse. We’re not in our homes, we’re in tents that are unfit for human life. With everything they’re dropping on us, it feels like we’re breathing in sulphur. It worsens his condition, causing severe inflammations."
Forcible displacement has pushed people into unbearable living conditions: they are crammed into makeshift tents made from scraps, suffering from water and food deprivation. The main morbidities observed by MSF teams supporting primary health care—such as skin diseases, upper respiratory tract infections, and diarrhea—are indicative of the appalling hygiene conditions. Vaccination schemes have been disrupted and the risk of outbreaks is real. The situation has only worsened as the winter months set in.
Even if the offensive ended today, its long-term impact would be unprecedented, given the scale of the destruction and the unique challenges of organizing health care in Gaza. A whole society needs rebuilding, while coping with a staggering number of war-wounded people who may require years of rehabilitation and risk infections, amputations, and permanent disability. The mental trauma caused by the violence, the loss of family members and homes, the strenuous living conditions, and the repeated displacement, represent a massive and urgent need, which will span generations.
"Two months ago, we were in what we thought was a safe area. But without warning, tanks started firing shells … I grabbed my husband and son, made them walk in front of me stretching my arms out to protect them. A shell landed between them, in front of me. We were in farmland, full of agricultural huts made of palm leaves. The huts caught fire. The people living there weren’t connected to any party or faction.
After the explosion, I screamed for help. One of the neighbors came out, saw my son with his leg severed, and started wailing...
I turned to my husband, Ahmed, his condition seemed better than our son’s. I told him, 'Ahmed, wait … Hamoud’s injury is worse. Let me see him, I’ll come back to you.' My husband was in pain but nodded in agreement. A neighbor took my son on a bicycle and found an ambulance on the way, so I returned to my husband but couldn’t find anyone to take him. I saw a water truck passing by and begged the driver, 'Please, take my husband to the hospital. I’ll give you anything you want.'
Once I was sure my husband and son were being transferred to the hospital, I looked around and saw a little girl whose head had been severed. I gathered her remains. I also found a man with no pulse, so I covered his face with his shirt. I arrived at the hospital, feeling deep down that I was about to lose my son. I came to say goodbye. I asked about my son, and they told me he was fine, stable even. I felt relieved and thanked God. But then they told me my husband had passed away. I went into shock again, blaming myself for choosing my son over his father.
When I got there, I found them both side by side in the emergency room. My son saw them covering his father’s eyes and asked, 'Mama, why are they covering Baba’s eyes?' It took only five minutes to turn our whole world upside down.
My son’s bone is exposed at the joints below his pelvis. The care he received here saved his right leg ... My son used to have panic attacks whenever he thought about what happened, and when he saw me crying, he stopped talking. He didn’t speak for 10 days."
The environmental impact of the war will further aggravate the long-term health risks. The number of excess deaths due to the war—including those due to the collapse of health care, malnutrition, and disease outbreaks—may be conservatively estimated at 186,000 (including 148,000 indirect deaths), according to The Lancet. Struggling to survive, trapped in a war zone with no safe space and no exit in sight, people in Gaza are living in a death trap.
In the north of the Strip in particular, the recent military offensive is a clear illustration of the brutal war the Israeli forces are waging on Gaza, and we are witnessing clear signs of ethnic cleansing as Palestinian life is being wiped from the area. Our first-hand observations of the medical and humanitarian catastrophe inflicted on Gaza are consistent with the descriptions provided by an increasing number of legal experts and organizations concluding that genocide is taking place in Gaza. While we don't have legal authority to establish intentionality, the signs of ethnic cleansing and the ongoing devastation—including mass killings, severe physical and mental health injuries, forced displacement, and impossible conditions of life for Palestinians under siege and bombardment—are undeniable.
Urgent calls for action
- An immediate and sustained ceasefire must be implemented. The complete destruction of Palestinian life in Gaza and all things that make up the very fabric of society must stop.
- The shameful and extreme rationing of humanitarian aid in the Gaza Strip must stop. Israel must end its siege on Gaza and open critical land borders, including the Rafah crossing, to ensure the delivery of humanitarian and medical aid on a massive scale. Israel must take all necessary steps to ensure that urgently needed aid reaches those in need, including by putting a stop to actions that disrupt law enforcement capacities within the Gaza Strip.
- Israel must revoke its recent law banning UNRWA and ensure that the agency can continue its vital role in supporting the population. The remaining local capacities in Gaza must be rebuilt and scaled up.
- Forced displacement must end. People in Gaza must be allowed to move freely, including returning to their places of origin, and restore their livelihood capacities. Israeli authorities must facilitate the evacuation of those who need specialized care or those who seek refuge outside of Gaza to leave, while ensuring their right to a safe, voluntary, and dignified return.
- In January 2024, the International Court of Justice (ICJ) ordered Israel to implement provisional measures to prevent genocidal acts in Gaza. Despite this, no action has been taken to address these measures. MSF’s first-hand observations align with those of an increasing number of legal experts and organizations, concluding that ethnic cleansing and genocide are taking place in Gaza. MSF calls on States, particularly Israel’s closest allies, to end their unconditional support for Israel and fulfill their obligation to prevent genocide in Gaza. States must leverage their influence to alleviate the suffering of the population and enable a massive scale-up of humanitarian assistance in the Gaza Strip.
- MSF renews its call for an independent investigation to determine the facts and responsibilities behind the repeated attacks on MSF teams and facilities, which killed eight MSF colleagues and many of their family members. This call also extends to investigating other attacks on humanitarian workers and medical staff.
Gaza: Life in a Death Trap
Bearing witness to 14 months of repeated attacks on civilians, the dismantling of essential civilian infrastructure including healthcare facilities, and a systematic denial of humanitarian assistance in Gaza.
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News Dec 19, 2024
Gaza death trap: MSF report exposes Israel’s campaign of total destruc...
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