The Israeli army has been relentless in its targeting of healthcare workers and infrastructure in Gaza. This is not a new strategy, and health has been previously documented as being used as a weapon against the occupied Palestinian population over years. While this is not a novel concept in modern day warfare either, we have not seen the tactic used on such a large scale to strangulate a population before.
The deliberate targeting of health infrastructure, manufactured scarcity of medical supplies and fuel, and restricted access to basic necessities are all different means through which the destruction of healthcare has been used as a weapon of war. With these actions, Israel seeks to amplify the scale of human losses inflicted upon civilians in the Gaza strip and push survivors into exodus.
Before October 2023, healthcare systems in Gaza were already teetering on the brink, with only 36 hospitals operating at full capacity and a total of 3,412 beds catering to a population exceeding two million. These data indicate a maximum ratio of 1.55 hospital beds per 1,000 individuals across the entire region. Patients requiring access to specialised treatment outside of Gaza have routinely been prevented from exiting. In 2021 alone, more than 36% of requests for medical permits have either been refused or left unanswered by Israeli authorities, condemning patients with urgent conditions to preventable deaths.
Six-year-old Palestinian Siwar Mahdi Ali and her father Mahdi Ali at the European Hospital in Khan Younis in the southern Gaza Strip on 26 February 2024. She was seriously injured when their family home was hit in an air strike on 10 October 2023. Her orthopaedic doctor has said she needs treatment abroad, but although her father has applied twice for a permit to leave Gaza with his daughter, he has been rejected due to Israeli restrictions that limit the age of Palestinians who can leave Gaza, even when accompanying a patient. (Photo: EPA-EFE / Haitham Imad)
A young patient is treated by nurse Zaki Shaheen Khader, who has worked to transform a supermarket into a medical point to treat displaced Palestinians in Rafah, southern Gaza, on 9 January 2024. (Photo: Ahmad Hasaballah / Getty Images)
In January 2024, the United Nations Office for the Coordination of Humanitarian Affairs released statistics related to the medical situation being faced in Gaza due to the unrelenting Israeli aggression:
- 337 healthcare workers have been killed;
- 145 UN staff have been killed;
- 14 of the 36 hospitals in Gaza are only partially functional, and they suffer from outages and major shortages of medical supplies;
- 26 of the 36 hospitals are damaged;
- 122 ambulances have been damaged; and
- 1.9 million Gaza residents are displaced.
The numbers are shocking, and the extent of damage is unfathomable, difficult to comprehend through numbers alone.
By November 2023, all hospitals in northern Gaza were completely out of service. It was at this point that we witnessed Israel leading armed invasions of hospitals, including the largest medical complex in the region, Al-Shifa, and the Indonesian Hospital, which at the time was the last remaining operational hospital in northern Gaza. This demonstrates a sustained and orchestrated commitment by Israel to the destruction and evacuation of healthcare facilities.
Despite claims by the Israeli army that armed Palestinian groups have used health facilities for military purposes, according to Human Rights Watch no evidence has yet been presented that provides legal justification for the loss of the protected status of hospitals and other health infrastructure, as codified by International Humanitarian Law.
A humanitarian Italian Air Force flight arrives at Rome’s Ciampino military airport from Cairo, Egypt, on 10 March 2024, with children, adults and companions from Gaza on board. The mission was co-organised by staff of the Crisis Unit in the Ministry of Foreign Affairs and International Cooperation for treatment in Italian hospitals. (Photo: EPA-EFE / Angelo Carconi)
Internally displaced Palestinians hold empty bowls as they line up to receive food aid provided by a Palestinian youth group in the Rafah refugee camp, southern Gaza Strip, on 7 March 2024. (Photo: EPA-EFE / Haitham Imad)
The Palestinian flag flies surrounded by the rubble of destroyed buildings following an Israeli military operation in Khan Younis in the southern Gaza Strip on 6 March 2024. (Photo:EPA-EFE / Mohammed Saber)
An extensive Washington Post investigation of the Israeli attacks and invasion of Al-Shifa Hospital found that the evidence provided by Israel does not demonstrate that the hospital was being used as a command and control centre, nor that the hospital building is connected to a larger tunnel network. Notably, the burden of proof remains with the attacker to provide adequate evidence that the protected status of a health facility has been lost, and “in case of doubt, there should be a presumption of civilian status”. If a health facility loses its protected status, the principles of proportionality, precaution and distinction still apply. Despite these succinct international laws, the destruction of the healthcare system has been the main thrust of the Israeli military strategy.
Read more in Daily Maverick: Israel-Palestine War
The repeated patterns of these attacks indicate that the damages inflicted on Gaza’s already precarious health system and the systematic murder of medical staff are part of a broader strategy to weaponise healthcare. Beyond overt destruction, Unicef released a report this week documenting the broader health-related impacts being suffered by the civilian Gaza population. These include:
- High levels of displacement and overcrowding in collective centres and scattered sites in the Gaza Strip continue, with extremely challenging hygiene and sanitation conditions. On average, 340 individuals share one toilet, and 1,290 share one shower;
- The babies of 5,500 women who are due to give birth in the next month in the Gaza Strip are at risk of dying, as their mothers do not have access to prenatal or postnatal check-ups because of bombings and need to flee to safety. Anxiety is also leading to premature births, as reported by the United Nations Population Fund; and
- More than 90% of children aged six to 23 months and pregnant, breastfeeding women face severe food poverty, with access to two or fewer food groups per day.
In addition to the above, withdrawal of fuel and power sources and the closure of all humanitarian corridors for the delivery of aid have created the perfect storm for the outbreak of multiple epidemics. Cases of scabies, lice, chickenpox, skin rash, hepatitis A and upper respiratory infections have been reportedly rising, in a context of disrupted vaccination campaigns and disease surveillance systems.
Demonstrators at a White Coat Rally outside Egypt’s embassy in Kuala Lumpur, Malaysia, on 16 November 2023 show solidarity with Gaza’s doctors after Israel launched a military ‘operation’ inside Al-Shifa Hospital on 15 November. (Photo: EPA-EFE / Fazry Ismail)
Displaced Palestinians in the Rafah refugee camp, near the border with Egypt in the southern Gaza Strip on 29 February 2024. According to the United Nations Relief and Works Agency for Palestine Refugees in the Near East, nearly 1.5 million people are in Rafah, more than six times the population before 7 October 2023. (Photo: EPA-EFE / Haitham Imad)
The weaponisation of health negates the right to exist and resist. It is a means of collectively punishing a population and discouraging or deterring any form of resistance, whether peaceful or violent. However, attacking a civilian population so disproportionately not only contradicts the basic tenets of international humanitarian law, but also perpetuates structural power imbalances borne out of the asymmetry seen between the coloniser and the colonised. By instilling fear and physical and psychological trauma, the weaponisation of health is instrumental in forcibly displacing Palestinians, by means of rendering Gaza inhabitable and hostile.
Any credible commitment to, and movement for, health justice must see both the ongoing and long-standing violence against healthcare workers and attacks against healthcare in this context as an extension of the systematic campaign of violence and oppression against the Palestinian people. As South African healthcare workers, we cannot allow Israel to continue to perpetuate this and must join the call by millions around the world demanding justice. DM
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“ The deliberate targeting of health infrastructure, manufactured scarcity of medical supplies and fuel, and restricted access to basic necessities are all different means through which the destruction of healthcare has been used as a weapon of war. With these actions, Israel seeks to amplify the scale of human losses inflicted upon civilians in the Gaza strip and push survivors into exodus.”.
Comments like this are non-factual and inflammatory. It is the Palestinian line and has no basis of fact.
True. It is a tragedy that so many health workers and others have been killed but isn’t that because they are at hospitals which house Hamas fighters and serve as ammunition storage and launch sites so with the obvious knowledge of hospital authorities and UNWRA. Also because patients refuse or prevented from leaving after warnings that Hamas will be targeted.
The author’s description of the healthcare infrastructure in Gaza sounds familiar, she could be describing public healthcare in South Africa…. wonder whether Hamas also has mafiosa?
Fair comparison, aside from the fact that the near-collapse of public health systems, particulalry in the eastern cape, are own goals.
Exactly.
The near-constant barrage of anti-Israel articles and pronouncements by the SA government is chilling, to say the least.
Barely a word about the onging and massive humanitarian crises in Sudan, Yemen, Haiti, and Ukraine.
This lack of balance is more more than ominous.
Thank you for writing this Dr Soni. I hope it opens the eyes of many who refuse to see the truth of what is happening in Gaza – and the West Bank. In fact, what has been happening for decades and the world stayed silent.
It’s about time politicians heeded the people’s voices and closed the door to funding and military aid instead of the pathetic attempt to airdrop parcels and send ships from Cyprus.
I think you should stay off the sauce
Truth hurts Steve
The sustained rocket attacks from Gaza by Hamas over decades have been indiscriminately focussed on whatever civilian targets in Israel they could hit. These attacks have been declared by many agencies as war crimes. Hamas has over many years openly admitted and boasted that they have used civilian, mosque and hospital locations to launch their missiles – how come is this suddenly unproven? In addition, polling in Gaza over the decades demonstrates that in excess of 66% of Palestinians have supported the rocket attack program. The only exceptions to this level of support occur in areas from which the rockets are launched. Bleeding heart articles like this are at odds with the provocation and prior deaths and aggression caused by the Palestinian militia groups.
You mean half the truth. She very conveniently omits the fact that Hamas uses hospitals as military bases, making them entirely legitimate targets. She also didn’t mention Al Ahli which was allegedly destroyed by Israeli bombs until the evidence made it clear that a failed Islamic Jihad rocket did the damage. Suddenly it was downgraded to a very minor incident. Lies much.
I do not believe Heathcare staff are deliberately targeted by Israel. Dr Soni may mean well but her biases are evident
If they are not targeted they are certainly not protected or treated with caution either.
Hard to do that when hospitals have military installations inside and underneath them.
What a strange piece of propaganda to publish. Made up numbers by a fundamentalist terrorist organisation being taken as fact. For everyone who believes what Hamas has to say, I have a bridge for sale……
To borrow a phrase – “an inconvenient truth”.
Inconvenient, because it doesn’t fit with the malignant demonisation of Israel spewing forth by our minister of foreign affairs, and a number of correspondents to DM.
And all statements from the IDF should automatically be taken as fact?
You don’t have to. But it makes no sense to disbelieve the IDF and believe Hamas. They can’t even tell the world how many living hostages they have but they can tell you the death toll precisely. They also don’t tell you how many of the dead were armed fighters.
How many of the “Health Care Workers” were actually Hamas terrorists? Doctors and Hospital Administrators knowingly allowed Hamas to build tunnels under and store weapons inside hospitals. Ambulance drivers transported terrorists and weapons inside their vehicles. So I view the contents of the article with a fair degree of skepticism. The IDF does not “target” healthcare workers. Why would they? They target Hamas. The same applies to claims of killing UN personnel. UNRWA has now proved to be riddled with Hamas operatives. They are not innocent bystanders.
Not one of the statements you have made has been proven by sources outside of Israel.
Yes they have!!!
Firstly the civilian casualties and deaths could have been minimized if Hamas gave back the hostages and stopped attacking Israel. Secondly it is proven they setup shop in schools and hospitals and mosques, and even had an intelligence operation underneath the main unrwa building.
Israel has has gone above and beyond to protect civilians in gaza dropping leaflets, sending out millions of sms and making phone calls to alert civilians to move, they even went as far as announcing their plans, severly limiting their tactical ability. Hamas wants civilian casualties for media propaganda like this. The casualty rate in this war, ie the civilian to combatant ratio is the lowest ever. And finally, the numbers coming out of gaza, from a terrorist organization that wants to inflate numbers for this exact media propoganda, cannot be believed. There is an article in tablet gaazine, tabletmag.com, that breaks down the numbers, using statistics, numbers don’t lie and it proves that the numbers provided are a lie, but somehow the media takes the terrorists word for truth. Let’s not also forget, any organization that operates in gaza, whether a humanitarian organization, reporter etc would not be there without hamas explicit allowance which would mean complicity, remember israel hasn’t had any involvement in gaza since August 2005, after which Hamas took control.
A highly biased article that only sees one side of the problem. The whole world wants peace in the ME and it will take compromise & flexibility to achieve it. Israel is there to stay as are the Palestinians. The two-state solution is the only viable one and such settlement was close, but was scuppered on numerous occasions, even under an Israeli Labour governments, by the radicals like Hamas, Islamic Jihad, Hezbollah and Iran. They all call the the total destruction of Israel – it is their way or nothing. Beyond stupidity and it is the ordinary folk who suffer on both sides, but mostly the Palestinians as these heinous cowards hide weapons etc. inside, near or under civilian structures like hospitals, schools etc. All this talk about wanting the land back, given by the Balfour Declaration etc. is nonsense. Israel (Judea & Samaria) was Jewish over 3000 years ago. Release the hostages, compromise, make peace and the whole world will embrace you!
Unfortunately a 2 state solution is not a viable solution, why you may ask? Well they’ve been offered one 5 times and rejected them everytime with attacks on Israel. The reality is they’ve never wanted one, the want only an Arab state, no Jewish state, what does everyone think from the river to the sea actually means? It’s also the reason why the palestians are refugees for perpetuity, to maintain this so called resistance movement to make it seem alright to constantly attack Israel and kill jews. Let’s also not forget they had a beginning of a 2 state solution in gaza, since Israel was not involved in gaza since 2005.
What the good doctor doesn’t mention is that Hamas used the hospitals as cover for their underground activities. Also, if Hamas had used the millions of dollars in aid money to uplift Palestinians and provide the health care, instead of building underground cities and tunnels, the whole scenario would have been totally different.
You mean like the underground tunnels in your mind ? Listen to the likes of Yuval Hariri for an ‘informed’ perspective … instead of trotting out old IDF propaganda. And if they do/have built tunnels … so what ? You mean all Israelis do not have ‘bunkers’ to escape to ?
Fascinating that you mention the Israeli bomb shelters. They’re used by ALL Israelis to shelter from the hundreds of thousands of rockets fired by Hamas, Islamic Jihad and Hezbollah.
Now the question is why Palestinians aren’t hiding in the huge tunnel network that Hamas has built. It seems like that network is reserved for Hamas. Care to comment?
Is it not obvious that all this death and destruction is by design from Hamas? The cowards who hide in tunnels.
Dr Soni, I clearly cannot apologise for the many appallingly biased, and deeply inhumane comments elicited by your article. Neither can I explain how so many see the world in such good/bad, black/white terms. However I can thank you personally for a remarkably dignified and restrained chronicling of the unspeakable. However dreadful the events of 17 October 2023, and other actions by Hamas have been, nothing can ever justify the total assault on the people of Palestine by the Israeli government and military. That the motivation is the complete extermination of Hamas is itself a complete nonsense, as the only certainty is that even if every single person connected with Hamas, however remotely , was to be killed, the Hamas essence will arise again and again far into the future. Hardly a single Palestinian family has not been impacted by the brutality, with the seeds of revenge being sown throughout the population, and destined to germinate and grow into unforeseen and unpredictable forms. This guarantees that both populations, Palestinian and Israeli, will live in enmity and fear forever. So just as Hamas are ensuring that their own people will never see peace, so Israel is ensuring the same for its people. It is a tragedy of grotesque proportions for which there is no obvious solution, but the only starting point must be a complete cessation of hostilities by both sides.However, hoping for any real acknowledgement of their culpability by each side is clearly foolish.
It is war crime to hide weapons in a hospital. The buildings previously used as hospitals in Gaza have become military bases for Hamas.