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Q&A: Carnage and complicity in Gaza

A member of our team in Gaza describes Doctors Without Borders’ response on the night of the Tal Al-Sultan camp massacre and the apocalyptic situation facing civilians in Rafah.

Destruction in Khan Younis, Gaza.

Destroyed buildings in Khan Younis, southern Gaza, photographed in May. | Palestine 2024 © MSF

On May 26, Israeli forces killed at least 49 Palestinians in airstrikes on a camp for displaced people in the Tal Al-Sultan area of Rafah, Gaza. More than 180 injured people were taken to a nearby stabilization point supported by Doctors Without Borders/Médecins Sans Frontières (MSF).

Two days later, Israel bombed a camp for displaced people in Al-Mawasi, west of Rafah, killing at least 21 Palestinians and leaving 64 wounded. These massacres are taking place just days after the International Court of Justice (ICJ) ordered Israel to immediately halt its military offensive in Rafah, in application of the Convention on the Prevention and Punishment of the Crime of Genocide.

Before the escalation of Israeli military operations in Rafah this month, more than 1.5 million Palestinians were sheltering in the city after being told to flee to the so-called “safe zone.” More than 900,000 people have since fled Rafah, forcibly displaced yet another time in a war without respite for civilians.

A member of Doctors Without Borders’ team in Gaza, Head of Emergency Programs Caroline Seguin, describes what happened on the tragic night of May 26 and the apocalyptic situation continuing to unfold in Rafah.

What happened after the May 26 Israeli airstrike on the camp in Tal Al-Sultan?

The MSF-supported stabilization point was operating around the clock right next to where the Israeli airstrikes took place. Our teams treated more than 180 people with complex injuries, including shrapnel wounds, fractures, and extensive burns. We also received 28 people who were already dead on arrival or died of their injuries soon after. The teams worked throughout the night to stabilize the patients and transfer them to health facilities located further west, near Al-Mawasi. They were forced to flee the following night as fighting intensified in the area, once again putting an end to vital medical activities for Gazans.  

Women and children were among the victims. There are entire families, often consisting of several dozen people, sleeping in tents and living in extremely difficult conditions. These are civilians who, once again, are being injured and killed by Israel’s bombing of densely populated areas.  

This strike illustrates once again the total disregard for Palestinian lives by Israeli forces. The area where the airstrikes took place is a camp for displaced people and the civilians there had not received any order to evacuate. There is no safe place in Gaza for civilians.

Displaced Palestinians flee Rafah, southern Gaza.
Displaced Palestinians leave Rafah after an evacuation order from the Israeli military on May 6, 2024.
Palestine 2024 © MSF

What conditions have displaced people been living in since the Israeli offensive on Rafah began on May 6?

More than 900,000 people have fled Rafah since the beginning of the Israeli offensive on the city and its surroundings. They have been forcibly displaced for the umpteenth time, this time to Al-Mawasi, a stretch of sand along the Mediterranean coast, as well as to Deir al-Balah and Khan Younis.

The Israeli military continues to push Gazans inexorably into areas that it declares safe but are in reality exposed to bombing and fighting. On May 16, 78 percent of the Gaza Strip was ordered by Israeli forces to evacuate. Palestinians in Gaza are now caught up in the fighting and crammed into a tiny, unlivable area, trying to survive in impossible conditions with no guarantee of safety.

Massive and indiscriminate Israeli bombings continue to devastate northern and central Gaza, including repeated airstrikes on the Palestinian refugee camp of Nuseirat and in the south with the current offensive on Rafah. Since the beginning of the war, more than 36,000 Palestinians have been killed, and at least twice that number have been injured and need treatment including complex surgical operations.

Doctors Without Borders teams have been forced to evacuate 12 health facilities, including nine that were attacked. It is worth repeating that our colleagues have suffered 23 violent incidents—direct attacks, and sometimes being rounded up, arrested, and tortured by Israeli forces.

This is a massacre that has been going on for almost eight months, in which women and children are the main victims. Today in Gaza, the whole population is within range of bombs, gunfire, and tank shelling, and anyone can be killed, including humanitarian workers in a clearly-marked convoy, as was the case for Doctors Without Borders in November 2023 and World Central Kitchen in April 2024.

A Palestinian man lights a fire in his tent in Rafah, southern Gaza.
Most of MSF’s patients are staying in tents or public buildings turned into shelters, conditions are poor and basic needs are inaccessible. Palestine 2023 © MSF

No MSF trucks have entered the Gaza Strip since May 6. On May 26, around 130 vehicles carrying humanitarian aid were allowed through the Kerem Shalom crossing, which is controlled by the Israeli military. The supply operation was interrupted by fighting, forcing around 70 trucks to turn back.

What are the consequences of the difficulty of getting supplies into Gaza? How are Doctors Without Borders teams continuing to work despite the shortage of supplies?

Since the total closure of the Rafah crossing on May 7, we have been witnessing a further strangulation of the Gaza Strip, a new collective punishment for Palestinians. We have had to reorganize the hospitals in which we work, closing facilities and transferring patients from the Indonesian and Emirati hospitals in Rafah to Nasser Hospital in Khan Younis, where we treat trauma and burns and provide follow-up care.

Water supply is critical throughout Gaza. Due to a lack of fuel, desalination plants are operating at a reduced level. This week we were only able to distribute 50,000 liters of water due to the lack of fuel, compared to 400,000 liters the week before. There is more imported food available in some markets, where it gets through in private company trucks, but it is unaffordable for most Gazans.

Doctors Without Borders could save more lives if the Israeli government stopped intentionally blocking humanitarian assistance. In addition to the bombings, people are dying every day because of Israeli obstruction of aid.

Caroline Segui, MSF head of emergency programs

Israel continues its policy of obstructing humanitarian aid. We are seeing this obstruction of aid combined with a charade designed to make people believe that aid can enter Gaza via the floating pier built by the United States or through the Kerem Shalom crossing. In reality, nearly eight months on, we are still facing a blockade, obstruction, and appalling delays in the transport of equipment that patients need for treatment, such as generators, water pumps, scanners, oxygen, X-ray and sterilization equipment, and more. Aid, when it is not completely blocked, comes in dribs and drabs, and can in no way adequately meet the immense needs of Palestinians in Gaza.

Doctors Without Borders could save more lives if the Israeli government stopped intentionally blocking humanitarian assistance. In addition to the bombings, people are dying every day because of Israeli obstruction of aid.

The only way to get aid into Gaza today is to increase the number of road entry points into areas where the lives of humanitarian workers are not in danger—areas that are not on the front lines, as is currently the case for Kerem Shalom, which is not a viable solution. Humanitarian aid must enter Gaza in sufficient quantities to meet the immense needs of a devastated population. We must have the means to distribute the aid and we must be able to do so unhindered and in safety.

It should also be remembered that more than 220 humanitarian workers have been killed in Gaza since the beginning of the war.

Destruction in Khan Younis, Gaza.
Destroyed buildings in Khan Younis, southern Gaza, photographed in May. Palestine 2024 © MSF

The ICJ has ordered Israel to “immediately halt its military offensive, and any other action in the Rafah Governorate" that could bring about "the physical destruction" of Palestinians. What does this ruling change in concrete terms on the ground?

For Palestinians who are being bombed and are trapped in the fighting, the ICJ ruling does not radically change their daily lives. The measures ordered by the Court are legally binding, but it has no means of enforcing them.

On January 26, the ICJ issued provisional measures ordering Israel to prevent and punish acts of genocide and ensure that basic services and aid reach people in Gaza. The Court’s rulings, both in terms of the pressure exerted on Israel and the media coverage generated, highlight the systematic and manifest nature of the destruction of civilian infrastructure in Gaza, including attacks on hospitals—which we have documented in recent months—as well as on schools, mosques, universities, roads, farmland, and more. These are being deliberately and methodically destroyed. The entire social fabric of Gaza is being annihilated.

Hospitals in the north of Gaza continue to be targeted in attacks and have undergone massive destruction, as is the case for Al-Awda and Kamal Adwan hospitals. There is no longer a fully operational hospital in Rafah since the Kuwaiti Hospital was taken out of service following an airstrike that killed two of its staff.

Schools, mosques, universities, roads, farmland ... these are being deliberately and methodically destroyed. The entire social fabric of Gaza is being annihilated.

Caroline Segui, MSF head of emergency programs

Since the beginning of the war, Gaza’s health system—hospitals, ambulances, medical personnel, and patients—has been the target of deliberate and systematic attacks by the Israeli military. Currently, Israel refuses to take in patients, [even] children, who cannot be treated in Gaza, while medical evacuation to Egypt has not been possible since Israel took control of the border.

There is a vital and urgent need to force Israel to immediately cease its policy of destruction of all sources of life in Gaza. The United States, which systematically opposes UN Security Council resolutions calling for a ceasefire, is complicit in this policy of destruction and is fueling it, as do the United Kingdom and other European states allied with Israel. These countries must stop supporting Israel’s military operations in order to protect civilian lives and prevent the genocide of the Palestinian people.

How we're responding to the war in Gaza