In the last seven months the healthcare system in the Gaza Strip has been systematically dismantled. According to OCHA[1], 24 hospitals in Gaza are now out of service, while 493 health workers have been killed. Each medical centre or humanitarian delivery system has been or is being destroyed, to be replaced by less effective, improvised options. There is no telling what the indirect human cost in deaths and long-term injuries will be as a result of aid and treatment having been denied. Staff and patients from Médecins Sans Frontières (MSF) have had to leave 12 different health structures and have endured 26 violent incidents (3.7 per month on average), which includes airstrikes damaging hospitals, tanks being fired at agreed deconflicted shelters, ground offensives into medical centres, and convoys fired upon. MSF has yet to receive accountability or any admission of responsibility for the killings, maiming, or the dehumanisation of our staff and patients.
While the past seven months have been devastating for communities in the Gaza Strip, the West Bank, and in Israel, from a medical humanitarian perspective, the violence faced by Palestinians in Gaza and the West Bank far pre-date 7 October. It is important to recall that there was already a humanitarian crisis in the Gaza strip, caused by Israel’s 16-year blockade of the enclave.
On 6 October 2023, MSF was running medical humanitarian activities in the Occupied Palestinian Territories, specifically in Hebron, Jenin, Nablus, Masafer Yatta, and the Gaza Strip. On that day, our colleagues were tending to patients in Gaza wounded by so-called butterfly bullets, fired by Israeli snipers at people as they protested in the days and weeks prior to the war that engulfed the region on 7 October. We were also treating 87 patients for long-term injuries (down from an original patient cohort of almost 900), sustained in the Great March of Return escalation in 2018 and 2019.
MSF medical staff were also continuing to treat patients wounded in the war of 2021, sparked by the seizure and settlement of property in Sheikh Jarrah, East Jerusalem, and resulting in the gravest escalation since 2014 with thousands of Palestinians displaced, massive levels of destruction, and hundreds killed.
The attacks of 7 October and the collective punishment that followed represent a paradigm shift in the way MSF has been able to operate in the Occupied Palestinian Territories. Without operations in Israel, the first thing our colleagues witnessed on 7 October were Israeli airstrikes in Gaza, immediately following Hamas attacks estimated to have killed some 1,200 people with the taking of 253 hostages. On 8 October, MSF offered support to the Israeli Ministry of Health, which ultimately was not accepted.
For MSF colleagues in Gaza who had been running projects focused on orthopaedic and reconstructive surgery, physiotherapy, burn care, psychological healthcare, and research and treatment for antimicrobial resistance in Gaza, it was not immediately clear what would become of our patients, how we could ensure their continuity of care, or what we would be able to do for those wounded in this new escalation.
However, what did become clear was that the increasing disrespect and disregard of medical humanitarian action and the destruction of health facilities and staff shelters, along with the killing of colleagues and patients, made it nearly impossible for MSF to negotiate the protection we usually seek in conflict settings.
The location of MSF or MSF-supported supported medical facilities, shelters and movements that have been hit or attacked had been communicated to the main parties to the conflict in Gaza prior to their attacks. Yet, these facilities and movements have not been respected nor protected, and many civilians have been killed and injured.
What follows is a timeline of attacks on MSF or MSF-supported medical facilities and medical practitioners in the Occupied Palestinian Territories since 7 October. It is important to note that where responsibility for these attacks is now verified, they have been attributed; however, often we are unable to say with certainty where attacks come from.
At the time of writing, Israeli forces have begun their offensive on Rafah, southern Gaza Strip, and on parts of the north of the enclave, and issued several evacuation orders. The offensive and the evacuation orders further reduce access to healthcare in an already decimated health system, leaving people almost no options for even basic medical care. Between 6 and 12 May, MSF had to suspend our activities at Al-Shaboura clinic, handed over our activities at Al-Emirati hospital, and was forced to close our activities in Rafah Indonesian Field hospital as we could not guarantee the security and safety of patients and our staff with the ongoing offensive.
In view of this extensive timeline of reprehensible actions, MSF once again calls on all parties to respect and protect healthcare facilities, healthcare workers and patients in Gaza and the West Bank. An immediate and sustained ceasefire must be implemented in Gaza now to put an end to the suffering of people and destruction of Gaza. We demand an immediate and unfettered flow of aid into the entirety of the Gaza Strip. We demand accountability for our colleagues and their family members who have been killed and wounded, and for patients.
Sources:
[1] The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) is a body established by the General Assembly to strengthen the international response to complex emergencies and natural disasters.
