Key moments over three years of siege, bombardment, and attacks on health care.
An injured child is carried to MSF’s clinic at Rafah Indonesian Field Hospital. | Palestine 2023 © MSF
This article was last updated on October 1, 2026.
On October 7, 2023, Hamas militants launched a major assault on Israel, leaving more than 1,200 people dead and taking 251 hostages. In response, Israel launched a massive military offensive on Gaza that has killed more than 73,000 Palestinians and wounded more than 173,000 to date.
Over more than three years, most Palestinians in Gaza have been displaced multiple times by Israeli forces' constant bombing and evacuation orders. Violence from Israeli forces and settlers has also surged in the West Bank, heightening the risk of ethnic cleansing. Doctors Without Borders/Médecins Sans Frontières (MSF) teams have worked in Palestine for decades, witnessing these escalations as well as the catastrophic human toll of Israel’s genocidal war on Gaza.
Although a ceasefire was announced in October 2025, Israeli airstrikes continue to hit Gaza, killing and injuring people across the Strip every day. Living conditions in the Strip remain desperate, with vital infrastructure destroyed, mass displacement, and insufficient aid. Almost a year into a so-called ceasefire, the wounds of war are not only unhealed — they are still being inflicted.
Here, we look back at MSF’s response to the devastating humanitarian consequences of the war in Gaza.
On October 7, 2023, following the Hamas attacks inside Israel, the Israeli military begins a major counteroffensive in Gaza, launching a barrage of airstrikes across the territory. Israeli strikes hit Indonesian Hospital and an ambulance in front of Nasser Hospital, killing a nurse and an ambulance driver and injuring several others. MSF has supported Indonesian and Nasser hospitals in southern Gaza since 2021 and 2011, respectively. MSF donates medical supplies to hospitals and health facilities across Gaza to respond to medical needs. In northern Gaza’s Al-Awda hospital, where MSF staff provide surgical and inpatient care, the bed capacity is increased in anticipation of an influx of patients.
On October 8, MSF offers support to Israeli hospitals that are treating large numbers of casualties following the attacks, but the offer is not accepted. We do not have existing medical programs in Israel, which has strong emergency and health systems.
Throughout November, MSF witnesses the targeting of health care workers and facilities. MSF colleagues are killed in three separate attacks, including a strike on our marked convoy. There is intense bombing and shelling around Al-Shifa Hospital, a 700-bed facility and the principal medical complex in Gaza able to provide emergency and surgical care. MSF is forced to evacuate its staff from the hospital, which is later stormed by Israeli forces. A temporary truce between Israel and Hamas in Gaza takes effect from November 24 to November 30.
Although a one-week pause in fighting in the last week of November inspires some hope for a ceasefire, on December 1 fighting resumes. Hours after the pause ends, a blast damages Al-Awda Hospital in northern Gaza. Israeli forces eventually take over Al-Awda Hospital on December 17 after a 12-day siege.
Also on December 1, new evacuation orders are issued to people in central Gaza and Khan Younis, including areas where two MSF clinics are located. By December 7, 1.9 million people are displaced (about 90 percent of the population), most of them forced to move to southern Gaza. MSF opens a clinic at Rafah Indonesian Hospital to help provide post-operative care and support the capacity of other facilities overwhelmed with mass casualties.
Among 1.9 million displaced Palestinians are thousands of pregnant women forced to give birth in terrible conditions, often in temporary shelters with limited protection from cold winter temperatures and rainfall. One pregnant woman, Maha*, is turned away from a hospital in northern Gaza because the delivery rooms are full. She delivers a baby boy in a latrine near her tent, but the child does not survive. Later, she receives postnatal care at MSF-supported Emirati Hospital and shares her story.
On January 8, the 5-year-old daughter of an MSF worker is killed by a suspected Israeli tank shell that hits a shelter where MSF staff and their families are staying. Prior to the incident, MSF had notified Israeli forces of the location of the shelter.
Despite promises from Israeli forces that medical staff, their families, patients, and one caretaker per patient would be allowed to remain inside, on February 14 and 15, they order everyone to evacuate Nasser Hospital before storming it. One MSF staff member is detained and released a month and a half later, on April 4.
On February 22, MSF Secretary General Christopher Lockyear addresses a United Nations (UN) Security Council meeting on Gaza to demand an immediate ceasefire and call for the protection of medical facilities, staff, and patients. The speech comes as more than 1.5 million Palestinians are trapped in Rafah amid mounting fears of an Israeli ground invasion. “We have watched members of this Council deliberate and delay while civilians die,” says Lockyear. He highlights a series of attacks on MSF staff by Israeli forces, noting that “this pattern of attacks is either intentional or indicative of reckless incompetence.”
The United States announces in early March its plan to build a “humanitarian aid pier” more than five months into the conflict. MSF USA Chief Executive Officer Avril Benoît calls this announcement a “glaring distraction” from the true causes of the lack of medical supplies and food: Israel’s indiscriminate and disproportionate military campaign and its blocking and restriction of aid.
On March 23, MSF co-signs a letter with other humanitarian organizations to President Biden, noting, “the humanitarian response in Gaza, including US funded humanitarian assistance, has been consistently and arbitrarily denied, restricted, and impeded by the Israeli authorities.”
By the end of March, months of restricted movement have resulted in severe food insecurity in northern Gaza, where between 12.4 and 16.5 percent of children under 5 years old have severe acute malnutrition, according to the World Health Organization (WHO). At the same time, only 28 percent of Gaza’s hospitals remain partially functional.
On April 1, after a two-week military operation, Israeli forces leave Al-Shifa Hospital wrecked and gutted. Over the course of the raid, Israeli forces detain medical staff and other people in and around the hospital. An MSF clinic in the hospital’s vicinity is also badly damaged. At least 21 patients die during the siege that began on March 18, according to the WHO. MSF calls for patients who remain in Al-Shifa Hospital to be safely evacuated so they can receive the care they need.
Also on April 1, an attack by Israeli forces kills seven humanitarian aid workers employed by World Central Kitchen. This event draws international attention to Israel’s conduct of the war and attacks on humanitarian aid. As of mid-April, at least 244 aid workers and 490 health workers have been killed in Gaza, the vast majority Palestinians, according to the UN humanitarian agency.
The physical and mental health of Palestinians is deteriorating rapidly as Gaza’s devastated health care system struggles to keep up with needs.
In the first week of May, Israeli forces announce plans to invade Rafah. On May 7 they seize the Rafah border crossing, a vital entry point for humanitarian supplies, as well as a key exit point for medical evacuations. Over the course of the month, Israeli evacuation orders and intense fighting in Rafah force nearly 1 million Palestinians to flee.
A heavy bombing campaign by Israeli forces on June 8 hits Nuseirat refugee camp in the Middle Area. MSF teams and other staff at Al-Aqsa Hospital treat hundreds of severely injured patients, including many women and children. MSF medical referent Karin Huster is in Al-Aqsa that day and reports seeing “the gamut of war wounds, trauma wounds, from amputations to eviscerations to trauma, to traumatic brain injuries, fractures, and obviously, big burns.”
On June 25 a UN expert committee warns, “there is a high and sustained risk of famine across the whole Gaza Strip.”
Health care staff and humanitarian workers must be protected.
From late April until mid-July, MSF is not able to get any aid into Gaza and faces critical supply shortages. Finally, from July 10 to 15, six trucks carrying essential medical items are allowed in through the Kerem Shalom border crossing. This is only a drop in the ocean given the immense needs of a devastated population.
On July 16, WHO announces that wastewater test results confirm the reemergence of the polio virus in Gaza for the first time in more than 25 years. It’s a direct result of the decimation of Gaza’s water and sanitation system, massive forced displacement, and the disruption of routine vaccinations.
In the last week of July, Nasser Hospital is once again driven to the point of collapse after a month of airstrikes and ground fighting in the surrounding area. MSF urgently calls on all warring parties to ensure safe access to care and avoid endangering patients and staff inside the largest remaining hospital in southern Gaza.
Gaza sees its first polio case in 25 years when a 10-month-old boy contracts the virus.
Israeli evacuation orders throughout July and August repeatedly force people into ever more crammed areas and shrink the so-called humanitarian zone. In late August, MSF opens a field hospital in Deir al-Balah as evacuation orders force people to flee nearby Al-Aqsa Hospital. However, the field hospital was designed to support and complement the care provided by Al-Aqsa, not replace it.
In the tiny coastal enclave of Al-Mawasi, where hundreds of thousands of people are displaced, people must line up for hours to shower or get clean water. MSF partners with the Palestinian Agricultural Development Association (PARC) to provide latrines, solar water pumps, and water treatment plants. Ten months of constant bombing have created abysmal sanitation conditions, and the PARC medical clinic sees approximately 200 children a day with skin conditions.
Near the end of August, Israeli forces yet again issue evacuation orders for Deir Al-Balah and Khan Younis. Among those fleeing are MSF staff, who describe the continuous forced displacement of people as inhumane. There is no room to set up tents. The combination of overcrowding, severe lack of water, and minimal sanitation services fuel the spread of diseases.
An estimated 12,000 wounded Palestinians are waiting for medical evacuation from Gaza, yet around 60 percent of evacuation requests are rejected by the Israeli authorities, according to WHO. For some who are able to leave Gaza, MSF supports their transfer to our reconstructive surgery hospital in Amman, Jordan. MSF calls on the Israeli authorities to ensure medical evacuations for Palestinians in need of specialized medical care, and for other states to receive and facilitate treatment outside of Gaza. We also call on Israel to ensure that all patients and their caregivers are guaranteed safe, voluntary, and dignified return to Gaza.
Beginning on October 7, Israel issues evacuation orders for Jabalia camp, while carrying out attacks at the same time that prevent people from leaving. MSF staff are among the thousands of people trapped in the camp.
Two of our colleagues in Gaza are killed this month. Nasser Hamdi Abdelatif Al Shalfouh is killed on October 8 in Jabalia, and Hasan Suboh, who was killed in Khan Younis on October 24.
At the end of October, we learn that MSF orthopedic surgeon Dr. Mohammed Obeid, who was sheltering and working in the Kamal Adean Hospital in the north, was detained by Israeli forces at the hospital on October 26.
We urgently call for his safety and protection, as well as for the safety and protection of all Palestinian medical staff who face horrific violence while trying to provide care in Gaza.
The situation in northern Gaza continues to deteriorate after a month of heightened siege and violence. The relentless attacks and evacuation orders result in an unbearable humanitarian situation as Palestinians remain trapped without access to sufficient humanitarian aid.
Across the Strip, the flow of humanitarian aid into Gaza reaches its lowest level in months, leaving patient care critically compromised as medical conditions linked to shortages of food, water, and shelter materials are expected to surge with the onset of winter. Areas Israel declared as “humanitarian zones” continue to be regularly attacked. MSF teams report that they are seeing severe health impacts such as respiratory disease and skin conditions among Palestinian children, newborns, and mothers.
On December 19, MSF releases the report “Gaza: Life in a Death Trap." The report illustrates how over 14 months, the dismantling of the health care system and other essential infrastructure, the suffocating siege, and the systematic denial of humanitarian assistance by Israel are destroying the conditions of life in Gaza.
A temporary ceasefire goes into effect on January 19, but for Palestinians in Gaza, this agreement arrives more than 465 days and 46,000 lives too late. During the more than 15 months of Israel’s war on Gaza, nearly 70 percent of all structures in the Strip were destroyed or damaged, along with 92 percent of all housing units. MSF staff trying to return to their homes in Rafah are shocked by the extent of the destruction they witnessed. “We couldn’t even recognize the streets where the Emirati Hospital was,” says MSF emergency coordinator Nadia Abo Mallouh, who used to work at the hospital, located in Rafah. “It’s sad seeing the hospital that used to bring life to earth totally empty—no signs of life, everything is destroyed.”
Following the implementation of the ceasefire, MSF teams are able to reach northern Gaza, which had been besieged by Israeli forces, to assess the medical and humanitarian needs. They find an appalling situation, with nothing left. Our colleagues no longer recognize their own neighborhoods, hospitals have been razed, and people are living in the rubble of their homes with no other shelter amid winter conditions. MSF emergency coordinator Caroline Seguin shares, “There is nothing there anymore. Only ruins and the smell of death everywhere because of the dead bodies still trapped under the rubble.”
Israeli authorities halt aid from entering Gaza on March 2, and then cut electricity on March 9—by extension blocking people’s access to water, because essential desalination plants, water pumps, and other infrastructure cannot operate.
On March 18, Israeli forces attack multiple areas in the Gaza Strip, killing hundreds of people, according to Gaza’s Ministry of Health. This wave of bombing kills MSF colleague Alaa Abd-Elsalam Ali Okal. MSF staff at Nasser Hospital report the ground shaking from the resumption of Israeli strikes, and received an influx of wounded patients.
Israel's resumption of hostilities and a near-total siege on March 18 rapidly depletes stocks of food, fuel, and medical supplies, leading to the suspension of medical activities and turning Gaza into “hell” and a “mass grave” for Palestinian civilians and humanitarian workers. Because of the siege on medical supplies, MSF doctors are forced to treat burn patients without any pain relief.
MSF denounces a US-Israeli proposal to bypass UN-led coordination and place aid delivery in Gaza under direct Israeli control, effectively forcing a militarized system on humanitarian organizations, donors, and civilians.
Rather than facilitate access, the plan—centered around the so-called Gaza Humanitarian Foundation—threatens to further institutionalize obstruction, instrumentalize aid, and entrench the Israeli occupation.
In June, MSF teams at Nasser Hospital assist with mass casualty response, treating Palestinians who were injured trying to collect aid from sites operated by the GHF. Patients recount being shot at from all sides by drones, helicopters, boats, tanks, and Israeli soldiers on the ground.
Although Israeli authorities create an illusion of aid flowing into the Strip, the minuscule amount getting in is nowhere near enough to meet the needs of a population entirely reliant on assistance. Three months into a total blockade, MSF's supplies are running critically low due to continuing restrictions imposed on entering goods.
As medical staff work with very little to eat and insufficient supplies, near-daily mass casualty incidents continue in Gaza—further taxing the health care system. Not a single hospital in the Gaza Strip is fully functional.
“The health system is overwhelmed and it's collapsing,” says Dr. Mohammed Fadlalla, MSF medical activity manager.
In screenings at MSF facilities in mid-July, 25 percent of children aged six months to five years old and pregnant or breastfeeding women were malnourished.
After 22 months of Israel destroying and restricting access to critical water infrastructure, the amount of water available in Gaza is wholly insufficient. Israel’s refusal to allow in fuel and equipment to repair damaged water pipes and desalination plants makes it impossible for people to get enough water, leading to deadly medical consequences.
In late August, Israeli forces begin a major offensive in Gaza City, where famine has recently been declared by the Integrated Food Security Phase Classification (IPC).
Palestinians in Gaza City are bombed day and night under an escalating Israeli offensive campaign. Without means to travel and no safe place to seek shelter, many Palestinians have no option but to stay in Gaza City.
Ahead of the UN General Assembly meeting in New York City, MSF launches a petition calling on US lawmakers to: secure an immediate surge in independent, lifesaving humanitarian aid to people in Gaza; suspend US arms transfers to Israel in compliance with section 620i of the Foreign Assistance Act; use US influence with Israel to ensure an end to attacks on civilians in Gaza, including attacks on health workers and hospitals; and call for an immediate and sustained ceasefire in Gaza.
Two MSF colleagues are killed in the first week of October when an Israeli strike hits a bus stop where medical workers were waiting to go to work. Our colleagues were wearing MSF vests.
A ceasefire officially goes into effect on October 10, but it is not the end of suffering of Palestinians in Gaza, who continue to live with ongoing attacks, dire living conditions, and insufficient access to basic needs. On October 8, the World Health Organization (WHO) reports that over 15,600 people—1 in 4 of whom are children—are awaiting medical evacuation for lifesaving care unavailable in Gaza’s decimated health system.
Despite the ceasefire, MSF continues to treat victims of Israeli strikes. According to the Ministry of Health, as of November 27 at least 347 Palestinians were killed by Israeli strikes since the announcement of the October 10 ceasefire.
New registration rules for international non-governmental organizations announced by Israel risk leaving hundreds of thousands of Palestinians in Gaza without lifesaving health care in 2026. The new requirements prevent organizations, including MSF, from providing essential services to people in Gaza and the West Bank.
MSF warns that if Israeli authorities revoke our access to Gaza in 2026, many Palestinians will lose access to critical medical care, water, and lifesaving support. Many of the services provided by MSF are largely unavailable elsewhere in Gaza due to the near-complete destruction of the health system over three years of genocidal war.
Throughout the year, Israeli forces continue to systematically violate the October 2025 ceasefire announcement, carrying out daily attacks on Gaza while authorities maintain their deliberate obstruction of aid for the Strip.
Since October 2023, 1,700 health workers have been killed, as well as 15 MSF colleagues.
