Israel’s systematic weaponisation of health in Gaza

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. 

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. 

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. 

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