Introduction by Croakey: Last week, Croakey reported on health professionals who shared their traumatic experiences of working in Gaza. They described heartbreaking scenes, the enormous emotional toll on healthcare workers, and the daily struggle with death.
In this piece, originally published in The Conversation, Associate Professor Tania King, Distinguished Professorial Fellow Fiona Stanley, Dr Guy Gillor, Professor Rob Moodie, and Dr Tilman Ruff emphasise the critical need to protect healthcare workers in Gaza.
Tania King, Fiona Stanley, Guy Gillor, Rob Moodie, and Tilman Ruff write:
A freeze on aid entering the Gaza Strip, imposed by Israel last week, means once again tons of urgent medical supplies and medicines are stuck at the border, with delivery uncertain.
But supplies are only one part of the picture, and their usefulness is limited without trained healthcare workers who know how to treat and care for patients.
Healthcare workers are the most critical component of any health system. Despite being protected under international law, they have been killed and injured at alarming rates in Gaza since October 7 2023.
There is also growing evidence of inhumane treatment and abuse of healthcare workers in Israeli detention. This has serious implications for the health of Palestinians, in both the short and long term.
What is the state of the healthcare system?
The health system in the Gaza Strip is in ruins. The Israeli Defence force has carried out at least 670 attacks on health services and facilities since 7 October 2023.
The most recent World Health Organization update in February reported only 50 percent of hospitals were partially functional, and 41 percent of primary healthcare facilities (for example, general practice clinics and pharmacies) were functional.
The latest report by the United Nations Relief and Works Agency for Palestine indicates only four out of the 22 health centres it runs are operational.
This widespread and systematic destruction of health infrastructure and equipment puts health professionals and their patients in immediate danger. Shortages of medical supplies and lack of reliable electricity and water make it harder for healthcare workers to provide care.
What about healthcare workers?
More than 1,000 healthcare workers – including nurses, surgeons and other clinicians, paramedics, pharmacists and technicians – have been killed in Palestinian territories in the last 17 months, according to estimates by the United Nations and Palestinian monitoring group Healthcare Workers Watch.
In September last year, a UN inquiry found Israeli security forces have deliberately killed, wounded, arrested, detained, mistreated and tortured medical personnel and targeted medical vehicles.
The latest report from Healthcare Workers Watch documents 384 cases of unlawful detention of healthcare workers in Palestine since the current war began, 339 of them from Gaza.
Of these, 96 have provided testimonies of inhumane treatment. At least 185 are known to remain in detention and 24 are missing after hospital invasions.
Physicians for Human Rights Israel and The Guardian have also documented testimonies of medical personnel released from Israeli detention. Many say they were detained while carrying out medical duties.
They report being subjected to interrogations without legal representation, medical neglect and starvation, abuse and torture.
One senior consultant surgeon, Dr Issam Abu Ajwa, told journalists from The Guardian and Arab Reporters for Investigative Journalism he was arrested while performing surgery and then detained for months without charge.
He alleges prison guards were given instructions to deliberately damage his hands: “They said they wanted to make sure I could never return to work”.
The Israeli Defence Forces (IDF) did not respond to the individual allegations but told The Guardian “suspects of terrorist activities” have been arrested and detained during fighting in the Gaza Strip. In a statement, the IDF said: “Those who are not involved in terrorist activity are released back to the Gaza Strip as soon as possible”.
The UN High Commissioner for Human Rights Volker Türk has said Israel’s claims hospitals are being used for military purposes are vague, unsubstantiated and “in some cases, they appear to be contradicted by publicly available information”.
What does this mean for people in Gaza?
Before 7 October, Gaza’s health system was already unable to meet the needs of its population. The escalation of those needs due to the bombardment and reduced sanitation in a shattered health system is catastrophic.
Losing healthcare workers – whether they are killed, injured or incarcerated – further depletes an overburdened system. As a result, ordinary people have reduced access to skilled and qualified personnel. And so do junior medical staff, meaning they miss out on opportunities to learn from the experience of senior staff.
All residents of Gaza, including healthcare workers and their families, face serious threats to their health. A lack of adequate sanitation, nutritious food and safe water compounds other issues, such as increased risk of respiratory and diarrhoeal diseases, as well as complications during pregnancy and birth.
The UN estimates 50,000 women are currently pregnant in the Gaza Strip, with about 5,500 due to give birth in the next month. About 1,400 of these will require a caesarean section.
What about the long term?
Israel’s freeze on humanitarian aid, and the threat of resuming aerial bombardments, makes the planning and delivery of health services increasingly difficult.
In a population of 2.1 million there are large unmet needs from pre-existing conditions. The UN estimates 45,000 people in Gaza have heart disease, 650,000 have high blood pressure, more than 2,000 are diagnosed with cancer each year and more than 485,000 have mental illnesses.
Many more diseases will emerge in the aftermath of war. We have already seen a resurgence of polio in Gaza.
Without enough health staff, there is reduced capacity for public health surveillance and control – for example, routine screening services and immunisation programs – and this increases the risk of disease outbreaks.
Health workers also play a vital role in training the next generation of health professionals. Disrupting this chain makes it harder to rebuild the health workforce and the health system more generally.
The impacts of war can’t simply be calculated in terms of fatalities, injuries and damaged healthcare centres or facilities.
What’s also damaged is a shared commitment to humanitarian principles and the respect for human rights and international law.
Previously at Croakey
- Stories from the frontlines of Gaza’s devastated healthcare services
- Doctors call for greater pressure on Israel over Gaza
- Calls to stop the siege of Gaza, halt the arms supply, and end the health sector’s silence
- Gaza medical staff working under ‘profound psychological strain’ as further threats loom
- World medical leaders call for Gaza ceasefire amid mass graves horror
- New publication documents the terrible toll on women in Gaza
- “Silence becomes complicity”: MPs and other health professionals urged to take stand on Gaza
- “The question is no longer whether Palestinians will starve to death in a famine, but how many will do so”
- World leaders put on notice over Gaza, amid “war on children”
- As children starve to death in Gaza, health and medical academics urge colleagues to speak up
- Australian academics call on their universities to demand ceasefire, amid fears about famine, disease and scholasticide in Gaza
- “To those speaking out for the people of Gaza – thank you for not looking the other way”: Dr Sophie Scamps
- As Australia and other countries put pressure on Israel, health and medical organisations describe horrific conditions in Gaza
- As humanitarian nightmare escalates in Gaza, and the world enters “an age of chaos”, we must work harder for peace
- As global leaders and aid groups speak up about “catastrophic crisis” in Gaza, health professionals are under pressure to remain silent
- Health workers and agencies document the war’s wide-ranging impacts on people in Gaza
- From Gaza: finding words for the unimaginable
- Health leaders join growing calls for permanent ceasefire in Gaza and Israel
- As the people in Gaza experience a “living hell”, medical and humanitarian leaders step up pressure for a permanent ceasefire
- This doctor is urging medical leadership on ceasefire in Gaza and Israel, as United Nations warns of threat to global security
- Amid catastrophic health threats in Gaza, health leaders urge a permanent ceasefire
- Amid ongoing health catastrophe in Gaza, why the silence?
- As Gaza hospitals become “scenes of death, devastation, and despair”, global community urged to act for peace
- Doctors who work with refugees urge medical organisations to speak up for a ceasefire in Gaza
- “Worse every day”: toll mounts in Gaza, including for children and health workers
- “This cannot go on” – a cry for an end to intolerable suffering
- Medical organisation publishes open letter expressing “extreme concern” at Australia’s failure to support ceasefire in Gaza
- Health sector urged to speak out for ceasefire in Gaza
- Calls for ceasefire amid catastrophe in Gaza – “every child everywhere deserves peace”
