Analyzing the Collapse of the Healthcare System in Gaza
Ihab Naser (1,*), Ahmad Elhaija (2,3), Shubhreet Bhullar (3,4), Ilia Talebi Dolouei (3,4), Maisune Abu-Elhaija (3,5,**), Dana Yambao (3,4), Zaki Zaqzook (6)
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Al-Azhar University - Gaza, Jamal Abel Naser Street, Gaza City, Gaza Strip, Palestine
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David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA, aelhaija@ucla.edu
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International Healthcare Organization, Los Angeles, CA, USA
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University of California, Los Angeles, 330 De Neve Dr, Los Angeles, CA 90095, USA
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Nasser Hospital, Khan Yunis, Gaza Strip, Palestine
*Corresponding authors.
**Independent Researcher. The author's affiliation with Brown University is for identification purposes only; the university did not fund, facilitate, or oversee this research.
Published: September 2026
DOI: https://doi.org/10.58417/QLAD3062
Abstract
Three years of ongoing high-intensity conflict has resulted in the catastrophic collapse of the healthcare system in Gaza. This paper examines systematic destruction across six domains: hospital infrastructure, primary care, healthcare workforce, emergency medical services, medical education, and population health. By synthesizing peer-reviewed literature, humanitarian reports, public health data, and seven key informant interviews, this study assesses statistical data and lived experiences to provide a multifaceted view of the healthcare collapse in Gaza. Findings indicate that direct attacks by the Israeli Defense Forces (IDF) have destroyed health facilities, supply lines, and electrical infrastructure, reducing hospital capacity while disrupting vaccinations, chronic disease management, and maternal-neonatal care. Healthcare workers have been killed, detained, displaced, or left to practice under severe resource and psychological strain. Furthermore, attacks on ambulances hamper emergency transport, compounding preventable mortality. Beyond short-term impacts, the destruction of universities, laboratories, and teaching hospitals threatens the training of future healthcare professionals. At the same time, malnutrition and infectious disease overwhelm the already depleted system. These combined factors and the intentional targeting of healthcare assets, represent a systemic rather than incidental disablement of healthcare infrastructure, raising critical ethical and legal concerns under international humanitarian law. The deletion of various health domains simultaneously underscores the urgent need for international intervention to address the immediate humanitarian crisis and extensive barriers to restoration.
Keywords: Gaza; healthcare system; hospitals, public health; medical education; humanitarian crisis
Introduction
The decimation of Gaza’s health infrastructure is severe: by late 2024 only 17 of Gaza’s 36 hospitals remained partially functional, and by May 2025 only 19 were still operating in any capacity (1). The World Health Organization (WHO) reported that at least 94% of Gaza’s hospitals had been damaged or destroyed by that time (2). With 90% of Palestinians in Gaza displaced from their homes, many of them forced to live in refugee camps dependent on limited humanitarian aid, rates of malnutrition and poverty soared. The World Bank reported in May 2024 that nearly every Gazan lives in poverty (3). This, in conjunction with plummeting healthcare access, means preventable diseases now run rampant. For example, the WHO reported roughly 600,000 cases of acute watery diarrhea and nearly 1 million cases of acute respiratory infections in the Gaza Strip. Non-communicable diseases such as diabetes and cardiovascular disease also saw increases (4). In addition, the conflict has taken a devastating toll on Gaza’s health workforce: it is estimated over 1,600 Palestinian health-care workers have been killed since October 2023, while Israeli authorities reportedly detained at least 185 health-care workers in Gaza and the West Bank as of early 2025 (5). However, the condition of Gaza’s healthcare system cannot be assessed solely by counting damaged hospitals. Clinical care depends on a network of facilities, personnel, medicines, electricity, transportation, public health surveillance, education, and referral pathways. Since October 2023, each of these elements has been weakened, often simultaneously. Mortality statistics capture only part of the resulting harm. Khatib and colleagues note that recorded deaths during active conflict may exclude people buried under rubble and cannot fully capture indirect deaths caused by infection, malnutrition, or interrupted treatment (1). The number of direct and indirect deaths in Gaza is estimated to exceed 186,000 over the past three years (6). According to the United Nations Human Rights Office of the High Commisioner, Israel banned over 37 aid groups from Gaza in January 2026, further making life unbearable for genocide survivors, while also reducing the capacity for tracking updated statistics on healthcare cases including deaths, injuries, infections, and operating capacity of healthcare facilities (7).
The analysis that follows considers hospitals, primary care, workforce capacity, emergency services, medical education, and malnutrition as parts of a single system rather than separate crises. The key information interviews add detail that institutional statistics cannot provide, particularly regarding interrupted cancer treatment, clinical triage under scarcity, and professional exhaustion. These qualitative insights are essential complements to quantitative reports because they reveal invisible structural failures and contextualize the profound psychosocial and ethical burdens faced by healthcare professionals and communities in Gaza. The literature appears to demonstrate that Gaza’s health crisis is systemic because physical destruction, supply restrictions, workforce depletion, population displacement, and educational disruption reinforce one another. Their cumulative effect is both immediate, through preventable illness and death, and long-term, through the erosion of the institutions needed to restore care. To demonstrate this interconnected collapse, this study aims to use key informant interviews and quantitative data to analyze Gaza’s healthcare crisis as a holistic, systemic failure rather than a series of isolated collapses.
Methods
This study used a systematic review of the literature to synthesize evidence on the condition of Gaza’s healthcare system. The review included twenty-one sources published between January 2024 and February 2026. Sources were purposely selected for their direct relevance to hospital functionality, primary care, workforce capacity, emergency transport and medical evacuation, higher education, nutrition, or population health. The evidence base combines peer-reviewed articles with operational reports from the World Health Organization, United Nations agencies, Médecins Sans Frontières, the International Committee of the Red Cross, and Physicians for Human Rights. This combination was necessary because the pace of events and restrictions on access mean that humanitarian organizations often document changes in service capacity before they appear in academic literature.
For this research process, a problem was initially identified and then relevant data was collected. IHO team members conducted a convenience sample of Skid Row adults recruited from the Midnight Mission rehabilitation center, the Union Rescue Mission common area, and the streets of Skid Row. 163 adult individuals responded to our survey, all of whom provided informed consent. Following data collection, the data was evaluated and analyzed before its findings could be presented. A descriptive analysis of data was conducted from our medical care survey, with percentages and mean answers to the survey questions being calculated. The data was inspected to gain insights regarding the unique integration of medical services for this community.
Seven key informant interviews were also included as contextual qualitative evidence. The interview set comprised participants with direct experience in clinical care, medical or higher education, or both. They included physicians working in oncology, surgery, and hospital leadership; an intensive care nurse; two university deans; and a medical student. Three participants are identified only by professional role in order to reduce potential risk to them and their families. Interviews were conducted virtually by International Healthcare Organization (IHO) members via Zoom from January 2025 to July 2026 using a semi-structured format focused on healthcare delivery, workforce conditions, educational disruption, and barriers to care. The interview accounts were reviewed for recurring themes, including treatment interruption, workforce strain, educational loss, psychological burden, and efforts to preserve local institutions. Findings from the interviews were interpreted alongside the literature and operational reports to provide contextual qualitative evidence of the broader patterns identified across Gaza’s healthcare system.
This study received ethical approval and was determined to be exempt from full Institutional Review Board review. All participants provided informed consent to participate and consent for publication of their interview material and quotations.
Destruction of Hospitals and Healthcare Facilities
The loss of hospital capacity has been cumulative rather than binary. Facilities have been damaged directly, placed under siege, subjected to evacuation orders, or deprived of the supplies required for ordinary operation. In May 2025, WHO reported that only 19 of Gaza’s 36 hospitals remained operational in any form. Several were limited to basic emergency services, and roughly 2,000 hospital beds were available for a population exceeding two million. Later reporting described hospitals functioning beyond capacity while essential medicines and medical disposables reached zero stock (5). In February 2026, UN OCHA reported that only 42% of health service points were functional, with over 90% of those being only partially functional due to severe shortages of supplies, equipment, and fuel (6). Hamamra and colleagues emphasize that the destruction of a hospital also removes diagnostic equipment, specialized services, and referral relationships that may have taken years to establish (6). The resulting losses have affected intensive care, oncology, cardiac care, neurosurgery, rehabilitation, and other services that cannot readily be replaced by temporary clinics.
Physical survival of a building does not mean that the institution inside it remains functional. Médecins Sans Frontières reported shortages of analgesics, sterile gauze, medications, and equipment severe enough to reduce the frequency of dressing changes for burn patients and threaten suspension of medical activities (8). Mughaiseb described a system being “strangled” by supply shortages and the repeated displacement of care (9). Interruptions in fuel and electricity have further compromised ventilation, dialysis, refrigeration, laboratory testing, sterilization, and infection control (2,5). Measures that classify a facility simply as open or closed therefore obscure substantial differences in the care it can actually provide. A hospital may remain on an operational list while lacking the staff, power, equipment, or safe access required to deliver treatment at an acceptable standard.
Collapse of Primary Healthcare Systems
The breakdown of primary care has allowed routine health needs to progress into emergencies. Immunization, prenatal and postnatal care, chronic disease monitoring, medication refills, and early treatment of infection all depend on community facilities and reliable supply chains. When these services are interrupted, preventable illness increases and patients are pushed toward hospitals that are already overwhelmed. Al Bakri and colleagues describe gaps in vaccination, communicable disease control, noncommunicable disease care, and maternal health as mutually reinforcing features of the crisis (10). WHO’s public health analysis similarly links overcrowding, unsafe water, inadequate sanitation, malnutrition, and weakened disease surveillance to increased infectious-disease risk (5). Souilla and colleagues add that extreme heat and displacement intensify dehydration, cardiovascular stress, and the transmission of communicable disease (11).
Maternal and reproductive health illustrate how quickly a disrupted continuum of care can become life-threatening. UNFPA documented women giving birth while displaced, with reduced access to obstetric services and shortages affecting safe delivery and postpartum care (12). UNICEF reports describe simultaneous threats to pregnant women, infants, and children from malnutrition, infectious disease, and reduced access to health services (13). A patient does not need to sustain a direct traumatic injury to face war-related medical risk. Missed prenatal screening, delayed recognition of complications, loss of emergency obstetric capacity, and an unavailable neonatal referral bed can each change the outcome of a pregnancy. Similar dynamics affect patients with diabetes, cardiovascular disease, cancer, and other conditions that require continuity rather than a single episode of treatment.
Targeting and Depletion of the Healthcare Workforce
Gaza’s healthcare workforce has been diminished by death, injury, detention, displacement, and prolonged exhaustion as a result of targeted attacks by the Israeli Defense Force (IDF). WHO and MSF describe clinicians repeatedly managing mass-casualty events with too few staff and inadequate supplies (2,8). Even before the current war, Gaza’s health system faced constraints in meeting population needs, which made the targeted killings and detentions of senior clinicians and specialists particularly consequential (14). The forced displacement or death of a surgeon, anesthesiologist, nurse, pharmacist, technician, or hospital administrator removes more than one unit of labor. It also eliminates expertise, informal coordination, and mentorship that are difficult to reproduce during an emergency. For services dependent on a small number of specialists, the loss of a single clinician may end local access altogether.
Material scarcity has also produced a form of ethical injury among those who remain. Shahvisi argues that bedside decisions about access to anesthesia, antibiotics, surgery, or a hospital bed cannot be separated from the conditions that have made those resources unavailable (15). Clinicians are required to triage patients who might all have been treatable under ordinary circumstances, often without reliable diagnostics or the possibility of referral. WHO’s September 2025 analysis documented severe shortages of essential drugs and medical disposables while hospitals continued to receive more patients than they could safely accommodate (5). The burden is therefore clinical, psychological, and moral. Health workers care for patients while facing danger to themselves and their families, and they must assume responsibility for decisions made within constraints they did not create.
Testimonies from Key Informant Interviews
We conducted seven key-informant interviews with individuals who had direct experience with the effects of the war on Gaza’s healthcare and higher-education systems. Participants included Dr. Zaqzook, an oncologist who worked at the Turkish-Palestinian Friendship Hospital and Nasser Hospital; Dr. Mograbi, an orthopedic and plastic surgeon who worked at Al-Shifa Hospital, Nasser Hospital, and an MSF-supported field hospital in Rafah; Dr. Baker Abu Safia, a senior surgeon at Al-Awda Hospital; and Dr. Ihab, Dean of the Faculty of Applied Medical Sciences at Al-Azhar University, who is currently based in Canada. The remaining participants are identified only by their roles and professional titles: an intensive care nurse working at Nasser Hospital alongside Médecins Sans Frontières, another Dean at Al-Azhar University in Gaza, and an Al-Azhar University medical student from Gaza who is currently displaced in Egypt. The names of these three participants have been withheld to protect them and their families from potential harm.
Dr Zaqzook; oncologist at the Turkish-Palestinian Friendship Hospital and Nasser Hospital
Dr. Zaqzook shared he “saw suffering and sickness beyond belief… all colors of suffering.” In the time of war in Gaza, sickness due to injuries and damage from war, the patients who suffered from cancer are already weak, and their treatment was interrupted with medications like chemo becoming short on supply. The Turkish Hospital (Turkish Palestinian Friend Hospital) in Gaza was the only one who had the significant capacity to help the cancer patients in Gaza.
He shared his team were trying to give the patients medication, just the cornerstone of care yet were often unable to as a result of the IDF violently intervening in most of the healthcare facilities and NGOs in Gaza. After the IDF destroyed the Turkish Hospital completely, he went to Nasser Hospital, “many were killed when the Turkish Hospital was destroyed, so the survivors had to be transferred to Nasser Hospital.” He shared, “Many people were killed in the streets, and didn’t get help and could not get access to chemotherapy; many of them needed it and could not get it, so they died due to progression of cancer.” He felt confident in himself that he could help. He said he felt he wanted to help those who couldn’t get help and who got very sick. After the IDF invaded Nasser Hospital he returned back to Nasser to see it nearly completely destroyed, but it was still partially working, so they tried to repair what they could from it and use it to continue helping people in a limited capacity. He recounts a specific instance with a patient: Mohamed Abu Jammah, a late-stage lung cancer patient with bilateral malignant effusion. He needed chemo- and radiation therapy, which were not available; he could have lived and recovered from his cancer with timely care, but there was a supply shortage, so he died early.
After exiting Gaza through the Kerem Abu Salem crossing with the help of the Red Crescent, Dr. Zaqzook traveled from Jordan to Moldova by air “in order to escape death”. He shared that his family had left Gaza earlier. “The IDF killed many of my colleagues” and there were no more facilities to help people properly or enough medical supplies to help, so he had almost no use being there. He is now online with his remaining colleagues to try to help them. However, they are limited in what they can do due to the destruction of facilities and limited medical supplies and medications.
Dr. Mograbi; orthopedic and plastic surgeon at Al-Shifa Hospital, Nasser Hospital, and an MSF-supported field hospital in Rafah
Dr. Mograbi was working at Nasser Hospital from October 7th, 2023. Before that he worked at Al-Shifa Hospital since 2006. For a period of time, he was the only consultant in the Hospital as an orthopedic plastic surgeon. Dr. Mograbi performed “thousands of surgeries, sometimes 15–20 cases per day.”
During October, November, and December 2023 and mid January 2024, he used to work such a big load because the IDF used to “attack randomly and massively… I used to receive dozens of patients at a time, including many children.” He shared, “The injuries I witnessed were so bad. Limbs were severed, children were burned. I felt sadness, and pressure, and fatigue but I kept going.”
Then the IDF imposed a siege at the Hospital and he stopped receiving patients after the siege. The medical workers were not allowed to move between buildings due to snipers and quadcopters from the IDF, “the IDF would kill people moving between buildings.” Then the IDF invaded the hospital facilities and the surviving medical workers had to move to Rafah. He said he was lucky to escape the Hospital, he and his family had sheltered in the Hospital and they got out. They moved to Rafah and he was “living in one tent in Rafah where me and my family lived and he worked for MSF fronts at a field hospital until the end of April 2024.” He was at a field hospital in Rafah where they could operate on patients they received. However, it was “less patients than at Nasser because it was very selective due to the severity of the situation and more limited capacity than Nasser Hospital”. At the end of April he escaped from Gaza to Egypt through Rafah. Within one week of him leaving, “Israel invaded Rafah and destroyed the crossing border.” He shared he is now in Belgium doing his best to help people still in Gaza. Articles about him can be found online, as well as an Al Jazeera interview, and he has an upcoming film being released about his experiences during the Genocide.
Intensive care nurse working at Nasser Hospital
We interviewed an intensive care nurse working at Nasser Hospital alongside Médecins Sans Frontières, who currently lives in Gaza and chose to remain anonymous to protect himself and his family.
He said Genocide by the Israeli occupation caused the collapse of the medical system in general. Shortage of medical supplies, IV fluids, medications, medical instruments… huge shortages due to the siege.” There were changes after the Genocide began in the leaders of the hospitals. Some went out of service and were reliant on outside hospitals like MSF and IRC. Many volunteer hospitals went out of service and had to close due to lack of safety. He worked at a European hospital in Gaza. Then, after the European Hospital closed due to IDF intervention, he worked at Nasser Hospital and with MSF Holland. He shared “the Gaza Ministry of Health still wants the medical workers to work at whichever medical facilities were able to operate due to a massive influx of injuries.” While working at the ICU, he witnessed "A lot of severe burn injuries, some people were completely charred and many died from burn injuries caused by IDF bombings and shellings.” Burn injuries were the most dangerous and severe that he saw. “In one case, a patient went into neurogenic shock due to the severity of the burn from the face to trunk from Israeli attacks.” He saw many IDF attacks in the vicinity of the hospitals, “there was no regard to the safety of the hospitals.” He works in Nasser Hospital now but “there are a million things that prevent the medical workers from working in the hospital due to damage to facilities, ongoing danger, and management restrictions.”
He said “Nurses like me go to work because of their own humanity. They work 160 hours inside of the hospital and get paid about 100 USD per month from this and work an extra hundred hours per month outside of the hospital just to survive, taking on jobs from humanitarian organizations such as caregiving for orphan children.” They have a big load that comes into Nasser Hospital, that they are unable to truly meet “and the nurses are seriously exhausted”. He shared, “many different organizations operating within Nasser to this day (in 2026), which is still not fully functional.” He said he is under very high risk, “many nurses have no choice but to work in Gaza to survive. Inflation is extremely bad: a kilogram of tomatoes is 20 USD; one piece of diapers is 3 dollars. So if you are a nurse who has a child, you cannot afford their most basic needs.” When asked what do you want the American public and international community to know, he shared “We love life… however due to Israeli oppression and attacks and the martyrs killed, it painted a picture of Gazans as oppressed, helpless people. However, we are highly educated.”
Dr. Ihab Naser; Dean of the Faculty of Applied Medical Sciences at Al-Azhar University-Gaza
Dr. Naser reflected on the state of the school where he once taught and served as a leader. He explained that not only had “all the infrastructure for education…been totally demolished,” but even the “spirit in the place, where the knowledge and the transfer of knowledge and the science, everything has been destroyed.” As a teacher and leader, he saw that the school’s destruction not only physically took away the place of learning, but also deprived students of the laboratories, equipment, mentorship, and academic environment through which they could pursue their intellectual curiosity. Despite having four newly inaugurated laboratories, Dr. Naser reflected that they had “not been used for a single time” before “everything [was] demolished.”
Dr. Naser described that loss as deeply personal. After leading a three-year Erasmus project to establish these four new laboratories for nutritional assessment, food analysis, and food preparation, he presented them merely two weeks before the war. His students never had the “joy of touching these instruments and using them for a single time,” and he recalled that years of work disappeared “within seconds.”
Yet Dr. Naser emphasized that the destruction had not eliminated his students’ commitment to learning and fulfilling their dreams. Even while living in tents without reliable electricity, water, or internet access, students continued attending remote classes and completing examinations. Some charged their phones and traveled several kilometers to “get the signal” and download their lectures. Although university leaders initially expected only 4,000 to 5,000 students to return to remote learning, 10,000 students enrolled, with participation later increasing to approximately 11,500. Reflecting on their persistence, Dr. Naser declared, “We will not stop dreaming,” even as Palestinians “are feeding their dreams with their blood and tears.” Dr. Naser repeatedly highlighted the resilience of his students and the Palestinian people, assuring that “we will never lose the hope. The hope, you know, it’s our…weapon.” He concluded his interview with a simple message: “Stop the bloodshed, stop the war, and then help us in rebuilding our country, rebuilding our academic institutes, our universities, our hospitals, our infrastructure.”
Dean at Al-Azhar University
Similar to how Dr. Nasser emphasized that the destruction of universities represented the loss of more than physical buildings, another Dean at Al-Azhar University described universities as living communities. His faculty building had already been destroyed and rebuilt three times during his academic career, and “this is the fourth time it is destroyed.” Yet he insisted that “universities are not infrastructure” and “universities are not buildings”; rather, “universities are community,” formed by professors, students, and staff. Even after lecture halls, laboratories, research stations, and community-service buildings were destroyed, they reorganized and continued teaching online because they believed education could “sustain…the hope of our future.”
Rather than focusing only on numbers, he explained that “we need to humanize those numbers” through the stories of individual students. He recalled a female student whose mother and two sisters were killed on the day of her final examination. Despite this loss, she contacted her instructor to submit the exam because “she doesn’t want to fail.” He also remembered a top-ranked graduate whom he had helped obtain a university teaching position. The student was preparing to apply for an international scholarship, and the Dean believed he might one day lead the institution. Less than one month later, the student was killed. Reflecting on his death, the Dean said, “I got the feeling that they are killing our future.”
Still, he maintained that “the loss is big, but the hope also is big for a better future.” He argued that recovery cannot be limited to reconstructing classrooms, but must also “rehabilitate the humanity” of children facing mass trauma. He concluded that outside support should strengthen institutions within Gaza rather than replace them, because “the resilience of institutions on the ground of Gaza would mean the resilience of the Palestinian people over their land.”
Dr. Baker Abu Safia; senior surgeon at Al Awda Hospital in northern Gaza
We interviewed Dr. Baker Abu Safia, a senior surgeon on duty in Al Awda Hospital in northern Gaza during the Genocide. He noted that the “Israeli occupation destroyed nearly all of the advanced medical technologies in Gaza Strip that used to be widely accessible, including MRI machines, CT scanners, advanced endoscopes, and advanced lithotripsy machines”. He shared, “The remaining medical facilities are barely functioning.” This issue was further exacerbated by the direct targeting of the medical workforce and the siege and invasion of hospitals like Al-Awada Hospital in Tal al-Zaatar. Dr. Baker reiterated the targeted plight of Gazan healthcare workers, noting that many medical professionals, mostly senior consultants and doctors, have been subjected to severe conditions. “Medical personnel were targeted, arrested, and even tortured.” He shared, “Senior figures were particularly targeted. For example, the Director of Kamal Edwan Hospital is currently held in solitary confinement in a detention center.” In addition to this, daily bombardments strain the emergency response. “The Ministry of Health has been displaced and physical reconstruction of medical infrastructure has been stalled. Many hospital sectors like Al-Awda Hospital in the Middle Area (Nuseirat) are physically inaccessible. The health system and basic societal living conditions have regressed by 50 years.” “Although foreign medical specialists have come in to help, they only stay for a month or two.” Despite this, the “local staff are supporting the vast majority of the medical workload” by “handling routine medical care in addition to war casualties.” To uphold medical education, “senior doctors are training and mentoring junior doctors”. Dr Baker remains confident that “the Palestinian people have the capacity to rise again” and “quickly rebuild the healthcare system” once the occupation ends. However, there are concerns that “the occupying force will undermine reconstruction and stability if they are unable to displace the Palestinian people entirely”.
Medical student at Al-Azhar University- Gaza
We interviewed a female medical student in Gaza. She discussed how the war destroyed her university, leaving her unable to continue her studies for months. Students faced many hardships, such as “limited internet, lack of a suitable study environment, and the immense psychological burden of an ongoing conflict”. In addition to this, “students in Gaza face immense financial difficulties” and the “emotional toll of the war makes it hard to stay motivated and focused on studies”. “It is difficult to focus on lectures when you are wondering if your family is safe or if you are anticipating being killed.” She shared, “I will never forget losing classmates from my own group or when our home was destroyed and my family and I were injured. Those around us were murdered. We live in constant fear awaiting our turn.” This has resulted in many mental health challenges, such as “anxiety and sleepless nights”. Gaza needs “access to mental health resources, education, and opportunities to rebuild (its) future”. Despite these challenges, the students of Gaza are determined to learn and grow. The student notes that while “some people are too focused on their personal struggles, many others are stepping in to support students and youth organizations.” Although the “youth of Gaza are broken in spirit and body”, local organizations have been instrumental in “planting seeds of hope”. The student wishes that global leaders and organizations “understood the long-term impact of war on their mental health, education, and future prospects”.
Synthesis of interview
Across the seven interviews, five themes recur. First, the loss of infrastructure was experienced as a loss of treatment itself, especially when cancer care, intensive care, imaging, surgery, and emergency referral became unavailable. Second, workforce depletion was inseparable from exhaustion among those who remained. Participants described sustained workloads, personal displacement, fear for the lives and safety of family members, and the moral burden of caring for patients without adequate supplies. Third, the destruction of universities and teaching hospitals threatened professional continuity by removing laboratories, mentorship, and spaces in which future clinicians would normally be trained. Fourth, interviewees recounted witnessing traumatic events including killing, injuries, arrests, and torture. This led them to be overwhelmed with grief, fear, and mental anguish when recounting these events. Fifth, the interviews repeatedly returned to institutional persistence. Clinicians continued working in damaged facilities, and students attempted to study despite displacement and unreliable electricity or internet access. These accounts are not statistically representative, but their convergence gives human and institutional context to the patterns documented in the literature.
Targeting of Emergency Healthcare Services
Emergency care depends on a sequence of timely actions: reaching the injured, stabilizing them, transporting them safely, and transferring them to a facility capable of definitive treatment. In Gaza, attacks on ambulances, movement restrictions, damaged roads, and delays in coordination have disrupted each part of that sequence. The ICRC reported the killing of Palestine Red Crescent Society medics and first responders by the IDF, underscoring the danger faced by personnel and vehicles that receive specific protection under international humanitarian law (16). When ambulances cannot reach casualties or travel safely between facilities, time-sensitive conditions such as hemorrhage, severe burns, sepsis, and obstetric emergencies become more difficult to survive.
The referral chain also fails when treatment is unavailable inside Gaza and patients cannot leave. Physicians for Human Rights documented prolonged obstruction of medical evacuations, including a period after the destruction of the Rafah crossing when only a small fraction of patients requiring care abroad were evacuated (17). WHO has likewise reported insecurity and impeded missions that prevented supply delivery, patient transfer, and assessment of damaged facilities (2). Emergency-system failure therefore occurs at several points: before an ambulance arrives, during transport, at an overloaded receiving hospital, and at the border when specialized treatment requires evacuation. Delay at any one of these points can render later care ineffective.
Destruction of Medical Education and Long-Term Systemic Collapse
The destruction of medical education extends the health crisis beyond the present generation of patients. Universities, laboratories, and teaching hospitals are where students develop clinical judgment, technical competence, and professional relationships. Their loss interrupts classroom instruction and supervised practice at the same time. Daher-Nashif argues that the collapse of public health capacity must be understood in relation to the institutions on which recovery will depend (18). McGahern’s analysis of Palestinian higher education describes universities as “spaces of hope,” suggesting that attacks on educational institutions damage social continuity and the capacity to imagine a future as well as physical campuses (19).
Remote instruction can preserve contact between students and faculty, but this is difficult due to limited internet access and the destruction of electrical infrastructure. Furthermore, remote instruction cannot replace anatomy laboratories, simulation equipment, or bedside teaching. The deaths and displacement of faculty and students further weaken the training pipeline. Gaza consequently faces a double loss: experienced professionals are being removed from practice while the institutions that would prepare replacements are also being dismantled. Temporary foreign medical teams may relieve a portion of the immediate workload, but they only stay for a limited period of time and cannot substitute for locally rooted schools, teaching hospitals, and senior clinicians who sustain training over many years. The majority of the workload is still being carried by local people and organizations.
Malnutrition and Public Health Collapse
Malnutrition is both a consequence of the humanitarian crisis and a cause of further illness. Displacement, restricted food entry, loss of livelihoods, unsafe water, and repeated evacuation reduce both the quantity and quality of available food. OCHA documented widespread food insecurity alongside displacement and inadequate access to essential services (20). UNICEF reported increasing acute malnutrition among children during 2025 and severe risks for pregnant and breastfeeding women (13). These conditions heighten susceptibility to infection, impair wound healing, complicate pregnancy, and reduce a child’s ability to recover from disease. They also increase demand for clinical and nutritional services at the moment those services are least available.
The consequences are not limited to acute wasting. Rabayaa and Rabaya identify impaired physical growth, neurodevelopmental harm, later chronic disease, and intergenerational effects among the possible long-term outcomes of childhood malnutrition (21). The disruption of primary care and nutrition programs makes early identification and treatment more difficult, particularly for displaced families moving between shelters. Malnutrition should therefore not be treated as a separate humanitarian indicator. It alters the course of infectious disease, trauma recovery, pregnancy, and childhood development, linking food insecurity directly to the broader collapse of public health.
Discussion: The Systematic Nature of Healthcare Collapse
Taken together, the findings support an assessment of systemic healthcare collapse. A health system becomes systemically disabled when failures in one part of care repeatedly undermine the others. In Gaza, hospital damage has reduced specialist and inpatient capacity, while the breakdown of primary care has increased the number of patients reaching hospitals with advanced or preventable illness. Restrictions on transport and evacuation have made referral less reliable. Workforce depletion has narrowed the services that surviving facilities can provide, and the destruction of medical education has weakened the means by which that workforce could eventually be replenished. Malnutrition, infectious disease, and displacement increase demand even as the capacity to meet it declines. The result is a self-reinforcing process rather than a set of independent shortages.
The distinction between physical presence and functional capacity is especially important. Operational reporting may list a hospital as open even when only a small number of departments are working, surgery is restricted, medicines are unavailable, or staff cannot safely reach the facility. WHO has documented repeated cycles in which hospitals were partially rehabilitated or resupplied and then faced renewed attacks, evacuation pressure, or supply interruption by the IDF (2,5). MSF accounts show how quickly a service can become unsafe when basic items such as analgesics, gauze, or sterile equipment run out (8,9). Hamamra and colleagues likewise emphasize that the loss of diagnostic technologies and specialized referral networks cannot be captured by a count of damaged structures alone (6). Functional collapse is therefore a question of what care can be delivered, to whom, and with what prospect of continuity.
A second feature of the collapse is its temporal reach. Some consequences are immediately visible in trauma wards, but others appear through missed vaccination, interrupted cancer treatment, uncontrolled hypertension or diabetes, unsafe pregnancy, and prolonged malnutrition. Khatib and colleagues warn that conflict mortality is difficult to measure precisely because indirect deaths may occur outside hospitals or long after the event that placed a patient at risk (1). The same temporal problem applies to education and workforce capacity. A destroyed laboratory or the death of a senior specialist may not produce a single countable health outcome on the day it occurs, yet the loss shapes diagnosis, treatment, and training for years. Rabayaa and Rabaya’s analysis of childhood malnutrition and McGahern’s work on higher education both point to harms that may persist across the life course and, in some cases, across generations (19,21).
The healthcare workforce sits at the center of these interactions. Buildings and equipment matter because trained people know how to use them, maintain services, and adapt under pressure. The interviews show that many clinicians continued working despite displacement, low pay, personal danger, and profound fatigue. That commitment should not be interpreted as evidence that the system remains resilient enough to absorb further loss. Rather, it indicates that a shrinking number of professionals are carrying responsibilities that would ordinarily be distributed across a much larger network. Shahvisi’s analysis is useful in this regard because it locates bedside scarcity within the political and material conditions that produce it (15). The moral burden placed on clinicians is not only the distress of treating severe injuries. It is also the requirement to decide which patients will receive scarce resources when ordinary standards of care have become impossible.
The documented pattern also raises serious questions under international humanitarian law. Medical units, healthcare personnel, ambulances, patients, and wounded persons receive specific protection, yet the consistent and repeated killing and destruction of these individuals and facilities indicates a pervasive lack of consideration for international humanitarian law by IDF operations in Gaza. Reports of damaged facilities, killed responders, obstructed supplies, and blocked medical evacuation warrant independent investigation and accountability (16,17). The ethical issue identified by Shahvisi follows from this point: when scarcity results from destruction and restriction, triage cannot be treated as if it arose naturally within an otherwise functioning healthcare system (15).
The evidence base remains constrained by the conditions it seeks to describe. Access restrictions, destroyed medical records, repeated displacement, and the deaths of patients and data collectors make precise measurement difficult. In active conflict, uncertainty may itself conceal harm, particularly when deaths occur outside facilities or when interrupted treatment produces outcomes that are not recorded as conflict-related (1). The consistency among peer-reviewed scholarship, institutional reporting, operational accounts, and the interviews presented here supports the conclusion that the loss of healthcare capacity extends across nearly every domain required for effective care.
The implications for reconstruction are substantial. Reopening individual facilities will have limited effect if they remain disconnected from electricity, clean water, laboratories, supply chains, ambulance networks, and a stable workforce. Al Bakri and colleagues and Prost and colleagues both frame recovery as a public health and institutional task rather than a narrow construction project (3,10). The interview testimony makes the same point from within Gaza: participants described universities, hospitals, and professional communities as institutions whose value lies in accumulated knowledge and relationships, not only in their buildings. External assistance will be necessary, but durable recovery will depend on whether Palestinian institutions can retain authority, rebuild training pathways, and develop services that remain after temporary international teams depart.
Conclusion
Gaza’s healthcare crisis is best understood as the deliberate erosion of an interconnected system by the IDF rather than simply the destruction of a collection of facilities. Hospitals have lost buildings, equipment, power, supplies, and specialist services. Primary care has been unable to sustain vaccination, chronic disease management, maternal care, and early treatment of infection. Ambulance access and medical evacuation have been repeatedly constrained, while the workforce has been reduced and placed under extraordinary physical and moral strain. At the same time, malnutrition and communicable disease have increased the number of people requiring care. Each failure places additional pressure on the others, which is why limited repairs to one part of the system have not restored overall functionality.
The consequences unfold on more than one timescale. In the immediate term, patients face preventable death from trauma, infection, untreated chronic illness, unsafe childbirth, and delayed emergency care. Over a longer period, the loss of clinicians, educators, students, laboratories, and teaching hospitals will shape who is available to provide care and what forms of treatment can be offered. The interviews give this institutional loss a human form. They describe interrupted chemotherapy, exhausted nurses, surgeons working through repeated mass-casualty events, students attempting to study from tents, and faculty members watching years of educational investment disappear. Their accounts also show that continued work and study should not be mistaken for normal function. Persistence under extreme conditions is evidence of professional and social commitment, but it cannot replace the resources and protections on which a health system depends.
The central implication is that healthcare protection and healthcare recovery cannot be separated. Continued damage, insecurity, supply restriction, and barriers to movement will undermine reconstruction even where buildings are repaired. Conversely, rebuilding will remain incomplete if it restores acute hospital care while neglecting primary care, public health surveillance, nutrition, emergency transport, mental health, and medical education. The evidence reviewed in this paper also supports sustained scrutiny of compliance with the protections afforded to healthcare during armed conflict. Independent investigation and accountability are necessary not only because of individual incidents, but because the cumulative loss of care has consequences for an entire population. An ongoing siege and blockade on Gaza by the State of Israel severely limits the capacity for restoration of Gaza’s healthcare system. Any durable recovery will depend on preserving and restoring Gaza’s local clinical, educational, and public health institutions so that the system can again provide continuous care rather than episodic emergency relief.
Works Cited
-
Khatib, Rasha, et al. “Counting the Dead in Gaza: Difficult but Essential.” Lancet, vol. 404, no. 10449, 10 July 2024, www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01169-3/fulltext, https://doi.org/10.1016/s0140-6736(24)01169-3.
-
World Health Organization, “Health System at Breaking Point as Hostilities Further Intensify in Gaza, WHO Warns.” World Health Organization, 22 May 2025, www.who.int/news/item/22-05-2025-health-system-at-breaking-point-as-hostilities-further-intesnify–who-warns.
-
Prost, Audrey, et al. “Gaza and the Collapse of Public Health: A Call for Action.” The Lancet, 2025, www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01690-3/fulltext.
-
OCHA, “Gaza Humanitarian Response Update | 28 September - 11 October 2025 | OCHA.” United Nations Office for the Coordination of Humanitarian Affairs, 15 Oct. 2025, www.unocha.org/publications/report/occupied-palestinian-territory/gaza-humanitarian-response-update-28-setpember-11-otober-2025.
-
World Health Organization, “Public Health Situation Analysis - Occupied Palestinian Territory - September.” World Health Organization, 10 Sept. 2025, https://www.who.int/publications/m/item/public-health-situation-analysis---occupied-palestinian-territory-September?
-
Hamamra, Bilal, et al. “The decimation of Gaza’s health care system - hospitals destroyed and lives endangered.” International Journal of Social Determinants of Health and Health Services, vol. 56, no. 1, 16 Sept. 2025, pp. 30-40, https://doi.org/10.1177/27551938251378096.
-
OHCHR, "Israel: Ban on 37 Aid Groups Makes Life Unbearable for Genocide Survivors in Palestine, Say UN Experts | OHCHR, www.ohchr.org/en/press-releases/2026/01/israel-ban-37-aid-groups-makes-life-unbearable-genocide-survivors-palestine.
-
Medicins Sans Frontieres, “MSF Health Facilities across Gaza Face Critical Shortage of Medical Supplies | MSF.” www.msf.org, 21 June 2024, www.msf.org/msf-health-facilities-across-gaza-face-critical-shortage-medical-supplies.
-
Mughaiseb, Mohammed Abu. “‘Medicine Is Being Strangled’: MSF Doctor on the Collapse of Gaza’s Health System.” Doctors Without Borders - USA, 13 Aug. 2025, www.doctorswithoutborders.org/latest/medicine-being-strangled-msf-doctor-collapse-gazas-health-system.
-
Al Bakri, Deema, et al. “The war on Gaza and its impact on public health: challenges and pathways to recovery.” Frontiers in Public Health, vol. 13, 13 Oct. 2025, https://doi.org/10.3389/fpubh.2025.1664850.
-
Souilla, Luc, et al. “The escalating health crisis in Gaza amidst armed conflict and Heatwaves.” Global Health Action, vol. 18, no. 1, 10 June 2025, https://doi.org/10.1080/16549716.2025.2513856.
-
United Nations Population Fund, “UNFPA Palestine Situation Report #11 - November 2024 (Covering Period: 01 September - 31 October 2024) - Question of Palestine.” United Nations, 4 Nov. 2024, www.un.org/unispal/document/unfpa-sitrep-01nov2024/.
-
UNICEF, “UNICEF Humanitarian Situation Report No. 42 (01 - 31 August 2025) - Question of Palestine” United Nations, 16 Sept. 2025, www.un.org/unispal/document/unicef-humanitarian-situation-report-no-42-01-31-august-2025/.
-
Elhaija, Ahmad, et al. “Analyzing the Capacity of the Healthcare System in Gaza to Address Gaza Residents Needs.” Journal of Healthcare Solutions, vol. 2, 2024, https://doi.org/10.58417/TTOG6828
-
Shahvisi, Arianne. “The ethical is political: Israel’s production of health scarcity in Gaza.” Journal of Medical Ethics, vol. 50, no. 5, May 2024, pp. 289-291, https://doi.org/10.1136/jme-2024-110064.
-
International Committee of the Red Cross, “Israel and the Occupied Territories: ICRC Appalled by Killing of PRCS Medics and First Responders.” International Committee of the Red Cross, 30 May 2025, www.icrc.org/en/news-release/israel-and-occupied-territories-icrc-appalled-killing-prcs-medics.
-
Physicians for Human Rights, “Gaza’s Healthcare Collapse: The Denial Of Medical Evacuations From Gaza.” Physicians for Human Rights, Jan. 2025, https://www.phr.org.il/wp-content/uploads/2025/03/6229_GazaHealth_Paper_Eng.pdf.
-
Daher-Nashif, Suhad. "Meducide - towards a new conceptual framework for the destruction of medical education in armed conflict." MedEdPublish, vol. 16, 18 June 2026, p. 23, https://doi.org/10.12688/mep.21604.1.
-
McGahern, Una. “Higher Education under siege: Attacking Spaces of Hope in Palestine.” Geopolitics, vol. 30, no. 2, 10 Sept. 2024, pp. 830-858, https://doi.org/10.1080/14650045.2024.2398240.
-
OCHA, "Humanitarian Situation Report: 18 September 2026." United Nations Office for the Coordination of Humanitarian Affairs - Occupied Palestinian Territory, www.ochaopt.org/content/humanitarian-situation-report-18-september-2026.
-
Rabayaa, Maha, and Doha Rabaya. “Starved Futures in the Gaza Strip: Long-term outcomes of childhood malnutrition as a humanitarian emergency.” BMJ Global Health, vol. 11, no. 1, Jan. 2026, https://doi.org/10.1136/bmjgh-2025-022254.
How to Cite: Naser, A., et al. "Analyzing the Collapse of the Healthcare System in Gaza." Journal of Healthcare Solutions, vol. 4, no. 1, 2026.