Israel’s War Destroyed Gaza’s Health Care System

The war unfolding in the Gaza Strip since the Hamas attack on 7 October 2023 has subjected its 2 million residents to a level of destruction unprecedented in the region’s history. Whether homes, hospitals, or schools, nothing has been spared by Israel’s near-continuous bombings, with the UN estimating that over 60 percent of all homes are damaged or destroyed, along with 84 percent of health facilities.

Few know the extent of the damage to Gaza’s health facilities better than Dr. Ghassan Abu-Sittah, a London-based, British–Palestinian reconstructive cosmetic surgeon who entered Gaza on 9 October through the Rafah crossing before it was shut down, and spent 43 days there, experiencing the human costs of the war first-hand.

Dr. Abu-Sittah made headlines earlier this month when he was banned from entering Germany to participate in the Palestine Conference in Berlin, a pro-Palestinian gathering that faced an extraordinary police presence and was ultimately shut down two hours after it began. Prior to the ban, he spoke with Sari Harb of the Rosa Luxemburg Foundation’s Ramallah Office about his experiences in Gaza and what the people there need to rebuild.

Dr. Abu-Sittah, you arrived in Gaza on 9 October, after the fighting had already begun. How did you manage to get in?

It was on Monday, 9 October. I was waiting in front of the Rafah border crossing at 8:00 in the morning, an hour in advance. When it opened at 9:00, I went in, and it was obvious that the crossing was empty. The usually prolonged process took very little time.

The decision, as was the case in 2014, was that I would be staying at my uncle’s house, which is about a 10-to-15-minute walk from al-Shifa Hospital in the Rimal district of Gaza City. I took a cab from Rafah to my uncle’s house. Within half an hour of getting there, I realized that the entire neighborhood was evacuating. The streets were full of families with their children, luggage, and mattresses. They were running away. The Israeli army had phoned people and told them to evacuate their homes, as they would be targeting Rimal.

I decided not to go my uncle’s house. Instead, I went to my cousin’s house, which is closer to the hospital. When I arrived there, the intense bombing started. Every couple of minutes, the house was shaking from the bombs. By that night, there were 350 air raids on Gaza City. I was trapped in the house until early Tuesday.

On Tuesday morning, there was a lull in the bombing, and I thought it would be a good time for me to try to get back to my uncle’s house, grab my belongings, and go to al-Shifa Hospital. I decided to walk there. It was at that time that I realized the intensity of what had been happening. Entire streets had been completely demolished. There were craters as large as 15 meters in the street. I had never seen such destruction, let alone in one night.

The amount of damage was excruciating. After walking around the different craters in the streets, I got to my uncle’s house. It was very badly damaged. I managed to find my suitcase under the rubble, and went to al-Shifa Hospital by foot. I got to al-Shifa in the morning, on 10 October.

Looking back six months later, what was the situation at the hospital like in October?

It was obvious that the hospital was under a lot of pressure. Ambulances were coming every minute, each had four or five wounded. The hospital was completely overrun. I joined the hospital’s burn unit, which is where the plastic surgery department is. The Gaza Strip has, at most, 2,500 hospital beds. By the middle of the second week of the war alone, there were 6,500 wounded. So, you can imagine the speed with which the beds were completely overwhelmed.

In the 43 days, starting from the day I walked into al-Shifa and up to the day I left, I lived inside hospitals.

Injured people were being put on mattresses in the emergency room, left on the floors of the corridors and in waiting rooms. Eventually, there were mattresses outside of the hospital buildings where the wounded were kept. The Health Ministry set up these big marquee tents, which were also turned into wards.

A second Israeli raid against the hospital ended in its total destruction on 1 April. What impact will that have on Gaza?

The al-Shifa Hospital constituted 30 percent of the capacity of the health system in the Gaza Strip. By destroying it to this extent, the Israelis have made it irreparable, so a new hospital now needs to be built. This ensures that Gaza does not have a functioning health system and becomes uninhabitable.

You left Gaza after 43 days of war. Why?

I was moving from hospital to hospital, where I was needed. On day 40, I had to move from the north to the south because we had run out of medication in al-Ahli Arab Hospital in Gaza, and we were no longer able to operate. In the south, I stayed at the Nuseirat refugee camp’s al-Awda Hospital, where I was just helping in the emergency room changing dressings. I quickly realized that the system in the south was paralyzed by the lack of fuel and medication. There was no capacity for it to function. The problem was not the lack of doctors and surgeons, but there was no capacity in the system. That was the reason I left.

How did you manage your daily life as a doctor during wartime?

In the 43 days, starting from the day I walked into al-Shifa and up to the day I left, I lived inside hospitals — moving between them and an ambulance. At al-Shifa Hospital, I woke up at 6:00 in the morning, went to discuss the patients with other doctors and staff, and made a list of the operations that needed to be done. I would start operating and continue until 1:00 that morning, stopping only to have something to eat. Sometimes, I would sleep on one of the mattresses on a stretcher. There were times when three or four days would pass without me even leaving the operating room.

Can you elaborate on the reports of famine in Gaza, especially in Northern Gaza?

If we think historically, famine was always an integral part of the machinery of genocide, from the Irish famine to the Indian famine to the African famine. Israel has not really invented anything new by using it.

A complete ecology of war was created in Gaza, and that ecology will shape people’s health for decades to come.

The only solution is to allow aid in unimpeded. On 18 March, we saw the Israelis attack Palestinian policemen who were trying to organize the distribution of the little aid that came into northern Gaza, in order to ensure that there was chaos, and that if aid did come in, it would be completely disrupted by looting or disorganization. It has become obvious that the Israelis want to use famine as a weapon in their genocidal war, much as they used infectious diseases by destroying the infrastructure — water supplies, clinics, and basic hygiene — necessary to prevent their spread.

You are back now in London. What are you doing after leaving?

Currently, there are 300 medical students from Gaza who were supposed to be graduating in June 2024, and of course, they have lost that chance. Therefore, I have been working to find placements in medical schools for the 300 final-year medical students. It is so important to save the careers of 300 doctors. I have been traveling in the region, trying to speak to medical schools to find placements for them to spend their last year abroad, so that they will be able to graduate.

I am also working on a project that aims to get some of the wounded children out to Lebanon for treatment, to the American University in Beirut, because there is a lot of experience in war surgery in Lebanon, and really, just trying to advocate for an end to the war and the genocide and attempting to get people to start thinking about how the health system in Gaza needs to be rebuilt.

What does Gaza need now to repair its healthcare infrastructure?

The war has completely destroyed the health system. The Israelis have killed 345 doctors and nurses. Of Gaza’s 36 hospitals, the only one left is the European hospital, while the Shuhada al-Aqsa Hospital in Deir al-Balah remains partially operational.

We need to rebuild the hospitals, and we need to retrain staff. Over 70,000 wounded have to be treated. There are also people who have not been receiving treatment for their chronic diseases, which therefore have progressed. People with high blood pressure or heart problems or diabetes have not been looked after for over six months.

Every aspect of health has been destroyed, beyond the health system itself. When you destroy the water and sewage treatment plants, as the Israelis did, you get an explosion of infectious diseases. When you starve people, particularly children, those who do not die of acute malnutrition will suffer from chronic malnutrition and health problems associated with chronic malnutrition.

So, what happened in Gaza? A complete ecology of war was created, and that ecology will shape people’s health for decades to come. The aim of rebuilding the health system is to try to dismantle that ecology of war.