Gaza devastation extends far beyond those killed by Israeli bombs and air strikes, says MSF

International NGO Médecins Sans Frontières — Doctors Without Borders — has pointed out that six months into Israel’s war in Gaza, the devastation extends far beyond those killed by Israeli bombardments and air strikes.

“With a decimated healthcare system and inhumane living conditions, Palestinians in Rafah face increased risks of disease outbreaks, starvation and the long-term impact of psychological trauma,” explained MSF in its latest report, “Gaza’s Silent Killings: The destruction of the healthcare system and the struggle for survival in Rafah”.

The report describes the massive struggle faced by Palestinians in Gaza today to access medical care and warns of large numbers of preventable deaths caused by disruptions to critical healthcare. It also warns that a military incursion in Rafah, on top of the current humanitarian crisis in Gaza, would be an “unfathomable catastrophe” and calls for an “immediate and sustained ceasefire”.

Six months into the devastating war in Gaza, more than 34,000 Palestinians have been killed, 75,000 have been wounded, and an estimated 8,000 remain trapped under rubble. “The industrial-scale destruction of civilian infrastructure, compounded by a suffocating siege, has pushed the civilian population to the brink,” said the NGO. “In Rafah – described by Israeli authorities as ‘safe’ — military operations are ongoing and the basic conditions for survival of the civilian population are absent.”

Through its humanitarian and medical response, MSF has witnessed first-hand the human cost wrought by the destruction of Gaza’s healthcare system.

On top of this casualty toll caused by the bombardments must be added what the NGO called the “silent killings”, individuals who have succumbed to conditions that are entirely preventable or had their health care disrupted due to the conflict.

“How many children have already died of pneumonia in overwhelmed hospitals?” asked Mari-Carmen Viñoles, head of MSF’s emergency programmes. “How many babies have died because of preventable diseases? How many patients suffering from diabetes are left untreated? What about the deadly consequences of the closure of kidney dialysis units in attacked hospitals? These are the silent killings of Gaza not reported in all this chaos, caused by the collapse of the healthcare system across Gaza.”

The MSF report points out that conditions for survival are not in place in Rafah, and dire living conditions are contributing to worsening health conditions of the population. There is a desperate shortage of clean water for drinking or bathing, while rubbish and raw sewage accumulate in the streets in this tiny wedge of land now hosting more than one million people who were forcibly displaced from the north of Gaza. “As a result of the siege on Gaza, acute malnutrition is emerging. The mental health of the population is in tatters, and people are at risk due to the looming threat of disease outbreaks in Rafah.”

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Humanitarian aid as a means to support this devastated healthcare system has been extremely challenging due to the insecurity in Gaza, said MSF. The NGO and other actors have faced substantial blockages in taking aid into Gaza.

In Rafah, more than one million internally displaced Gazans are living under the threat of disease outbreaks, starvation and psychological trauma. As this catastrophe unfolds, says the report, the collective capacity of aid organisations to launch the full-scale response required to save lives is severely constrained by the ongoing insecurity and by restrictions imposed by the Israeli authorities on the entry of humanitarian aid into Gaza. While MSF’s medical response in Rafah is a “drop in the ocean” compared with people’s needs, even this limited support is now under threat with the Israeli confirmation of an imminent military invasion of Rafah.

“A military incursion on top of the current horrific humanitarian crisis in Rafah would be an unfathomable catastrophe,” concluded MSF. “Without an immediate and sustained ceasefire, and the entrance of meaningful humanitarian assistance, we will continue to see more people die.”

Across just two of the primary healthcare centres run by MSF in the Al-Shaboura and Al-Mawasi areas, the NGO’s medical teams are providing an average of 5,000 consultations every week, many linked to people’s sub-standard living conditions. Over 40 per cent of these consultations are for patients with upper respiratory tract infections. MSF has seen an increasing number of suspected cases of hepatitis A. In the last three months of 2023, cases of diarrhoeal illnesses reported among children under five were 25 times higher than during the same period in 2022. Between January and March 2024, teams treated 216 children under five for moderate or severe acute malnutrition, a condition which was almost entirely absent prior to the ongoing conflict.

With hospitals overwhelmed with trauma patients, people with other types of medical needs, such as pregnant women with complications and people living with chronic diseases, are often unable to receive the care they require. In Emirati Hospital, where MSF is supporting the postpartum department, medical teams struggle to deal with close to 100 deliveries a day, five times more than before the war. In MSF’s clinics, consultations for hypertension, diabetes, asthma, epilepsy and cancers have been increasing as patients seek monitoring and medication. However, if their condition worsens and they require specialised medication or equipment, which are increasingly difficult to obtain in Gaza, little can be done for them. Many medical referrals in Gaza today are delayed or are simply not possible.

For MSF, trying to support Gaza’s devastated healthcare system has been extremely challenging due to the insecurity. MSF has also faced substantial challenges bringing medical supplies and humanitarian aid into Gaza due to delays and restrictions by Israeli authorities, which are described in detail in the report’s annex.

“As an international emergency medical organisation, we have the expertise and the means to do much more and scale up our response,” said Sylvain Groulx, MSF emergency coordinator. “Palestinian medical staff are highly skilled and only need to be given the means to work in acceptable and dignified conditions to treat and save lives. But today all this remains absurdly impossible.”

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