The Collapsing Health System in Gaza
Photo via Getty Images
SARA MEDINA: Israeli strikes on hospitals in the Gaza Strip have exacerbated the instability of the Gazan health system amidst civilian casualties and increasing rates of infectious disease and malnutrition, underscoring the direct impact of the ongoing war on civilian health and Israel’s violation of international humanitarian law.
Even before the Oct. 7 attack on Israel by the militant group Hamas and the subsequent Israeli retaliation in Gaza, the Gazan healthcare system was fragmented. Care providers were uncoordinated in defining their roles, leading to frequent overlaps or gaps in service. These providers included the Hamas-controlled Palestinian Health Ministry, health NGOs, and the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). The issue of fragmentation was furthered by the reliance of the Health Ministry on donor support, as well as the political division between Hamas, which governs Gaza, and the Palestinian National Authority (Fatah), which governs the West Bank.
The ongoing attacks on the Gaza Strip have put pressure on an already fragile healthcare system. As of Dec. 21, the World Health Organization (WHO) estimates that 93% of the Gaza population is confronted with “crisis levels of hunger,” and the prevalence of diarrheal diseases is 25 times higher than before the conflict began. Rates of other infectious diseases are similarly surging due to displacement and overcrowding coupled with lack of clean water and sanitation. Maternal health is also of particular concern. Most of the estimated 50,000 pregnant women in Gaza are living in these conditions, increasing their risk of severe complications during childbirth.
The war has also directly resulted in record numbers of civilian injuries and deaths, necessitating adequate emergency healthcare. The Israeli Defense Force (IDF) has argued that because Hamas operates in underground networks, it is difficult to avoid adverse effects on civilians. Though exact figures are difficult to discern as Hamas officials do not separate civilian and combatant deaths, data provided by the Health Ministry suggests that two-thirds of casualties have been women and children. The total Gazan death toll since Oct. 7 is over 25,000, according to the Health Ministry.
Yet while the need for healthcare is becoming more and more urgent, the healthcare system is crumbling.
A report by the WHO released on Jan. 24 stated that out of 24 hospitals in northern Gaza, only seven remain open. Even among the open hospitals, capacity is limited, as both medical supplies and healthcare workers are scarce. A CNN analysis of satellite images, videos from the ground, and interviews with eyewitnesses suggests that at least 14 of the hospitals were directly hit.
The IDF has admitted to targeting some of these hospitals due to alleged evidence that Hamas was harboring hostages, weapons, and command centers within and underneath them, a claim supported by U.S. intelligence at Al Shifa Hospital.
Though international humanitarian law (IHL) protects medical establishments in times of war, hospitals can lose this protection if they are being used to commit an “act harmful to the enemy.” However, IHL clarifies that the attacking party must avoid harm to patients and medical personnel. Despite the IDF enabling evacuation of the impacted hospitals, the attacks on health systems have resulted in 619 deaths and 835 injuries as of Jan. 18.
The attacking party is also obligated under IHL to mitigate effects on civilian health services after the attack. Israel Prime Minister Benjamin Netanyahu claimed on Nov. 12 that the IDF offered fuel to Al Shifa Hospital following the Nov. 3 airstrike, a gesture that Hamas declined. A few days later, the IDF also delivered mobile incubators to Al Shifa.
But since November, Israel has made no other attempts at alleviating the stress on the Gazan health system. The Gaza Strip is left with minimal functioning health facilities, which has especially severe implications for pregnant women who require obstetric and neonatal services as well as for civilians injured during attacks.
In the absence of adequate Israeli support in rebuilding the disintegrating health system in Gaza, the WHO and its partners stepped up to lead a mission to deliver fuel to Al Shifa Hospital on Jan. 12. Since the WHO’s last mission ten days prior, the hospital saw improvements in functionality, including resuming regular conduction of trauma surgeries.
The Jan. 26 ruling against Israel by the International Court of Justice for the “crime of genocide” mandates the state to provide “basic services and humanitarian assistance to address the adverse conditions of life faced by Palestinians in the Gaza Strip.” In light of this ruling, it is even more imperative that Israel address the deadly consequences of the hospital attacks.
Until Israel steps up to this role, the unregulated targeting of hospitals remains a clear violation of IHL. Regardless of whether the intelligence on Hamas command centers is valid, the lack of aid to civilian patients and healthcare workers severely impacted by the attacks cannot be permitted.
In a conflict characterized by emotionally charged, historically rooted, and religiously defined divisions, it is important to keep civilians separate from political strife, especially in the matters of health and wellbeing. This conflict should remain a war between the State of Israel and Hamas, not between Jews and Muslims, and certainly not between civilians. Gazan civilians must not be left to grapple with record rates of injury, malnutrition, and infectious disease in a collapsing health system because of a conflict between authorities that began over 75 years ago.
Sara Medina is a freshman in the School of Health studying Global Health. She is from Southborough, Massachusetts. She is particularly interested in the impact of world politics on population health.