Gaza-Israel War

Escalation of violence in Gaza

Conflict escalation

Decades of conflict exploded on 7 October 2023 as Hamas attacked Israel on a large scale. Hostilities in Gaza and Israel are ongoing, and violence in the West Bank has surged.

Growing humanitarian needs

More than 2 million people are currently trapped in the Gaza strip with no access to food, water, electricity and medicines. Indiscriminate bombing has turned a chronic humanitarian crisis into a catastrophe. 

Displaced people

Close to 1.7 million people has been displaced within Gaza.

Hospitals are overwhelmed

Across Gaza, the number of injured in need of urgent medical assistance far exceeds the capacity of the health system. Medical facilities are overwhelmed and under fire. As of January 2024 there are only four hospitals that are fully functional out of 40  in Gaza.

MSF calls for an enduring humanitarian ceasefire in Gaza and Israel and for lifting the blockade to allow increased and continuous humanitarian supplies to cross into Gaza, and aid workers unrestricted access to provide lifesaving medical care. We are calling on all parties to ensure the safety of civilians and medical facilities.

More than 27,000 people have died and more than 65,000 have been wounded so far, according to the local health authorities. 

More than 2.2 million people are currently trapped in the Gaza strip, where indiscriminate bombing has turned a chronic humanitarian crisis into a catastrophe. 

Over 1.7 million people in Gaza,  are estimated to be forcibly displaced in unsafe, unhealthy conditions while no place is safe from the bombing. Millions of men, women and children are facing an inhumane, collective punishment in the form of total blockade in addition to constant bombing, and the pending threat of a ground offensive.

People in Gaza are deprived of essential items such as food, water, shelter, fuel and electricity, as well as healthcare, due to Israel’s complete, inhumane siege of the entire Gaza Strip. Any supplies allowed into Gaza so far have been negligible compared to the immense need in a place that has been blockaded for fifteen years and was crucially reliant on foreign aid even before this war. 

According to an IPC (Integrated Food Security Phase Classification) report published in December 2023, 90 per cent of the population are in an emergency situation and 25 per cent of people in the north are enduring crisis levels of hunger. 

The current situation

The situation in Rafah is extreme. More than a million people are packed into a tiny piece of land, having faced repeated forced displacements and orders to move south.

After four months of war, little is left of water pipes and sanitation infrastructure in general in the enclave. This is causing shortages of clean and safe water, forcing people to drink contaminated water and often falling sick as a result. 

“These systematic attacks against health care are unacceptable and must end now so that the wounded can get the care they need. The entire health system has been rendered inoperative."

Guillemette Thomas
MSF medical coordinator in Palestine

Amid ongoing heavy fighting and bombing in Khan Younis, south Gaza, vital medical services have collapsed at Nasser hospital, the largest functioning health facility in the enclave. 

People are left with no options for treatment in case of a large influx of war wounded. The hospital’s surgical capacity is now almost non-existent, and the handful of medical staff remaining in the hospital must contend with very low supplies that are insufficient to handle mass casualty events – large influxes of wounded people. 

 “People’s lives are at risk because of the lack of medical care. With Nasser and European Gaza Hospital almost inaccessible, there is no longer a healthcare system in Gaza,” said Guillemette Thomas, MSF medical coordinator in Palestine. 

Over the past months, the Israeli Forces’ all-out assault on the Gaza Strip has drastically diminished the options for people to find medical care. The amount of safe space for organisations to provide healthcare to people is now virtually non-existent. Constant evacuation orders and attacks on health facilities have repeatedly forced organisations such as Médecins Sans Frontières (MSF) to evacuate hospitals and leave patients behind.


On 8 December (local time) the United Nations Security Council failed to adopt a resolution demanding a ceasefire in Gaza—blocked by a veto from the United States. By vetoing this resolution, the US stands alone in casting its vote against humanity.

On 27 November, a truce was agreed between Hamas and the Israeli Government as part of a deal in which Hamas will free dozens of Israeli hostages in exchange for a four-day pause in fighting in Gaza and the release of dozens of Palestinians held in prisons in Israel. however, just ours after the truce ended Al Awda hospital was damaged in a blast.

Israeli forces called for people in some neighbourhoods in the Middle area and Khan Younis to evacuate further south to Rafah. MSF-supported clinics Martyrs and Beni Suhaila are located in areas under the evacuation order.

Many civilians have already been displaced several times since 7 October. Civilians are being ordered to move south, but nowhere in Gaza is safe due to the indiscriminate bombing and continued fighting.  

On October 21, after negotiations involving multiple parties, the Rafah border crossing connecting Gaza and Egypt briefly opened, permitting the entry of 50 humanitarian delivery trucks; the following day another 14 trucks reportedly crossed into Gaza. The number of trucks allowed into the Strip represents a tiny fraction of the number that crossed into the Strip daily before the war.

Attacks on hospitals

Hospitals and healthcare facilities, patients and medical staff have been constantly under attack, or have come under fire with little or no regard for their safety. The duty of treating the sick and wounded, and the correlating protection of medical personnel and facilities, is at the core of International Humanitarian Law (IHL).

Since the beginning of November, there have been repeated attacks on hospitals, medical staff and patients in the north of the Gaza Strip. Our Palestinian colleagues in Gaza city, in the Al-Shifa, Al-Quds and Al-Nasser paediatric hospitals, witnessed systematic attacks by the Israeli army. 

On 10 February, MSF staff report shots fired at people inside Nasser hospital, Gaza. Two people were killed, five others injured, including one nurse who was severely wounded.

Medical staff are afraid to move within and around the hospital due to fear of being shot. Israeli forces are continuing operations in the immediate vicinity of Nasser hospital. Heavy fighting has trapped people inside the building and is preventing anyone from entering to access care. 

WHO estimates that since 20 December northern Gaza has been without a functioning hospital. After entering a number of hospitals in the north, Israeli soldiers made arrests and humiliated people. 

Just hours after the truce ended on 4 December, Al Awda hospital, where MSF staff continue to work, was damaged.

Attacks in healthcare facilities

On 21 December, there was an un-reported explosion 200 metres from one the places where we accommodate our staff. All its windows were blown out in the explosion.

On 17 December, Israeli forces took control of Al Awda hospital, after besieging it for 12 days. Males over the age of 16 were taken out of the hospital, stripped, bound and interrogated – six MSF staff were among them.

After the interrogations, most of them were sent back into the hospital and told not to move. Al-Awda hospital still has dozens of patients inside, including children. The hospital was out of essentials like general anaesthetic and oxygen. Over the 10 weeks prior, Al Awda has been besieged, damaged in strikes, and medical staff have been killed in blasts

On 21 November 2023, MSF-supported Al Awda hospital in the north of Gaza was struck. Two MSF doctors, Dr Mahmoud Abu Nujaila and Dr Ahmad Al Sahar, and a third doctor, Dr Ziad Al-Tatari were killed in this attack. Al Awda Hospital was one of the last remaining functional hospitals in northern Gaza. Other medical staff, including MSF staff, were severely injured. 

MSF routinely shared information about Al Awda as a functioning hospital and the presence of its staff to warring parties. GPS coordinates were also shared with Israeli authorities the day prior. More than 200 patients remain in Al Awda and are not receiving the level of care they need; they need urgent, safe evacuation to functioning hospitals.

On 20 November 2023, An MSF outpatient burns clinic in Gaza city came under fire. A wall was torn down, an Israeli tank was seen in the street, 4 MSF cars were burned down. All had MSF logos.

On 18 November 2023, an MSF staff’s relative died and another one was injured, and passed away on 23 November, after an attack on an MSF convoy trying to evacuate 137 people - MSF Palestinian staff members and their families. They were trapped for a week in MSF premises located near Al-Shifa hospital in Gaza. MSF condemns this deliberate attack in the strongest terms.

In early November, Al-Shifa hospital complex was been hit several times, including the maternity and outpatient departments, resulting in multiple deaths and injuries. Staff are witnessing people being shot at as they attempt to flee the hospital.

Al-Shifa hospital is the principal hospital complex in Gaza and the only facility able to admit and treat many patients with complex, sometimes life-threatening injuries.

On 10 November, Al-Shifa hospital lost electrical power. The ambulances could no longer move to collect the injured, and non-stop bombardment prevents patients and staff from evacuating. 

Map of the hospitals where MSF has been working or supporting after 100 days of siege in Gaza

Map of the hospitals where MSF has been working or supporting after 100 days of siege in Gaza. © Jorge Montoya/MSF

How is MSF responding

Our activities in Gaza are currently very limited. We have extreme difficulties delivering aid and providing healthcare due to the insecurity and the unpredictability of the bombardments.

As of 12 February MSF operates in four hospitals (An-Najar Hospital, Rafah Indonesian Field Hospital, European Gaza Hospital, and Emirati Maternity Hospital), one primary healthcare facility (Al-Shaboura clinic) and two health posts in Al Mawasi, in Rafah area. 

MSF also supports Nasser hospital in Khan Younis and two hospitals in the north, Al-Awda Hospital and Al-Shifa Hospital. MSF activities are mainly in the south of Gaza.

Our teams are offering surgical support, wound care, physiotherapy, postpartum care, outpatients' consultations, vaccination, and mental health services, but repeated, systematic sieges on various hospitals are pushing our activities onto an ever-smaller territory and limiting response.

We currently have between 15 and 20 internationally mobile staff based in Rafah, composed mostly of surgical and emergency staff, the rest offering logistic support and coordination.

How is MSF helping in Gaza right now?

Al-Aqsa Hospital 

On January 6, MSF had to evacuate Al-Aqsa hospital due to fighting all around the premises and evacuation orders that made MSF’s pharmacy store inaccessible. Three MSF-supported staff remained on premises, working autonomously. On February 6, MSF team returned to Al-Aqsa and prepared the premises for a full return to previous activities. On February 7, wound care and rehabilitation resumed.

Al-Awda Hospital

The last remaining main hospital in north Gaza has been crippled and is barely functional. The hospital was struck in early October and at least 5 hospital staff, including two MSF doctors, were killed while caring for their patients. In early December, Israeli forces besieged the hospital, and took control of it on 17 December after heavy fighting and detaining all males above 16 years old– six MSF staff among them.

After the interrogations, most of them were sent back into the hospital and have been working there autonomously since. They report shortages of everything and difficult work conditions. As of February 5, we still have several staff members working here. 

Nasser Hospital 

Nasser was the main surgical centre in the south of the Gaza Strip, located in Khan Yunis, and had become the largest hospital in Gaza after Al-Shifa was brought to a standstill by Israeli military operations.

The area surrounding Nasser has been under evacuation orders since January 23, following weeks of intense bombing and fighting. This prompted 90 percent of staff to leave, including most MSF staff, though a handful decided to remain on the premises.

International mobile staff left on December 26. Remaining staff describe shortages of everything from beds to anesthetics, fuel, food and water. In late January, 150 patients too sick to move are trapped inside the hospital, the emergency room is open but cannot cope with a large influx of wounded that could result from strikes in nearby areas. 

European Hospital 

Access to European Gaza Hospital is proving harder every day due to insecurity on the way to the premises and on at least two occasions staff could not reach the hospital. Our plastic surgeon and small team of nurses are seeing between 20 and 30 patients a day for a change of dressings, and working in the operational theater providing debridement, flap surgery and sutures.

Many of these patients are children with trauma and severe burn injuries, who were wounded at the beginning of the war and now have their wounds infected due to lack of medical care. 

Rafah Indonesian Hospital  

MSF supports the outpatient department at Rafah Indonesian Field Hospital, taking care of patients in post-operative care, all showing war-related wounds, with wound dressing, physiotherapy, and other small procedures to relieve the patient load from Nasser, European and An-Najar hospitals. Inpatient activities were scaled up to 60 beds in January and include one procedure room to do small surgical interventions (skin graft, debridement, removal of external fixators). Outpatient activities now run 6 days a week with about 150 consultations a day, providing dressing, physiotherapy, and counselling.

El-Emirati Hospital 

MSF is supporting the Emirati maternity hospital with medical supplies, staff including gynecologists, nurses and hygienists working in round-the-clock shifts. MSF team is offering postpartum care and managing complications in pregnancies. While deliveries are managed by the Emirati hospital team. The teams built an extension of the maternity department in the parking lot of the hospital to increase the postpartum department’s capacity to 20 beds, as of January 15, allowing more patients to receive proper monitoring post-delivery. 4 to 6 more beds will be added in the coming week.  

Al-Shifa Hospital   

After MSF staff was forced out of Al-Shifa hospital on 18 November due to repeated attacks by Israeli forces, two nurses returned to the premises to assist with medical procedures on a voluntary basis, before leaving in early February as strikes approached the hospital again.  

On 22 January, staff reported that medical activities at Al-Shifa hospital are very limited as 50,000 displaced people have sought shelter inside the facility making it difficult to run operations. The ER department is open but overcrowded with hospitalized patients War wounded suffering from burns or gunshot injuries are there along with patients with chronic diseases. Shortages in fuel, in medicine, food, and water continue to cripple the medical response.

Indonesian Hospital 

Since MSF staff were forced to leave Indonesian hospital at the outset of this war due to increasing bombardment in the area and progressive ground invasion of Israeli forces, we cannot provide any updated regarding this facility or the situation inside. We are not aware whether there are any patients or hospital staff still inside the Indonesian hospital.  

Primary health care centers 

MSF was forced to suspend support to Martyrs and Beni Suhaila clinics, where we had been providing basic health care, wound dressings, and mental health consultations after Israeli forces ordered people to evacuate the areas on 1 December.

An-Najar Hospital

MSF operational in An-Najar hospital since January 22nd, with 1 IMS and 4 Palestinian staff (three surgeons and two nurses), performing surgeries and wound care and getting ready to scale up activities. 

Al-Shaboura Clinic 

On 9 December, MSF restarted working at Al-Shaboura clinic in Rafah, gradually scaling up activities with 31 staff. MSF team is providing outpatients services, including general consultations, reproductive health services, dressing, mental health services including psychological first aid, individual and family session, and psychoeducation and health promotion activities. We’re also performing systematic malnutrition screening among children under 5 and pregnant and lactating women in Al-Shaboura clinic.

Water and sanitation 

MSF Teams are supporting two water distribution points in Al-Mawasi near the OCB health post and in the informal camp of internally displaced people. Distribution began on January 30th, and provides 7,600 liters of water to 5,067 people six days a week.

MSF teams are also supporting 9 water distribution points, all near informal camps of internally displaced people (including one site near Qatari hospital, and another near Shaboura clinic). In total, the teams are providing 110,000 liters/day to 20,625 beneficiaries (around 3,500 families) with each family receiving 32 liters/day, but still struggling to provide enough per person. 

Donations 

MSF sent over 75 tons of medical supplies (mainly surgical and dressing kits) into Gaza in three deliveries – one in October, one in November and one in January. These supplies are primarily being used at Nasser Hospital, while some were delivered to the Rafah Clinic, the European Hospital and Shaboura clinic. Bringing supplies into Gaza has been extremely difficult due to administrative barriers, movement restrictions, and a large backlog of trucks at the border.

Reports of widespread looting in Gaza have been confirmed by MSF teams who witnessed some of these incidents. This is a sad reminder of how difficult the situation is and how desperately Gaza needs a much larger, steady flow of essential items and humanitarian supplies.

How is MSF responding in the West Bank and Egypt?

West Bank

MSF is maintaining operations in the West Bank, focusing on providing emergency care, primary health care via mobile clinics, and mental health care in Hebron, Nablus, and Jenin.

In Hebron, our teams provide mental health services through 10 mobile clinics, support to 4 PHCs, implementation & support of the maternity and ER capacity increase in Halhoul Hospital, increase ER capacity in Moktaseb Hospital, mental health support, capacity building in emergency response, and advocacy & protection. We are supporting various hospitals with donations and first-aid kits to community focal points in Beit Omar, Al Rshaydeh, and to the emergency care centre in Um El Khair; we support and trained medical staff in Al Moktaseb Hospital, Hal-Hul, Dura, and Yatta Hospital in Hebron area.

As the disruption to medical access increased since October 2023, MSF is progressively expanding its response to bring health care to people who are unable to reach medical facilities. MSF mobile clinics now reach a total of 10 locations covering the areas outside and inside Hebron's Old City, but also in the remote villages of Masafer Yatta in the Southern West Bank.

In addition to the expansion of medical activities since October 7, the MSF team increased health promotion activities in the community, and the distribution of relief items, hygiene kits and food parcels to internally displaced Gazans, and West Bank residents affected by violence and forcible displacement.

We continue to offer psychological individual and group therapy as well as psychiatric consultations in Nablus, Qalqiliya and Tubas despite very challenging circumstances, particularly with regard to restrictions of movement in the area by the Israeli forces, which were already a disruptive factor but have intensified since 7 October. We provided first aid and first responder training for 300 PRCS volunteers in the Nablus area.

In Jenin refugee camp, our teams are currently supporting the emergency room in the Ministry of Health hospitals in Jenin (Khalil Suleiman Hospital) and Tulkarem (Thabet Thabet Hospital) governorates. We equip volunteer paramedics in Jenin, Tulkarem and Nur Shams refugee camps with donations and training, so they can stabilize patients during active hostilities and keep them alive until they reach hospitals. In December, we started supporting the MoH emergency plan with the setup of stabilization points in pre-existing health facilities and train the staff on trauma care.

In both governorates, we run activities to strengthen the existing mental health care services and support Gazan workers stranded in the west bank after the 7th of October.

Egypt

Currently we have a rear base in Egypt to facilitate the transit of our internationally mobile teams and supplies. Our teams in Egypt are ready to send more medical supplies into Gaza if allowed to safely do so. We are in contact with the Egyptian authorities and the relevant actors in Egypt to start activities in Egypt to provide healthcare for injured or sick Palestinian people allowed to exit Gaza if needed as well. 

What are the medical needs MSF is seeing in Gaza?

Accessing health care has become increasingly difficult for the wounded and the sick in Gaza, adding to an already shocking toll from this war. In addition to the scores killed and wounded since October 7, needs are growing as the displaced population is pushed towards the Egyptian border in Rafah. Malnutrition is looming, communicable diseases are spreading, clean water is scarce and winter weather is making life conditions worse for people who were not able to take warm clothes when the war began.

Over 1.7 million – over 75 per cent – of the entire population in Gaza had to flee their homes according to OCHA. Half of those displaced are crammed into the southern part of Gaza, where they live in appalling conditions, with temporary shelters made of stray pieces of wood and plastic sheeting. These flimsy shelters are now being battered by the strong winds and heavy rains of winter, while many people are sleeping in the streets or other open areas, where they struggle to find enough water to meet basic hygiene needs.

Infections resulting from poorly treated wounds are rising fast, putting lives at risk. The risks of infection are incredibly high because of the conditions that people are forced to live in and the fact that there just isn’t the capacity and ability to provide the in-hospital care that these patients truly need.

The World Health Organization also reports an increase in infectious diseases including diarrhea, acute respiratory infections, skin infections, and outbreaks like hepatitis. As food and water shortages worsen, 40 percent of Gaza’s people are at risk of famine, according to UNRWA. Pregnant mothers struggle to find access to delivery rooms due to crowded hospitals, leading to stillbirths or births in terrible conditions for both mother and child.

Due to the unprecedented number of wounded in Gaza, the severity and complexity of injuries, and continuing extreme violence and siege, we need to be able to provide safe and medicalized passage to health facilities outside of Gaza for patients who need it and choose to do so. Palestinians who are medically evacuated must retain the right to return home to Gaza as required under international human rights law.

MSF’s mental health teams have been addressing the psychological toll of the war and forced displacement on children’s emotional wellbeing in Gaza after nearly three months of siege and bombardment. Children have been exposed to extremely traumatic episodes with some patients recovering from physical injuries and some having lost their family members. 

How long has MSF been working in Palestine?

MSF began working in Palestine in 1989 and has run medical programs in Gaza for more than 20 years. 

Working in three hospitals and several outpatient clinics, we offer comprehensive care for people suffering from burns and trauma, which includes surgery, physiotherapy, psychological support, occupational therapy and health education. 

Since 2018, we have also been running a reconstructive surgery programme in northern Gaza. MSF’s project is crucial since Gaza’s local healthcare system is overstretched and underfunded, and deeply impacted by over a decade of blockade.

Since we currently only run programs in Palestine, our reporting is rooted in the direct witnessing of our patients and staff on the ground there. However, we have offered support to Israeli hospitals treating casualties from these attacks.

Why is MSF not working in Israel?

We are a humanitarian organisation, which means we treat everyone who needs help, but our resources are not unlimited: we focus them where they are needed the most. The Palestinian healthcare systems, both in the West Bank and the Gaza Strip, have been crippled by over 70 years of occupation and over ten years of blockade. They are unable to meet the basic health needs of their respective populations. In contrast, Israel has an excellent healthcare system and has not requested support from MSF at this time. 

The declarations of war and blockade must not amount to a collective punishment of the Gaza Strip.

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