On October 7, 2023, Hamas militants launched a major assault on Israel, leaving more than 1,200 people dead and taking 251 hostages. In response, Israel launched a massive military offensive on Gaza that has killed more than 43,000 Palestinians, wounded more than 100,000, and displaced 1.9 million. Violence has also surged in the West Bank, and across the region.
Doctors Without Borders/Médecins Sans Frontières (MSF) teams were already working in Palestine before the escalation, and we have witnessed the catastrophic human toll of Israel’s all-out war on Gaza over the past year. Gaza’s medical infrastructure was already weakened by years of a blockade that began in 2007. Since October 2023, the ongoing siege and obstruction of aid have denied people access to desperately needed food, water, and medicines. People in Gaza are facing acute food insecurity and a high risk of famine. The destruction of water and sanitation infrastructure has led to the resurgence of polio, a disease not seen in Gaza for 25 years.
Despite the extreme challenges, MSF teams continue to adapt to provide medical aid in Gaza, including surgical care, maternal and pediatric care, and mental health support in various hospitals and health centers. MSF is assisting the large-scale polio vaccination campaign across the territory. We have opened two field hospitals to help cope with the growing demands, but they cannot replace a health care system that has been systematically dismantled.
Here, we look back at MSF’s response to the devastating humanitarian consequences of the war in Gaza.
October 2023
On October 7, following the Hamas attacks inside Israel, the Israeli military begins a major counteroffensive in Gaza, launching a barrage of airstrikes across the territory. Israeli strikes hit Indonesian Hospital and an ambulance in front of Nasser Hospital, killing a nurse and an ambulance driver and injuring several others. MSF has supported Indonesian and Nasser hospitals in southern Gaza since 2021 and 2011, respectively. MSF donates medical supplies to hospitals and health facilities across Gaza to respond to medical needs. In northern Gaza’s Al-Awda hospital, where MSF staff provide surgical and inpatient care, the bed capacity is increased in anticipation of an influx of patients.
MSF offers on October 8 support for Israeli hospitals that are treating large numbers of casualties following the attacks, but the offer is not accepted. We do not have existing medical programs in Israel, which has strong emergency and health systems.
November 2023
Throughout November, MSF witnesses the targeting of health care workers and facilities. MSF colleagues are killed in three separate attacks, including a strike on our marked convoy. There is intense bombing and shelling around Al-Shifa Hospital, a 700-bed facility and the principal medical complex in Gaza able to provide emergency and surgical care. MSF is forced to evacuate its staff from the hospital. Al-Shifa is later stormed by Israeli forces. A temporary truce between Israel and Hamas in Gaza takes effect from November 24 to November 30.
December 2023
Although a one-week pause in fighting in the last week of November inspires some hope for a ceasefire, on December 1 fighting resumes. Hours after the pause ends, a blast damages Al-Awda Hospital in northern Gaza. Israeli forces eventually take over Al-Awda Hospital on December 17 after a 12-day siege.
Also on December 1, new evacuation orders are issued to people in central Gaza and Khan Younis, including areas where two MSF clinics are located. By December 7, 1.9 million people are displaced (about 90 percent of the population), most of them forced to move to southern Gaza. MSF opens a clinic at Rafah Indonesian Hospital to help provide post-operative care and support the capacity of other facilities overwhelmed with mass casualties.
January 2024
Among 1.9 million displaced Palestinians are thousands of pregnant women forced to give birth in terrible conditions, often in temporary shelters with limited protection from cold winter temperatures and rainfall. One pregnant woman, Maha*, is turned away from a hospital in northern Gaza because the delivery rooms are full. She delivers a baby boy in a latrine near her tent, but the child does not survive. Later, she receives postnatal care at MSF-supported Emirati Hospital and shares her story.
On January 8, the 5-year-old daughter of an MSF worker is killed by a suspected Israeli tank shell that hits a shelter where MSF staff and their families are staying. Prior to the incident, MSF had notified Israeli forces of the location of the shelter.
February 2024
Despite promises from Israeli forces that medical staff, their families, patients, and one caretaker per patient would be allowed to remain inside, on February 14 and 15, they order everyone to evacuate Nasser Hospital before storming it. One MSF staff member is detained and released a month and a half later, on April 4.
On February 22, MSF Secretary General Christopher Lockyear addresses a UN Security Council meeting on Gaza to demand an immediate ceasefire and call for the protection of medical facilities, staff, and patients. The speech comes as more than 1.5 million Palestinians are trapped in Rafah amid mounting fears of an Israeli ground invasion. “We have watched members of this Council deliberate and delay while civilians die,” says Lockyear. He highlights a series of attacks on MSF staff by Israeli forces, noting that “this pattern of attacks is either intentional or indicative of reckless incompetence.”
March 2024
The United States announces in early March its plan to build a “humanitarian aid pier” more than five months into the conflict. MSF USA Chief Executive Officer Avril Benoît calls this announcement a “glaring distraction” from the true causes of the lack of medical supplies and food: Israel’s indiscriminate and disproportionate military campaign and its blocking and restriction of aid.
On March 23, MSF co-signs a letter with other humanitarian organizations to President Biden, noting, “the humanitarian response in Gaza, including US funded humanitarian assistance, has been consistently and arbitrarily denied, restricted, and impeded by the Israeli authorities.”
By the end of March, months of restricted movement have resulted in severe food insecurity in northern Gaza, where between 12.4 and 16.5 percent of children under 5 years old have severe acute malnutrition, according to the World Health Organization (WHO). At the same time, only 28 percent of Gaza’s hospitals remain partially functional.
April 2024
On April 1, after a two-week military operation, Israeli forces leave Al-Shifa Hospital wrecked and gutted. Over the course of the raid, Israeli forces detain medical staff and other people in and around the hospital. An MSF clinic in the hospital’s vicinity is also badly damaged. At least 21 patients die during the siege that began on March 18, according to the WHO. MSF calls for patients who remain in Al-Shifa Hospital to be safely evacuated so they can receive the care they need.
Also on April 1, an attack by Israeli forces kills seven humanitarian aid workers employed by World Central Kitchen. This event draws international attention to Israel’s conduct of the war and attacks on humanitarian aid. As of mid-April, at least 244 aid workers and 490 health workers have been killed in Gaza, the vast majority Palestinians, according to the UN humanitarian agency.
The physical and mental health of Palestinians is deteriorating rapidly as Gaza’s devastated health care system struggles to keep up with needs.
May 2024
In the first week of May, Israeli forces announce plans to invade Rafah. On May 7 they seize the Rafah border crossing, a vital entry point for humanitarian supplies, as well as a key exit point for medical evacuations. Over the course of the month, Israeli evacuation orders and intense fighting in Rafah force nearly 1 million Palestinians to flee.
June 2024
A heavy bombing campaign by Israeli forces on June 8 hits Nuseirat refugee camp in the Middle Area. MSF teams and other staff at Al-Aqsa Hospital treat hundreds of severely injured patients, including many women and children. MSF medical referent Karin Huster is in Al-Aqsa that day and reports seeing “the gamut of war wounds, trauma wounds, from amputations to eviscerations to trauma, to traumatic brain injuries, fractures, and obviously, big burns.”
On June 25 a UN expert committee warns, “there is a high and sustained risk of famine across the whole Gaza Strip.”
Remembering our colleagues killed in Gaza
Health care staff and humanitarian workers must be protected.
July 2024
From late April until mid-July, MSF is not able to get any aid into Gaza and faces critical supply shortages. Finally, from July 10 to 15, six trucks carrying essential medical items are allowed in through the Kerem Shalom border crossing. This is only a drop in the ocean given the immense needs of a devastated population.
On July 16, WHO announces that wastewater test results confirm the reemergence of the polio virus in Gaza for the first time in more than 25 years. It’s a direct result of the decimation of Gaza’s water and sanitation system, massive forced displacement, and the disruption of routine vaccinations.
In the last week of July, Nasser Hospital is once again driven to the point of collapse after a month of airstrikes and ground fighting in the surrounding area. MSF urgently calls on all warring parties to ensure safe access to care and avoid endangering patients and staff inside the largest remaining hospital in southern Gaza.
August 2024
Gaza sees its first polio case in 25 years when a 10-month-old boy contracts the virus.
Israeli evacuation orders throughout July and August repeatedly force people into ever more crammed areas and shrink the so-called humanitarian zone. In late August, MSF opens a field hospital in Deir al-Balah as evacuation orders force people to flee nearby Al-Aqsa Hospital. However, the field hospital was designed to support and complement the care provided by Al-Aqsa, not replace it.
In the tiny coastal enclave of Al-Mawasi, where hundreds of thousands of people are displaced, people must line up for hours to shower or get clean water. MSF partners with the Palestinian Agricultural Development Association (PARC) to provide latrines, solar water pumps, and water treatment plants. Ten months of constant bombing have created abysmal sanitation conditions, and the PARC medical clinic sees approximately 200 children a day with skin conditions.
Near the end of August, Israeli forces yet again issue evacuation orders for Deir Al-Balah and Khan Younis. Among those fleeing are MSF staff, who describe the continuous forced displacement of people as inhumane. There is no room to set up tents. The combination of overcrowding, severe lack of water, and minimal sanitation services fuel the spread of diseases.
September 2024
An estimated 12,000 wounded Palestinians are waiting for medical evacuation from Gaza, yet around 60 percent of evacuation requests are rejected by the Israeli authorities, according to WHO. For some who are able to leave Gaza, MSF supports their transfer to our reconstructive surgery hospital in Amman, Jordan. MSF calls on the Israeli authorities to ensure medical evacuations for Palestinians in need of specialized medical care, and for other states to receive and facilitate treatment outside of Gaza. We also call on Israel to ensure that all patients and their caregivers are guaranteed safe, voluntary, and dignified return to Gaza.
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