Israel’s unrelenting war on Gaza healthcare requires urgent action

In late December, South Africa filed a landmark case at the International Court of Justice alleging that Israel has committed multiple “genocidal acts” against Palestinians in Gaza, including an “assault on Gaza’s healthcare system, which renders life unsustainable”.

Destruction of a healthcare system is indeed an act of genocide – especially in a besieged territory where over two million displaced, desperate, starving people are facing relentless, indiscriminate bombardment and sniper fire. Once the health system is destroyed, injuries cannot be treated, primary care cannot be delivered, and famine cannot be managed – in other words, life cannot be sustained.

While the ICJ will likely take some years to issue a final verdict on the case against Israel, it should be clear to anyone paying any attention to the situation of healthcare in Gaza that the Strip is on a scandalous pathway to complete ethnic cleansing.

Since October 7, Israeli forces have been blocking the entry of essential medical supplies and medicines to the Strip, bombing hospitals and other medical facilities, killing and kidnapping healthcare staff, and targeting ambulances. Even Gaza’s sole paediatric cancer ward has been attacked and destroyed by the Israeli military.

It is difficult to see these sustained, deliberate attacks on healthcare in Gaza as anything other than an ethnic cleansing strategy aimed at creating a major health crisis that would kill thousands of Palestinians and deem the territory uninhabitable for the survivors.

Since the beginning of its latest war on Gaza, Israel conducted more than 400 attacks on healthcare facilities in the Strip, including on every single one of its hospitals, leaving the majority non-functional. As of February 13, only 11 out of 36 hospitals in Gaza are partially functioning – five in the north and six in the south. According to the WHO, hospital bed capacity across all of Gaza has now been reduced from 3,500 to just 1,400. In many cases, the Israeli authorities tried to justify these attacks by claiming, without providing any independent, conclusive evidence, that hospitals are being used by Hamas, or that there are “Hamas command centres” under them.

At this point in the conflict, the few partially functioning hospitals are only able to deliver desperately needed trauma care and there is no treatment for other critical primary care needs, such as chronic illnesses.

In addition to attacks on health facilities, we know of 374 health workers that have already been killed, some in targeted assassinations. By late December, the number of health workers killed in Gaza had already exceeded the total number of all health worker deaths recorded across all other conflicts globally last year, and in any single year since 2016. Many health workers have also been kidnapped, including Dr Muhammad Abu Salmiya, the director of Gaza’s largest hospital, al-Shifa, who remains missing.

Ambulances have also faced attacks in Gaza, with about 120 of them completely destroyed. There have been many incidents in which ambulances have been prevented from reaching critically injured patients. In one case, an Al Jazeera journalist injured from Israeli bombardment bled to death after the ambulance trying to reach him came under fire. In another, Israeli forces bombed the Palestine Red Crescent ambulance trying to rescue a six-year-old child trapped in a car with the dead bodies of her family members, killing the two paramedics onboard. Later, it was revealed that Israeli forces also killed the child they tried to rescue.

Antenatal and maternity care across the territory – care that is crucial for the long-term survival of the Palestinian population in Gaza – is also extremely limited.

It is estimated that 183 women give birth in Gaza every day, but access to care for a safe pregnancy is dependent on reaching a facility still able to deliver antenatal care. Few women are able to do so and those facilities that still offer care for pregnant women are hugely overcrowded and subject to conditions described as catastrophic – lacking basic hygiene necessities, fuel, water, anaesthetics, drugs, blood products, and other supplies. With no fully functioning maternal hospitals, many women are forced to give birth in one of the few healthcare facilities that are still partly operational. However these are not geared for maternal care, and the risk of complications is very high for all mothers and babies.

In November 2023, al-Hilo Hospital, which was serving as a designated maternity hospital after the collapse of all other specialist facilities, was shelled by Israeli forces. A Palestinian doctor then reported that “[f]ear is the common condition of every pregnant woman” in Gaza.

The looming famine in Gaza – caused by the near complete siege imposed on the territory by Israel since the beginning of the war – is also posing a threat to pregnant women.

Today, half of all pregnant women in Gaza are suffering from anaemia and at least 50,000 pregnant women are facing extreme hunger, affecting not just the current generation of people living in Gaza, but the next. There are reports of an increased number of miscarriages, too.

Health workers in Gaza are working under immense stress and hardship, having to carry out amputations, c-sections and other procedures without anaesthesia, electricity, and most basic medical supplies. UN experts have framed the war on the Gaza health system as one that has resulted in the complete obliteration of healthcare infrastructure.

Presented with evidence for all this and more, on January 26, the ICJ issued a preliminary ruling in the genocide case against Israel, explaining that it has seen sufficient evidence of dispute for the case to proceed, and ordering Israel to take action to prevent acts of genocide in Gaza and provide humanitarian aid to Palestinians.

And yet, despite the ICJ’s provisional order, Israel’s military assault on the health system has continued unabated. In fact, the attacks on remaining healthcare facilities in Gaza intensified significantly in the past few weeks.

On January 27, just one day after the ICJ announced its provisional orders, Doctors Without Borders (Medecins Sans Frontieres, or MSF) announced that “amid ongoing heavy fighting and bombing in Khan Younis, south Gaza, Palestine/OPT, vital medical services have collapsed at Nasser Hospital, currently the largest functioning health facility in the enclave”.

Since then, the hospital faced numerous other attacks from air, land and sea, and has been under an Israeli siege for weeks. On February 9, Israeli snipers killed at least 21 displaced civilians trying to reach the hospital.

In just more than four months, Israel’s military onslaught on Gaza killed more than 28,000 people, and injured more than 60,000 others. Most of Gaza’s more than two million inhabitants are now displaced, and waiting in fear for the next attack in flimsy tents and damaged buildings in freezing temperatures. The decision taken by several Western nations to suspend funding for UNRWA, the main UN agency providing humanitarian aid and essential services to Palestinians in Gaza, has amplified the looming threat of famine.

With the remaining healthcare services on the brink of collapse, and health workers under constant attack, there is little hope for Palestinian life to continue in Gaza if the international community does not take urgent action.

The evidence before us  – evidence reported by brave Palestinian journalists on the ground, evidence presented to the ICJ by the South African legal team, evidence we see every day on our social media feeds in videos shared by Gaza’s people – is clear: Israel is conducting in Gaza a sadistic ethnic cleansing campaign, a genocide, aimed at ridding the Strip off its native population.

The sustained attacks on Gaza’s healthcare workers are perhaps the most effective element of Israel’s relentless campaign to render life in the Strip unsustainable for Palestinians. Once this war is over, surviving Palestinians can theoretically rebuild their destroyed homes, schools, businesses and hospitals in a matter of months, but the human capital that is lost to Israeli bombs and bullets – doctors, surgeons, paramedics, nurses and professors killed and maimed by Israel’s actions – can not be replaced for many, many years. Israel’s actions have not only physically and psychologically traumatised the Palestinians, but expertly left them without the very resources that could help them heal and rebuild their lives, on their land that was turned into a wasteland.

The international community, which created the conditions for this humanitarian catastrophe with its indifference to Israel’s violations of international law and crimes against Palestinians, need to take urgent action.

It needs to take action to protect what is left of Gaza’s healthcare system, as a first step to putting an end to Israel’s blatant ethnic cleansing efforts and genocide.

The views expressed in this article are the authors’ own and do not necessarily reflect Al Jazeera’s editorial stance.