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Evacuation orders and heavy bombing leave few health care options in Gaza

100 days into the conflict, there are virtually no safe spaces left to provide lifesaving medical services to civilians.

Palestinians crowded into the streets of Rafah in southern Gaza.

Rafah's population has more than tripled since the start of the war, as people flee bombings in northern and central Gaza. | Palestine 2023 © MSF

NEW YORK/JERUSALEM, January 12, 2024—Nearly 100 days into the Israeli forces’ all-out assault on Gaza, Palestine, medical needs continue to rise as care options dwindle, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today.

The number of safe spaces for organizations like MSF to provide health care is now virtually non-existent as constant evacuation orders and attacks on health facilities have repeatedly forced medical staff to evacuate hospitals and leave patients behind.

“We’re gradually being cornered in a very restrictive perimeter in southern Gaza, in Rafah, with dwindling options to offer critical medical assistance while the needs are desperately growing,” said Thomas Lauvin, MSF project coordinator in Gaza. “As the assault on Gaza has progressed, we have had to evacuate several health facilities in the north of Gaza, then in the Middle Area. Today we are limited to mainly working in the south because we cannot work elsewhere. In short: we’re running out of hospitals. We are forced to leave patients behind.”

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The health care system in Gaza has virtually collapsed due to the direct impact of the conflict as well as dire supply shortages. The World Health Organization reports that only 15 out of Gaza’s 36 hospitals are still partially functional. The two major hospitals in southern Gaza are operating at three times their bed capacity and are running out of basic supplies and generator fuel.

Al Awda Hospital's Limb Reconstructive Surgery unit after the strike on November 21

Attacks on Gaza's health facilities

Medical facilities and their surrounding areas have repeatedly been attacked or subjected to evacuation orders in different parts of Gaza—particularly in the north—making access to, and the provision of, health care extremely dangerous. Several hospitals where MSF was working have been struck, or staff have been forced to evacuate due to safety concerns.

For example, the Indonesian Hospital in northern Gaza had to be evacuated in October. Al-Shifa Hospital—Gaza’s largest—was hit and the staff were forced to evacuate in November. Then Al-Awda Hospital, an MSF partner hospital since 2018, was hit and three doctors, two of whom worked for MSF, were killed. Most recently, on January 6, MSF teams were forced to evacuate from Al-Aqsa Hospital in Gaza’s Middle Area after Israeli forces issued evacuation orders for neighborhoods surrounding the hospital.

“Leaving Al-Aqsa Hospital and our patients was a devastating decision and our last resort,” said Enrico Vallaperta, MSF project medical referent in Gaza. “Drone strikes, sniper fire, and bombardments in the close vicinity of the hospital made the space too unsafe to work in. There's virtually no secure space to provide even minimal medical care to people.”

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Now, this pattern is repeating itself in southern Gaza, which hosts five times the number of people it did before the war. Since the November truce broke down, the south of Gaza has been targeted by intense bombing, resulting in a massive need for emergency, surgical, and post-operative care.

The lack of hospital capacity, in particular, is depriving patients of adequate treatment and proper hygienic conditions, resulting in increasing numbers of infected wounds and medical procedures being carried out in extreme conditions. Beyond critical injuries, many who undergo Cesarean sections are discharged just six hours after delivery to make space for other pregnant people, while some are simply turned away and give birth in makeshift tents.

MSF's commitment to continuing care

MSF remains committed to providing medical care in Gaza and calls for the protection of hospitals, medical staff, and patients. Additionally, MSF reiterates its call for an immediate ceasefire that will spare the lives of civilians and restore the flow of humanitarian assistance and re-establish the health care system on which the survival of Palestinians in Gaza depends.

MSF is currently providing pre- and postpartum care at the Emirati Hospital in Rafah, assisting Palestinians with physiotherapy and post-operative care at the Rafah Indonesian Hospital, and offering primary health care consultations, wound dressings, and mental health support at Al-Shaboura Clinic, also in Rafah. Additionally, teams are supporting the European Hospital with surgeries, and a small team of nurses there is assisting patients in need of wound dressings. At Al-Awda Hospital in northern Gaza and Nasser Hospital in Khan Younis, a handful of MSF staff are working in extremely difficult conditions, including without food and medical supplies due to airstrikes and nearby fighting.

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