Israel’s attacks on the Gaza Strip since October 2023 have left its healthcare system in ruins, with nearly all hospitals partly or completely destroyed, along with much of their medical equipment.1 More than 1000 healthcare workers have been killed.2

A temporary ceasefire agreement between Hamas and Israel came into effect on 19 January, 470 days after Hamas’s 7 October 2023 attack on Israel, which resulted in around 1200 people being killed and more than 200, including children, being taken hostage. Over the next 16 months Israel has bombarded Gaza, raided hospitals, and carried out ground offensives across the strip. An estimated 47 000 Palestinians have been killed and 111 000 injured, and around 10 000 people are believed to be beneath rubble.3

The effects of the war go far beyond these numbers, says Mohammed Abu Mughaiseeb, deputy medical coordinator for Gaza for the charity Médecins Sans Frontières (MSF). “We don’t count the people who have died as a result of the lack of medical services. A lot of people who had cardiac problems died. A lot of people with renal failure died. A lot of people with cancer—children and adults—died because of a lack of treatment and services,” Mughaiseeb tells The BMJ from southern Gaza.

The British Palestinian consultant surgeon Ghassan Abu-Sittah, who was working in Gaza in October and November 2023, says the healthcare system has been “completely eviscerated” and the “magnitude of injury and illness has not been seen before.”