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Gaza: Rafah evacuation order jeopardises medical care for wounded

21 Feb 24

Gaza: Rafah evacuation order jeopardises medical care for wounded

In Rafah, an MSF medic checks on a war-wounded patient who was forced to flee Al-Aqsa Hospital in Gaza's Middle Area Caption
In Rafah, an MSF medic checks on a war-wounded patient who was forced to flee Al-Aqsa Hospital in Gaza's Middle Area

The war in Gaza has displaced some 1.5 million people to Rafah, in the southern corner of the Gaza Strip. Over the past four months, most of the people now here have been displaced multiple times, carrying what few belongings they have left.

Plastic tents have been erected on every available piece of land, on the streets and open ground in and around Rafah City. Now there is no space left: cars can barely drive through on the overcrowded streets, and even walking can be challenging.

People sheltering in the area have been deprived of their basic needs, including water, food and shelter, and have been subjected to repeated evacuation orders and forced displacement by the Israeli military.

In the recent week attacks have intensified on Rafah and people have started to flee back north towards the Middle Area of Gaza Strip. At the same time, evacuation orders and attacks on Nasser Hospital, in the southern city of Khan Younis, have forced patients undergoing treatment to leave the hospital.

There is no safe place in Gaza; people have nowhere left to go.

Trauma injuries, burns and long-term care

At Rafah Indonesian Field Hospital, MSF teams are treating people for war-related trauma injuries and burns that require continued, sustained care.

“Most patients with injuries need dressing changes at least twice a week, as well as antibiotics, pain killers and constant medical care,” says MSF medical coordinator Guillemette Thomas.

“If the injury is severe, the patient also needs physiotherapy to avoid losing the functionality of the injured limb."

Most of MSF’s patients are staying in tents or public buildings turned into shelters, where their dire living conditions make it almost impossible to keep open wounds clean, resulting in infections.

This high risk of infections is one of the main issues for injured patients in Rafah. Without proper medical treatment, infections can spread through the body, to the bones, causing a lot of pain and leading to death if left untreated.

At MSF's out-patient department in Batil refugee camp Gandhi Pant, a nurse, escorts a patient with a possible appendicitis to a waiting ambulance. 

Batil is one of three camps in South Sudan’s Upper Nile State sheltering at least 113,000 refugees who have crossed the border from Blue Nile state to escape fighting between the Sudanese Armed Forces and the SPLM-North armed group. Refugees arrive at the camp with harrowing stories of being bombed out of their homes, or having their villages burned. The camps into which they have poured are on a vast floodplain, leaving many tents flooded and refugees vulnerable to disease. Mortality rates in Batil camp are at emergency levels, malnutrition rates are more than five times above emergency thresholds, and diarrhea and malarial cases are rising.

Help us prepare for the next emergency

Since mid-December 2023, MSF teams in Rafah Indonesian Field Hospital have been supporting the post-operative, inpatient and outpatient departments, providing wound dressings and physiotherapy and carrying out small surgical procedures.

So far, they have provided more than 5,800 consultations and admitted more than 200 patients for treatment. In the outpatient department, some 60 percent of patients seen by MSF teams have trauma injuries. The remaining 40 percent have war-related burns.

More than 40 percent of the outpatient department’s patients are children.

The medical response in Gaza only scratches the surface of people’s overwhelming needs for medical care, with local health officials reporting that almost 70,000 Palestinians have been injured since October 2023.

A humanitarian catastrophe in waiting

In the past week, Israeli authorities have made public their intention to evacuate people from Rafah and launch a ground offensive in the area. Attacks have intensified and people sheltering in Gaza’s far south are living in fear of their lives.

For patients needing continued care for trauma wounds or burns, another forced displacement could result in severe health complications, or possibly death.

“In other hospitals in Gaza, we have seen that when hospitals are evacuated, patients leave on foot, in wheelchairs or even lying in hospital beds,” says Guillemette.

“This can be extremely dangerous for them. When someone with a severely fractured leg starts to walk, it compromises their possibility to regain mobility and can have life-threatening consequences.”

Close to Rafah Indonesian Field Hospital, a camp for displaced people overlooks destroyed buildings Caption
Close to Rafah Indonesian Field Hospital, a camp for displaced people overlooks destroyed buildings

Since the war began, MSF medical teams and their patients have been forced to evacuate nine different health facilities in Gaza, after coming under fire from tanks, artillery, fighter jets, snipers, and ground troops, or after being subject to an evacuation order. Medical staff and patients have been arrested, abused, and killed.

Providing people with medical are and scaling up life-saving humanitarian assistance has been made almost impossible by the intensity of Israel’s bombing and shelling of Gaza, as well as by intense fighting.

MSF teams are extremely worried about the escalations of violence in Rafah and the impending evacuation of the area, where millions of people are sheltering, including the wounded, the sick, the elderly and those with limited mobility.

“People have lost everything – their homes, their loved ones, their basic needs and security   – and now they barely survive, living in muddy plastic tents or on the floors of hospitals and schools, without any belongings,” says MSF project coordinator Lisa Macheiner.

“Rafah and the whole of Gaza need a safe humanitarian response at a much larger scale, which is only possible with a sustained and immediate ceasefire.”

MSF teams continue to provide medical care in Rafah in four hospitals, one clinic and two health posts, and in one hospital in the Middle Area.

However, without an end to relentless bombings and forced displacement, providing humanitarian aid is almost impossible. We reiterate our call for an immediate and sustained ceasefire, which is the only way to put an end to the humanitarian catastrophe unfolding in Gaza.

MSF and the Israel – Hamas conflict

An unprecedented humanitarian crisis is unfolding in Gaza. MSF teams have worked to treat the wounded and supply overwhelmed hospitals as indiscriminate airstrikes and a state of siege threaten millions of men, women and children.

Médecins Sans Frontières / Doctors Without Borders (MSF) is horrified by the events that began on Saturday 7 October – both the brutal mass killing of civilians perpetrated by Hamas in Israel, and by the massive attacks on Gaza now being pursued by the Israeli military.