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Israel – Gaza war

Israel – Gaza war

MSF medical staff treat wounded patients at Al-Shifa Hospital in Gaza - 24 October Caption
MSF medical staff treat wounded patients at Al-Shifa Hospital in Gaza - 24 October
© MSF

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.

MSF is calling for an immediate and sustained ceasefire to prevent more deaths and injuries, and for the protection of civilians and healthcare facilities at all times. We call on all parties involved to restore the scale and flow of humanitarian aid on which the survival of the people of Gaza depends.

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How is MSF responding to the crisis?

In Gaza, one of the most densely populated places on Earth, 2.2 million people were already living through a chronic crisis before what has now become a humanitarian catastrophe.

As of 27 May 2024, over 36,000 people have been killed and 80,000 have been wounded according to local health authorities. In March 2024, a further 7,700 people were estimated to be buried under rubble.

Over 1.7 million people are estimated to be forcibly displaced and living in appalling conditions that are unsafe and unhealthy – without adequate shelter, food, water or medical care. This number represents nearly 75 percent of Gaza's population.

MSF staff have been working at hospitals and clinics through the conflict, providing essential medical aid that includes:

  • Surgical care
     
  • Wound and burn care
     
  • Maternity care
     
  • Physiotherapy 
     
  • Mental health support
     
  • Vaccinations
     
  • Outpatient consultations

Many hospitals that MSF supports have been hit by airstrikes or faced incursions by ground forces. Meanwhile, our staff and our patients have been subjected to dangerous evacuation orders that have put lives and the continuity of care at risk.

The situation has been extremely volatile. This means that our operations have had to adapt continually and move frequently.

Hospitals and clinics that we currently support or have previously supported include:

  • Nasser Hospital, European Gaza Hospital, and the Martyrs and Beni Suhaila clinics in Khan Younis
     
  • Al-Aqsa Hospital in Deir al-Balah 
     
  • Al-Awda Hospital in northern Gaza 
     
  • Al-Shifa Hospital in Gaza City 
     
  • Rafah Indonesian Field Hospital and Al-Emirati Maternity Hospital in Rafah

MSF is delivering around 200 tons of medical supplies each month. This includes medicines, wound dressings, surgical kits and key logistical items.

However, border restrictions and the limited options for crossing into Gaza have made our supply operations extremely difficult. Our team in Egypt are ready and waiting to send more medical supplies as soon as they can do so safely.

Access to safe, clean drinking water is particularly difficult in Gaza, exacerbating living conditions, hygiene and health issues.

In Rafah, MSF works to provide around 300 cubic metres of water per day. We have also set up a water desalination plant on the coast at Al-Mawasi.

MSF’s activities in the West Bank have been affected by the escalation of violence and movement restrictions that have limited people’s access to essential services, including healthcare. The impact on our patients' mental health has been a particular concern.

We have responded by expanding our work to reach communities directly, help local emergency services and support healthcare centres and clinics.

This includes:

  • Supporting four healthcare centres and running 10 mobile clinics in Hebron, as well as training healthcare staff at Al Moktaseb, Halhoul, Dura, and Yatta hospitals.
     
  • Providing medical supplies to community focal points and emergency centres in Beit Omar, Al Rshaydeh and Um El Khair.
     
  • Providing relief items and food parcels to Gazans displaced within the West Bank.
     
  • Increasing capacity at hospitals including Halhoul, Thabet Thabet, Moktaseb, Jenin, and Khalil Suleiman.

MSF is an impartial organisation. So, we are sometimes asked why we do not currently run medical programmes in Israel.

We have offered our support to Israeli hospitals treating high numbers of casualties. However, Israel has strong emergency and health systems in place.

MSF focuses on filling gaps in healthcare and going wherever that need is greatest. Our teams are working in Gaza and the West Bank – as we have for 20 years – providing medical aid and supporting a healthcare system that urgently lacks both staff and supplies.

This is why we report on what our staff and patients are directly witnessing and experiencing in Gaza. Hospitals are becoming overwhelmed and facing shortages of drugs, medical supplies, and fuel for generators.

From the start of the conflict, hospitals across the Strip have been completely overwhelmed and have faced running out of critical supplies. Some medical facilities have been hit by indiscriminate bombing while others have been under siege. Our staff have repeatedly spoken of the wounded screaming without painkillers, how already sick people cannot reach care, and the fear of being hit in an airstrike.

Now, after months of conflict, the threat of injury, illness and death has evolved beyond the violence.

In Gaza, the risk of infection has become incredibly high and is putting lives at risk.

Infected wounds are common with patients facing the double hit of unsanitary living conditions and a healthcare system that is unable to provide the in-hospital treatment and support that they need. Meanwhile, infectious diseases – including diarrhoea, respiratory infections and hepatitis – are increasingly reported across Gaza.

Pregnant mothers struggle to access maternity care and delivery rooms, leading to dangerous childbirth complications.

And, as food and water shortages deepen, the UN has warned that 40 percent of Gaza's people are at risk of famine.

MSF is an independent, impartial and neutral humanitarian organisation. We operate based on medical need alone, going wherever that is greatest.

MSF teams have been working in Palestine since 1989, providing trauma care, mental health services and running a specialist reconstructive surgery project.

We currently have over 400 staff members in Gaza. The majority are Palestinian and many have now lost homes or family members in the violence.

What is MSF calling for?

On March 25, the United Nations Security Council ordered an immediate ceasefire in Gaza. However, this resolution was not implemented which makes it little more than political theatre.

Israeli forces continue to carry out widespread attacks that disproportionately impact civilians. Palestinians in Gaza are suffering every day from a destructive military campaign that blatantly ignores the rules of war.

States have obligations and must do everything they can to stop the continued killing. However, without an immediate and sustained ceasefire, and the entrance of meaningful humanitarian aid, we will continue to see more people die.

Since the start of the war in Gaza, MSF has witnessed systematic attacks against healthcare facilities and medical staff, with devastating consequences for people in need.

As of 27 May 2024, 493 healthcare workers have been killed, of which five were MSF staff.

To be clear, the healthcare in Gaza has been dismantled. Medical centres and humanitarian systems have been destroyed and replaced with improvised and less effective options. Out of the 36 main hospitals present before the war, only 16 remain even partially functional.

MSF denounces the destruction and disruption of the healthcare system, as well as essential civilian infrastructure that is critical to the survival of the Palestinians who rely on it.

MSF staff and patients have had to leave 13 different healthcare facilities and have endured 26 violent incidents. This includes airstrikes damaging hospitals, tank shells fired at clearly identified shelters, humanitarian convoys fired upon and ground offensives into major hospitals.

These attacks show the failure of deconfliction measures in a war fought with no rules, while Israel has offered no accountability for the attacks that we have raised with them.

We expect Israel to follow the obligations of international humanitarian law and we expect Israel's allies to take their responsibility seriously beyond weak political rhetoric.

We demand accountability.

The Israeli offensive on Rafah, in Southern Gaza, has made the delivery of humanitarian and medical aid nearly impossible. The nearby Rafah crossing at the border with Egypt has been a literal lifeline, so its closure now means stocks of fuel, food, water and medicines are dangerously low.

The Israeli government’s policy of deliberate deprivation only allows a trickle of food and water to enter Gaza and will inevitably lead to malnutrition and death.

MSF teams are already seeing the widespread impact of this food insecurity, however, Israeli restrictions prevent us from doing essential assessments and launching a full-scale response. What we do see is already alarming and we cannot afford to wait for the emergency to get worse.

The urgent need to get more aid into Gaza is now desperate. Reopening the Rafah crossing is a crucial tool and could help to bring in a larger flow of supplies that is only possible via overland routes.

In Gaza, aid has been instrumentalised to create an illusion of safety.

People have been displaced, often multiple times, towards designated “safe” or “humanitarian zones” which maintain a pretence of Israel’s adherence to international humanitarian law.

However, people in these densely populated areas receive minimal assistance and are forced to live in deplorable conditions which only endanger their lives further. Shockingly, there are now incidences of displacement camps being directly hit by Israeli airstrikes with truly horrific consequences.

In general, MSF finds that what Israel communicates about aid delivery is very different to the reality of what we see getting into the strip.

On 16 May, the US military anchored a temporary pier to the Gaza coastline to increase the amount of humanitarian aid arriving. However, this is a clear distraction from the real problem: Israel’s indiscriminate and disproportionate military campaign alongside its obstruction of aid.

This is not a logistics problem. It is a political problem.

On January 26, the International Court of Justice (ICJ) recognised a risk of genocide in Gaza. The court then ordered Israel to take provisional measures to prevent genocidal acts, notably by allowing humanitarian aid into the Strip.

However, these measures have not been implemented by Israel and the situation in Gaza has passed the threshold of absolute horror. 

On May 24, the ICJ then ordered Israel to half its offensive on Rafah and reopen the Rafah crossing.

MSF has been calling for an immediate and sustained ceasefire in Gaza since the beginning of the war and has raised the alarm about the disastrous consequences of the Rafah offensive since it was first announced in February.

However, it is states have the responsibility to ensure that the ICJ’s words are put into action. At the same time, all states that are supporting Israel in these circumstances are morally and politically complicit.

We call all on countries, in particular the US, UK, and allied EU Member States, to do whatever is in their power to influence Israel and stop supporting the ongoing siege and attacks against civilians in Gaza.

In-depth: Attacks on healthcare

Throughout the conflict in Gaza, there have been serious incidents of attacks on hospitals, violence against medical personnel and obstructions to healthcare.

Shockingly, more than 493 healthcare workers were killed between 7 October 2023 and 27 May 2024 - this includes five of our own staff. As of 28 December, 14 incidents of strikes on MSF medical facilities or vehicles were recorded. 

For example, the MSF-supported Al-Shifa Hospital was hit several times, resulting in injuries and deaths, in the lead-up to Israeli forces entering the complex on 15 November. The facility was soon evacuated and became unable to function. Elsewhere, MSF staff were killed in strikes on Al-Awda Hospital while clearly identified MSF vehicles have been destroyed by tanks.

The systemic use of evacuation orders affecting the areas around hospitals and the effective siege of multiple facilities has taken a shocking toll on the ability to both provide and access healthcare. The safety of patients, staff and displaced community members has been under serious threat.

Currently, no healthcare facility in Gaza is able to handle the large flow of wounded people.

Treating the sick and injured, as well as protecting medical personnel and facilities is at the core of International Humanitarian Law.

MSF reiterates its urgent call:

All parties to the conflict must sustain Gaza’s fragile healthcare system and protect the few remaining hospitals, ambulances and medical staff.