One year of a war without rules has left Gaza shattered

Since the atrocities committed by Hamas on 7 October 2023, killing up to 1,200 people and taking around 250 hostages, Israeli forces have pursued an all-out war on people in the Gaza Strip, killing more than 41,500 people, and wounding over 96,000.

For a year, Israel, Hamas, and their respective allies have catastrophically failed to reach a deal on a sustained ceasefire in Gaza, while the risk of a full-blown regional conflict is now increasing. Israel must immediately stop the indiscriminate killing of civilians in Gaza and urgently facilitate the delivery of aid to alleviate suffering inside the Strip, including through the reopening of vital border crossings, in compliance with the measures requested by the International Court of Justice.

Médecins Sans Frontières’ (MSF) medical staff have treated patients on a daily basis with wounds caused by massive bombings. People have extensive burns, crushed bones, and have been dismembered. Since the beginning of the war, MSF teams have treated over 27,500 patients for violence-related injuries, with more than 80 per cent of the wounds linked to shelling.

“Israeli bombardments of densely populated areas have repeatedly caused injuries on a massive scale. Our teams have been forced to perform surgeries without anaesthesia, witness children die on hospitals floors due to a lack of resources, and even treat their own colleagues and family members,” says Dr Amber Alayyan, MSF medical programme manager. “Meanwhile, the healthcare system in Gaza has been systematically dismantled by Israeli forces.”

MSF teams were already treating the effects of Israel’s 17-year occupation, blockade, and recurrent attacks on people in Gaza, including treating patients for long-lasting injuries, mental health conditions, and severe burns, inflicted before 7 October. Since that date though, while needs have soared as a consequence of Israel pummelling the Strip, access to healthcare has been reduced to shreds.

Today, only 17 out of out of 36 hospitals are partially functional. Warring parties have conducted hostilities near medical facilities, endangering patients, caretakers, and medical staff. Six MSF colleagues have also been killed. From October 2023, staff and patients from MSF have had to leave 14 different health structures, due to serious incidents and ongoing fighting. Each time a medical facility is evacuated, thousands of people lose access to lifesaving medical care. This will have consequences on people’s health, not just in the immediate term, but in the weeks and months to come.

The lack of access to healthcare is compounded by the dearth of enough humanitarian supplies in Gaza. Israeli authorities have routinely imposed unclear, unpredictable criteria for authorising the entry of supplies. Once supplies cross into the Gaza Strip, they often do not make it to their destination, due to an absence of safe and accessible roads, ongoing fighting, and looting of food and basic supply items.

“As the medical needs in the Strip increase, our capacity to respond continues to be limited; we just cannot get enough humanitarian and medical supplies into Gaza,” says Dr Alayyan. “The field hospitals we set up as a last resort are simply a bandage to fix the devastation caused by the war and destruction of the healthcare system. Even their setup has been hampered and delayed by restricting our ability to procure materials and equipment. As it stands, the medical facilities that remain operational cannot cope with the vast needs.”

As the availability of medical care has shrunk so too have the options for people to seek out desperately needed healthcare in Gaza. Repeated evacuation orders have displaced 90 per cent of people into so-called safer zones which Israel has nonetheless bombed over and over again. People are now urged to stay within a tiny patch of 41 square kilometres, with limited shelter, food and water. There is an increased risk of disease due to overcrowding. Out of the two million people in the Gaza Strip, at least 12,000 people desperately need to be medically evacuated. The medical evacuation of those in need, and the right of Palestinians simply seeking safety for themselves and their families to leave the Strip, must immediately be facilitated, without prejudice to their right of return.

While the past 12 months have been marked by destructive actions, they have also been defined by shameful inaction.

“For one year, Israel’s allies have continued to provide their military support to Israel, as children are killed en masse, tanks fire on deconflicted shelters, fighter jets bomb so-called humanitarian zones,” says Chris Lockyear, MSF Secretary General. “This has been accompanied by a consistent public narrative dehumanising people in Gaza and failing to distinguish between military targets and civilian lives. The only way to stop the killing is with an immediate and sustained ceasefire.”

Time and again, political allegiances have been put before human life. ​ While Israel´s allies publicly speak on the importance of a ceasefire and need to facilitate humanitarian aid into Gaza, they continue to provide arms to Israel. The United States in particular, while recently espousing calls for ceasefire, has frequently worked to obfuscate, block, and undermine ceasefire efforts through its role in the United Nations Security Council.

Meanwhile, the war in Gaza is fuelling regional tensions, which are reaching disastrous heights. Israeli attacks have surged in the West Bank, and now in Lebanon, with already devastating consequences on civilians.