Hospitals and clinics lie in ruins, while millions of tons of debris are tainted with hazardous materials, unexploded ordnance, and human remains. The injuries sustained by tens of thousands of individuals will require ongoing, long-term medical care. As residents of Gaza start to navigate through the remnants of their neighborhoods, they are confronted with additional threats on top of serious health challenges. Over the span of fifteen months of conflict, more than 47,000 people have died, as reported by local health officials. An alarming 90% of the population has been displaced, and many regions are reduced to mere rubble. Access to clean water is minimal, and essential sanitation systems are heavily damaged, raising fears of an outbreak of infectious diseases.
Aid organizations are hastily mobilizing to provide food and basic supplies amid a fragile ceasefire between Hamas and Israel while strategizing for what lies ahead. “You have a population grappling with an exhaustive range of health needs … who have been without access to care for more than a year,” said Yara Asi, an authority in global health management and a visiting scholar at Harvard’s FXB Center for Health and Human Rights. “What will that mean in both the short-term and long-term?”
The healthcare system in Gaza has suffered catastrophic damage. According to the World Health Organization, nearly all 36 hospitals in the region have been impacted by aerial strikes, with only around half still functioning at a minimal capacity. Close to two-thirds of health clinics are non-operational, making it unfeasible to provide adequate urgent and long-term care for the many in need, including an estimated 30,000 individuals requiring continuous rehabilitation for severe injuries, such as amputations.
The WHO has stated that once conditions allow, it will collaborate with various organizations to prioritize essential services such as trauma and emergency assistance, primary healthcare, and mental health support. Efforts will include augmenting hospital-bed capacity in both northern and southern Gaza and deploying prefabricated containers to facilitate patient care in the damaged healthcare settings. International personnel will also be essential to alleviate staffing deficiencies, according to the organization.
Experts, including Asi, emphasize that much of the hospital equipment has been destroyed and will be costly and logistically challenging to replace. “How can Palestinians import the sophisticated, costly medical devices that turn a hospital from being just a building into a functioning facility?” Asi pondered. “Rebuilding that infrastructure will take years.”
Israel asserts that Hamas bears responsibility for the devastation of the healthcare system, claiming that the group utilized hospitals as bases for military activities. During the ongoing six-week ceasefire, Israel has permitted a significant increase in humanitarian aid. However, a permanent cessation of hostilities has not been established, and no detailed plans for reconstruction and recovery have been presented by Israeli authorities.
The scope of injuries sustained during the conflict is staggering, with the WHO estimating that a quarter of the roughly 110,000 injured individuals have “life-changing” conditions. Over 12,000 of those require urgent evacuation for advanced medical treatment. Among the victims are a number of children who require prosthetic limbs and long-term medical attention, according to Marc Sinclair, a pediatric orthopedic surgeon from Dubai, who has been volunteering in Gaza for many years.
Sinclair’s charity, the Little Wings Foundation, is set to collaborate with the Palestinian Children’s Relief Fund and a German prosthetics firm to facilitate workshops designed to train doctors and produce prosthetics in the West Bank, with plans to shift operations to Gaza when feasible. “The sheer number of casualties is overwhelming, and the need is immense,” he stated. “We’re dealing with children who have not just single amputations but multiple ones.”
Yara Asi added that countless individuals have suffered traumatic injuries, including brain damage, necessitating lifelong care. “Additionally, you have many who are dealing with chronic health issues,” she mentioned. “They’ve gone without care or medications for over a year in some cases.”
The risk of infectious diseases is heightened due to a lack of clean water, malfunctioning sanitation facilities, overcrowding, and missing vaccinations for children. Asi, co-director of the Palestine Program for Health and Human Rights, expressed concern for children who have experienced malnutrition and psychological distress. The region has even seen a polio outbreak for the first time in decades, underscoring the risks facing both children and adults from various infectious diseases, she warned.
Living conditions are dire; descriptions of overcrowding, lack of hygiene supplies, and rubbish and sewage in the streets illustrate the extent of the crisis. “It’s truly a health disaster from every conceivable angle,” she lamented, noting outbreaks of respiratory infections in camps and shelters, along with many individuals suffering from unidentified skin conditions and wounds.
Experts caution that Palestinians retaking their homes in Gaza may encounter hazardous dust or debris laced with toxic chemicals, asbestos, and undetonated munitions. Recently, tens of thousands began returning to northern Gaza as part of the ceasefire, discovering only piles of rubble in place of their residences.
Prompt action is crucial to identify and manage environmental threats to prevent residents from inadvertently engaging with harmful substances, warned a representative from the United Nations Environment Programme. The agency aims to commence assessments in the next two to three months, contingent on safety conditions.
Initial efforts should prioritize specialized teams to locate and clear unexploded ordnance, as well as to test air, water, and soil for toxic materials, suggested Paul Walker, chair of the Chemical Weapons Convention Coalition. “There’s understandable urgency to rebuild,” he indicated, but returning home could pose significant dangers, adding, “As residents sift through the wreckage, we should anticipate injuries and possibly fatalities.”
However, influencing people to defer their return may prove difficult, Asi noted. She has witnessed videos depicting lines of individuals eager to return, often mindful that little remains except the need to reclaim their land and recover the bodies of lost family members or ascertain the fate of their homes.
