As the need for medical care in Gaza soars, accessing working hospitals and health centres is becoming more and more difficult. Alternative solutions such as evacuating patients overseas and setting up field hospitals are under way, but may offer little hope if there is no end to fighting in the Palestinian enclave, experts say.
One month after the October 7 Hamas attack prompted Israel to launch extensive air strikes on the Gaza Strip, 14 out of 35 hospitals with inpatient services are no longer operating in the Palestinian enclave and 71% of primary care facilities have closed, according to figures from the UN.
Even in medical centres that are still functioning, the situation is dire. “Hospitals are swamped … In the past few weeks all of the hospitals in the north have not received any supplies at all,” said Michel-Olivier Lacharité, the manager of emergency programmes for Doctors without Borders (Médecins sans Frontières or MSF), at a press conference in Paris on Tuesday.
Reports have emerged of doctors being forced to perform surgical procedures without access to anaesthesia and in increasingly unsanitary conditions due to limited access to clean water and medical supplies.
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Meanwhile, patient numbers have soared as an estimated 25,000 people in Gaza have been wounded since October 7, according to the Gaza Health Ministry.
Many hospitals are also crowded with those seeking shelter, hopeful the medical facilities will offer a measure of protection, even as strikes on or near hospitals are becoming commonplace.
The World Health Organization (WHO) has verified 218 attacks on healthcare centres in the Palestinian territory since October 7, and 19 in Israel, describing such attacks as “a violation of international humanitarian law”.
Gaza’s Hamas-run health ministry said on Tuesday that Israel's latest overnight barrage hit two paediatric hospitals and the enclave’s only psychiatric hospital.
Over the weekend, strikes hit Shifa Hospital in Gaza City and the Indonesian Hospital in North Gaza, both of which had stopped functioning days earlier due to lack of fuel.
Shifa, Gaza’s largest hospital, was operating at 150% capacity, according to figures from the WHO, when a strike targeted a convoy of ambulances leaving the building on Saturday. At least 15 people were killed and more than 60 were wounded, according to a statement from the Palestinian Red Crescent Society.
“The humanitarian situation is catastrophic,” said FRANCE 24 correspondent Maha Abu Al Kass, who was reporting from Gaza on Friday. “They were forced to stop everything, even the intensive care and neo-natal units.”
Read moreMalnourished, sick and scared: Pregnant women in Gaza face ‘unthinkable challenges’
Israel has justified attacks on medical facilities on the grounds that Hamas uses them to shelter its members or store weapons. Hamas has been accused by Israel in the past of establishing military bases or armouries in civilian areas, or using them to stage rocket attacks.
‘Safe passage for very scared patients’
Israel in mid-October ordered the evacuation of 22 hospitals in northern Gaza treating more than 2,000 inpatients. Other countries have echoed the call to move hospital patients either to south Gaza or out of the enclave altogether.
Turkey said on Sunday it would accommodate up to 1,000 of Gaza’s 2,000 cancer patients and other civilians needing urgent care after the Turkish-Palestinian Friendship hospital – Gaza’s only cancer treatment hospital – went out of service after running out of fuel last week.
Turkey’s Health Minister Fahrettin Koca said that two hospital ships had been granted access to Egyptian ports “for the shipment of field hospitals and ambulances that Türkiye wants to send to Egypt”.
France has sent a first hospital ship to the region and is currently equipping a second ship with advanced medical facilities that is expected to set sail in the coming days.
France is also in talks with Egypt to establish a military medical facility on the ground, including a surgical unit for people seriously wounded in the Gaza Strip, French Defence Minister Sébastien Lecornu told Lebanon's L'Orient-Le Jour newspaper on Monday.
Egypt is already building its own field hospital in North Sinai near the Gaza strip and the Rafah border crossing between Gaza and Egypt, which opened on November 1 to allow limited evacuations of foreign passport holders and wounded Gazans.
So far, only a small number of patients have managed to enter Egypt. The WHO said on November 2 that just 46 patients and 36 family members had managed to pass through the tightly controlled crossing.
Read moreThe Gaza-Egypt Rafah crossing explained: ‘It is not a normal border’
In terms of evacuating patients, “all the preparations are there on site, on the Egyptian side … The problem is getting safe passage for very scared patients,” said Dr Mike Ryan, Executive Director for WHO’s World Health Emergencies Programme at a press conference on November 2.
Successful evacuations also depend on patients being well enough to make the dangerous and complicated journey.
“We have more than 1,000 kidney dialysis patients – are they going to evacuate all of these?” asked Fikr Shalltoot, Gaza director at the Medical Aid for Palestinians charity. “Are they going to evacuate the neo-natal patients? Women give birth every day in Gaza. What about premature babies – how are they going to evacuate them?”
What is allowed to enter?
Navigating the Rafah crossing is also notoriously difficult for aid trucks trying to gain access to Gaza. In the past month, just 450 trucks were permitted entry to Gaza, according to MSF – equivalent to around a day’s worth of aid crossings that were permitted before October 7.
This makes the prospect of transporting the large quantity of materials necessary to set up field hospitals inside the enclave – as the United Arab Emirats on Monday proposed to do – unlikely, said Lacharité.
And it is hard to know how to maximise the chances of being allowed through. “The filtration system that defines what is given priority and what is allowed to enter into the Gaza Strip is completely opaque,” he said.
MSF aid trucks have been refused or allowed entry for seemingly arbitrary reasons, Lacharité added, under the logic that any items that can be used for “aggressive” purposes can be turned away – a rule that can easily be applied to medical essentials such as fuel and oxygen concentrator machines.
“It very unlikely to think that we could set up field hospitals … to organise emergency aid,” Lacharité said. “We have seen in the past few years [that] all of the construction materials have been refused entry, so it is extremely unlikely that we would be able to have a flow of provisions.”
Even if field hospitals could be set up it is unclear where they could be located that would be safe and practical for patients.
“How will patients be able to reach field hospitals?” asked Shalltoot. “We are not only talking about those injured [by airstrikes], we are talking about all of the sick people who need to have proper, constant access [to hospitals] and also to be close to their families.”
‘The immediate priority is a ceasefire’
Even if sufficient supplies could make it across the border, field hospitals would struggle to respond to the current medical needs at scale.
Before the escalation of the conflict with Israel began after the October 7 attacks, there were more than 1,000 people in Gaza who needed kidney dialysis to stay alive, 45,000 people with cardiovascular diseases and more than 60,000 people with diabetes requiring regular hospital treatment.
There are an estimated 50,000 pregnant women in Gaza and around 100 additional patients need to access specialist healthcare services outside the Gaza Strip each day, according to the UN.
As the number of people of requiring long-term care due to continuing air strikes – such as burn victims and amputees – continues to rise, cases of communicable illnesses like chicken pox, scabies and diarrhoea are also soaring.
Meanwhile, setting up just 200 hospital beds – with staff, supplies and medical equipment – would take around one month, according to MSF.
“If we look at the thousands of hospital beds that are needed today, it would be a feat to make this transition to scale,” Lacharité said. “It is really only a ceasefire that will allow us to organise aid in this situation.”
“What people need in Gaza is an immediate ceasefire,” agreed Shalltoot. The next step, she said, should be to “enhance the entry of aid and allow the aid to reach all of the hospitals without limiting this to the south or the north. All hospitals have to have access to enough medical supplies.”
With a ceasefire in place, Gaza’s healthcare system could move towards stabilisation. Some 20,000 health workers including surgeons, nurses, pharmacists and midwives are still working in the enclave and more than half of hospitals are still functioning, despite intensely challenging conditions.
“The best and most effective and most rapid way to save lives is to support the existing system,” Ryan told the WHO press conference.
“The facilities are there, the machinery is there, the beds are there, the operating theatres are there. It is the responsibility of all parties to the conflict to allow those hospitals to be resupplied.”
