Sixteen months of bombings and attacks have decimated Gaza’s health system and workforce. Palestinian doctors tell Elisabeth Mahase of the British Medical Journal (BMJ) about the effects on mental health, what needs to happen next, and how UK doctors can help.
6 March, 2025
Gaza’s health system is “completely eviscerated”—what happens now?
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r361 (Published 25 February 2025) Cite this as: BMJ 2025;388:r361
Israel’s attacks on the Gaza Strip since October 2023 have left its healthcare system in ruins, with nearly all hospitals partly or completely destroyed, along with much of their medical equipment.1 More than 1000 healthcare workers have been killed.2
A temporary ceasefire agreement between Hamas and Israel came into effect on 19 January, 470 days after Hamas’s 7 October 2023 attack on Israel, which resulted in around 1200 people being killed and more than 200, including children, being taken hostage. Over the next 16 months Israel has bombarded Gaza, raided hospitals, and carried out ground offensives across the strip. An estimated 47 000 Palestinians have been killed and 111 000 injured, and around 10 000 people are believed to be beneath rubble.3
The effects of the war go far beyond these numbers, says Mohammed Abu Mughaiseeb, deputy medical coordinator for Gaza for the charity Médecins Sans Frontières (MSF). “We don’t count the people who have died as a result of the lack of medical services. A lot of people who had cardiac problems died. A lot of people with renal failure died. A lot of people with cancer—children and adults—died because of a lack of treatment and services,” Mughaiseeb tells The BMJ from southern Gaza.
The British Palestinian consultant surgeon Ghassan Abu-Sittah, who was working in Gaza in October and November 2023, says the healthcare system has been “completely eviscerated” and the “magnitude of injury and illness has not been seen before.”
He says, “Hospitals have been destroyed. So have numerous health clinics. There are no microbiology labs in a place where almost 90% of all infections are now multidrug resistant, and there is no radiology beyond x rays.” He adds that 90% of homes have been destroyed and people are living in “cramped, overcrowded, exposed areas” where infectious diseases such as hepatitis, diarrhoeal diseases, and respiratory diseases continue to run rampant among the malnourished population that has little access to clean water or working sewage treatment systems.
British Palestinian consultant surgeon Ghassan Abu-Sittah describes the medical situation in the Gaza Strip
“We lost everything”
Sameer Sah, director of programmes at the charity Medical Aid for Palestinians, describes the current situation in Gaza as “like hell,” with little access to clean water and no rubbish disposal. He says key infrastructure needs to be urgently rebuilt, including communication systems, roads, water supply systems, and sanitation systems.
“People cannot live a healthy life if they are continually suffering from disease and death because they don’t have drinking water and adequate sanitation facilities,” Sah tells The BMJ.
Currently, he says, some hospitals are partly functioning, in that they are dealing with life threatening injuries. “But it’s not like if you’re having a heart attack you can go to the hospital.”
He adds, “There’s a shortage of equipment, a shortage of doctors, and a shortage of lifesaving medicine. I remember when Nasser Hospital [in Khan Younis] was occupied by Israeli forces [in early 2024], they burnt everything, including the warehouse, which stored medicines and medical equipment.”
Doctors are still imprisoned
At least 330 healthcare workers are estimated to have been detained by Israeli authorities since October 2023,4 including the orthopaedic surgeon Mohammed Obeid and paediatrician Hussam Abu Safiya.5 Many are still being held.
An investigation by Human Rights Watch last year found that Palestinian healthcare workers in Gaza had been arbitrarily detained and deported to Israeli detention facilities, where they reported being beaten, tortured, and threatened with rape.6
Three Palestinian doctors are confirmed to have died while in Israeli detention, including the orthopaedic surgeon Adnan Al-Bursh. The Israeli human rights organisation HaMoked said its evidence showed that Al-Bursh has been beaten and assaulted before he died.7
Many of those who have been released from prison have been “so badly tortured that they’ve not been able to get back to work,” says Ghassan Abu-Sittah, the British Palestinian consultant who has been working in Gaza, adding that they “don’t know how many are coming back.”
In January the World Medical Association urged Israel to confirm the location and health status of the healthcare workers who were being held prisoner.8
MAP’s warehouse in northern Gaza, which had contained “assistive devices like prosthetics and wheelchairs was also burned and bombed,” Sah adds. “We lost everything.”
Gaza has faced shortages of vital supplies throughout the war, after Israel intensified its blockade on 9 October 2023, cutting off Gaza’s access to electricity, food, fuel, water, and medical supplies. Israel’s restrictions on the movement of people and goods in and out of the Gaza Strip, originally imposed in the early 1990s, have “undermined the living conditions of Gaza’s residents for years,” the United Nations has said.910 Before 7 October 2023 around 500 trucks carrying aid supplies were having to enter the strip every day.
“Massive” reconstruction effort
Speaking from Gaza City, MSF project coordinator Mohammad Wady tells The BMJ, “We need to rebuild hospitals. We need training programmes for doctors and nurses. Gaza has lost too many skilled workers. And we need a reliable supply chain. No more begging for medicine. We need local production.”
Sah says that in the short term there needs to be a “massive effort to reconstruct” at least some basic services, such as emergency and surgical departments, oncology departments, and dialysis units. At the same time, there is a desperate need for primary care. “The GP doesn’t exist in Gaza any more,” he says. “You’re talking about a population of two million with hardly any health facilities.”
Improving the healthcare situation in Gaza continues to be impeded by Israel, he adds. “If we want to send in more medics, we still have to depend on the limited number of seats in the UN convoy, and we still depend on the Israeli’s vetting them and approving their entry into Gaza.”
Sah says that only one suitcase is allowed per person entering, meaning they cannot carry all the equipment they need. “Even in Sierra Leone and Liberia, I never saw medical teams being obstructed or unable to work,” he tells The BMJ. “You can usually set up a field hospital within a week and start working with as many doctors as you want . . . Gaza is different.”
In July 2024 the UN estimated that it could take 15 years to clear all the rubble from Gaza.11 “I’m sure that’s much more now,” Sah says, given the continuing destruction since then, including the intense bombing in the few days between the ceasefire being agreed and its coming into effect.
The situation has been complicated by unexploded devices, the UN has said. Doctors told The BMJ of displaced families returning to the north of Gaza to find their houses in ruins and sifting through the rubble to find their belongings, or even the remains of loved ones, putting themselves at risk.12
Tired and traumatised doctors
“Gaza had five consultant pathologists. It now has two,” says Abu-Sittah, “Gaza no longer has any board certified nephrologists. Gaza no longer has any board certified emergency medicine consultants. That’s the kind of holes that now exist in the system.”
How those holes will be plugged is an open question. Abu-Sittah says all 12 universities in the Gaza Strip have been destroyed—along with their medical schools.
Healthcare workers who have survived and can continue working are beyond burned out, Sah says. “From 7 October [2023] to today, they haven’t had a day off. They’ve lived under constant bombardment, attacks, fearing for their lives and the lives of their families. They’re suffering mental trauma. They have suffered the loss of their family members. They’ve lost all their possessions. They’ve lost their houses.”
Gazans are also in desperate need of mental health support. Sah says, “They have been under continuous bombardment for 16 months. They have experienced things you would never want to see in your lifetime We can’t do anything about it because of the shortage of mental health specialists inside Gaza.” He adds that, even before 7 October, two in three adolescents in Gaza were suffering from post-traumatic stress disorder.
“Every time you speak to people, your mind is unable to comprehend,” says Abu-Sittah. He recalls a recent conversation he had with a family friend who lives in northern Gaza. “She was telling us how she saw the Israeli snipers shoot her son. She was lying on the floor in her house and shouting at the soldiers to allow her to retrieve her son’s body. Over the following weeks, she would watch the dogs eat that body so that, by the end, when the Israelis withdrew, what was left was his legs and his shoes. And that’s what she buried.”
What can doctors do to help?
Doctors in the UK or elsewhere in the world who want to help can do so in several ways. They could travel to Gaza to provide medical care, through humanitarian and medical aid organisations such as MSF and Medical Aid for Palestinians.
Another way is by donating money to aid organisations or by helping to provide online training and support to healthcare workers in Gaza. “If you can be part of the relief effort, then you should,” says British Palestinian consultant Ghassan Abu-Sittah. “But you also need to form direct links between your institutions and Palestinian health institutions, between yourself and your colleagues and your Palestinian colleagues, to see how you can help them rebuild their institutions and rebuild their lives.”
Advocacy is another way doctors can get involved. Retired paediatrician Tony Waterston is part of a new group called Child Health Advocates for Palestine, which campaigns on issues relating to Gaza, including putting pressure on the UK government to accept critically ill children who need to be medically evacuated and encouraging UK health institutions to do more. Waterston said, “It’s about maintaining the spotlight on what’s happening in Gaza, because clearly we’re only at the beginning now—and what has to be ensured is justice.”
References
Israel attacks push Gaza healthcare “to brink of collapse.” UN News. 31 Dec 2024, https://news.un.org/en/story/2024/12/1158646
Strikes, raids and incursions: Over a year of relentless attacks on healthcare in Palestine. Médecins Sans Frontières. 7 Jan 2025. https://www.msf.org/strikes-raids-and-incursions-year-relentless-attacks-healthcare-palestine
What is happening in Gaza? Aid urgently needed as thousands return to their homes. British Red Cross. 13 Feb 2025. https://www.redcross.org.uk/stories/disasters-and-emergencies/world/whats-happening-in-gaza-humanitarian-crisis-grows
Humanitarian situation update #253: Gaza Strip. UN Office for the Coordination of Humanitarian Affairs. 8 Jan 2025. https://www.ochaopt.org/content/humanitarian-situation-update-253-gaza-strip
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- Mahase E
. Gaza: Israeli raids leave Kamal Adwan Hospital “out of service” with head doctor detained. BMJ2024;387:q2885. doi:10.1136/bmj.q2885 pmid:39797805
Israel: Palestinian healthcare workers tortured. Human Rights Watch. 26 Aug 2024. https://www.hrw.org/news/2024/08/26/israel-palestinian-healthcare-workers-tortured
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- Mahase E
. Palestinian surgeon was assaulted before dying in Israeli detention, reports say. BMJ2024;387:q2672. doi:10.1136/bmj.q2672 pmid:39608813
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- Mahase E
. Gaza: World Medical Association calls for Israel to publish charges levelled against detained doctors. BMJ2025;388:r155. doi:10.1136/bmj.r155 pmid:39848661
Gaza crossings: movement of people and goods. UN Office for the Coordination of Humanitarian Affairs. https://www.ochaopt.org/data/crossings
Israel defying ICJ ruling to prevent genocide by failing to allow adequate humanitarian aid to reach Gaza. Amnesty International. 26 Feb 2024. https://www.amnesty.org/en/latest/news/2024/02/israel-defying-icj-ruling-to-prevent-genocide-by-failing-to-allow-adequate-humanitarian-aid-to-reach-gaza
Clearing Gaza rubble could take 15 years, UN agency says. Al Jazeera. https://www.aljazeera.com/news/2024/7/15/clearing-gaza-rubble-could-take-15-years-un-agency-says
No time to lose” in Gaza, as ceasefire offers fragile respite. UN News. 13 Feb 2025. https://news.un.org/en/story/2025/02/1160121
