Invisible War: The Obliteration of Health in Gaza

by yaleglobalhealthreview, posted in Uncategorized

BY NIRAJ SRIVASTAVA

“The smell of death is everywhere,” describes one doctor in Gaza [1]. 

Children die of malnutrition [2]. Epidemics resurge [3]. Gunshots and missiles barrage hospitals [4]. People undergo amputations without painkillers. Fathers, mothers, and children die silently in blood-stained hospital hallways with no surviving family to comfort them [1]. 

These are not exceptional circumstances under Israeli bombardment. For the innocent civilians of Gaza, these have become the horrifying norms of life. Since October 7, 2023, Israel’s government and the Israeli Defense Forces (IDF) have obliterated the sacrosanctity of health for civilians in war, triggering and exacerbating health crises while systematically dismantling the capacity of Gaza’s healthcare system to respond. 

On October 9, 2023, Israel issued a complete siege on the Gaza Strip, cutting off food, water, electricity, fuel, and medical supplies to the entire Gazan population of 2.3 million people, the vast majority of whom are innocent civilians and half of whom are children [5]. With no water from outside pipelines, functional desalination or wastewater facilities, nor fuel to pump water through taps, Gaza’s water system collapsed [6]. In November 2023, the average Gazan was living off three liters of water per day, five times below the international humanitarian standard of 15 liters for emergencies [7]. With over 70% of Gaza’s water infrastructure destroyed by more than a year of Israeli bombardment, potable water is still exceedingly scarce [8]. Crowded living conditions for 1.9 million internally displaced Gazans combined with the inability to practice hygiene without clean water or soap has fueled a surge in communicable gastrointestinal, respiratory, and skin diseases, such as scabies, lice, and impetigo (3, 9-10). Diarrhea incidence alone increased by 2,000% amongst kids under the age of five [11]. A reemergence of polio further demonstrates perfect conditions for the outbreak of communicable diseases [10]. 

Meanwhile, Israel’s severe restrictions on humanitarian aid leave more than 1.8 million Gazans at critical levels of hunger [12]. About one in three children under the age of two suffer from acute malnutrition in the north Gaza Strip, while screenings in the southern city of Khan Younis found 28% of children under the age of two suffered acute malnutrition, with 10% of them experiencing severe wasting [2]. The situation is modeled to worsen between November 2024 and April 2025, with 345,000 Gazans expected to experience catastrophic levels of food insecurity [12].  

In areas of high population density, the IDF implements widespread bombing with the knowledge it will cause mass civilian casualties. For example, on October 31, 2023, the IDF dropped two 2,000-pound bombs capable of flattening entire buildings on the urban refugee camp of Jabilia in a purported attempt to kill one Hamas commander: 195 people died, 777 people were injured, and more than 120 people were missing under the rubble (13-14). The resulting injuries are polytraumas, which are deeply explosive injuries to the bones, abdomen, back, or brain coupled with severe burning. Such complex medical complications require multiple surgeries and postoperative care virtually impossible to attain in Gaza due to constant displacement from Israeli evacuation orders, periodic IDF destruction and siege of hospitals, and the critical lack of supplies and healthcare staff [10]. More than 96,000 injured Gazans, often suffering from life-altering polytraumas, are left without access to the critical healthcare they need for improved health outcomes (10, 15). 

According to the Gazan Health Ministry, the sole organization collecting a death toll count,  more than 44,000 Gazans have been killed by Israeli attacks [16]. The ministry does not distinguish between combatants and civilians; however, the vast majority of these deaths have been innocent women, children, and men. The true death toll is likely higher than reported because people are killed indirectly, buried under rubble, or unable to be accessed by medics (16-17). 

Only 17 hospitals are partially functioning in Gaza [15]. Due to the siege and restriction of humanitarian aid, they lack fuel, electricity, staff, clean water, food, and medical supplies, such as blood, anesthesia, and oxygen. Medical care has regressed decades. Médecins Sans Frontières (MSF) doctors report surgeons operating on the floor due to overcrowding, surgeries performed without anesthesia, and children’s fevers unable to be treated due to lack of acetaminophen [10]. Crowded hospitals leave staff no option but to treat agonized patients on floors smeared with blood and bodily fluids [1]. An MSF nurse recounted when one hospital ran out of sterile gauze to stop life-threatening bleeding in patients, so nurses used the same abdominal rag on different patients and wrung the blood out of the rag between treatments of each patient [18]. 

Healthcare workers are triaging to the best of their ability given the lack of staff and resources and the extremely severe nature of polytrauma from bombing. Postoperative care is nonexistent because doctors do not possess enough supplies to even provide life-saving emergency care. Consequently, Gazans experience health complications that would have been preventable with the proper medical care [10]. For example, MSF doctors frequently see infection and necrotic tissue because people’s wound dressings have not been changed in days or sometimes weeks [19]. 

Furthermore, Gazans with chronic diseases, such as cancer, diabetes, hypertension, and asthma, are in constant peril because the healthcare system is unequipped to provide the care they need. Specialty care is virtually nonexistent. For example, some patients with kidney transplants have not taken immunosuppressant medications in six weeks due to critical shortages, risking transplant rejection and death [20]. These preventable deaths are deemed “silent killings” [21].

As the physical health of Gazans plummets, mental health is catastrophic. Even before the escalation of conflict in October 2023, the World Bank reported the rate of post-traumatic stress disorder (PTSD) amongst Gazan children at a staggering 53.5% [22]. After more than a year of constant bombardment, injury, displacement, and loss of family members, Gazans accumulate a series of deep psychological traumas, resulting in tormenting acute stress syndrome and developing into PTSD after a month [23]. Life is so dismal and full of pain that children as young as five years old have expressed to humanitarian workers that they want to die [17].

Meanwhile, Israeli conduct has created an atmosphere of fear around healthcare. Civilians feel unsafe traveling to and from hospitals because the IDF has repeatedly surrounded hospitals with heavy shelling. The IDF has also raided multiple hospitals, jeopardizing patient care, intimidating and even detaining healthcare workers, and damaging the inside of hospitals, rendering them nonfunctional [1]. The IDF has carried out more than 516 healthcare-related attacks that have killed more than 765 people in Gaza, targeting hospitals, ambulances, medical convoys, and access roads [15]. The Israeli military justifies these attacks with evidence that Hamas uses healthcare infrastructure to hide military infrastructure [4]. However, international law strictly dictates that even when healthcare facilities are used to commit acts harmful to the enemy, a military must do everything in its power to ensure the safety of civilians, medical staff, and patients [24]. Repeatedly, the Israeli military violates this obligation, dismantling hospital after hospital, endangering staff and patients, and preventing adequate healthcare for the thousands of innocent civilians severely wounded by Israeli bombardment [4]. The Secretary General of MSF remarks that “[t]his pattern of attacks is either intentional or indicative of reckless incompetence” [25].

Israeli conduct in Gaza has destroyed the notion of sanctity in healthcare. Due to the Israeli government and IDF’s repeated and brazen disregard for innocent civilian life, there is no future where the health of Gazans can be safeguarded while Israeli forces attack Gaza. An immediate and sustained ceasefire combined with unfettered access to humanitarian aid is the bare minimum needed to even begin to address the dire health needs of the more than two million civilians in Gaza. The precedent set by Israeli breaches in the protection of healthcare endangers the future of all civilians caught in war zones. As the MSF president warned the United Nations Security Council: “Medical ethics cannot be buried by war” [26]. Yet the international community permits Israel to do just that. Gazans have a right to the utmost protection of health. The burial of medical ethics in Gaza—or their retrieval—reflects on all of humanity.

Niraj Srivastava is a first-year in Pauli Murray College.

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References

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