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Israeli destruction of the Gaza Strip healthcare system

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During the Israel–Hamas war, the Israeli military destroyed the healthcare system of the Gaza Strip. According to international and local medical organizations, the Israeli military deliberately attacked and targeted Gaza's hospitals, destroying critical facilities such as oxygen tanks and CT scanners.[1] The United Nations reported that none of Gaza's 36 hospitals were fully functional; while some were still partially operational, many had been completely destroyed.[1] In fact, Israel used some of Gaza's hospitals as military bases.[2] Gaza's medical personnel and healthcare workers were also directly affected, with hundreds of healthcare workers killed or detained by Israeli forces.[3][4]

Israel also conducted targeted raids and attack on hospitals, including a military incursion at Gaza City's Al-Shifa Hospital, where violence and arrests against both patients and staff within the facility were reported.[1] In June 2024, Doctors Without Borders stated Gaza was in an "apocalyptic" health crisis, stating the health system was at the "point of collapse" due to a lack of safety and resources.[5] In October 2024, the World Health Organization stated it had recorded 516 attacks on Gaza's healthcare since October 2023.[6] The International Committee of the Red Cross warned about the extensive damage in southern Gaza, stating that the healthcare system was at its breaking point.[7]

Israel's actions received international condemnation, with both states and humanitarian organizations criticizing the "systematic dismantling" of Gaza's health services.[8][9] Medical Aid for Palestinians and other NGOs described the destruction as coordinated, asserting that the situation in Gaza was among the worst they had encountered.[10][11][12] In October 2024, a United Nations inquiry found Israel's policy of destroying Gaza's healthcare system constituted both war crimes and the crime against humanity of extermination.[13]

Attacks on hospitals

[edit]
This section is an excerpt from Attacks on health facilities during the Israel–Hamas war § Attacks in the Gaza Strip.[edit]

On 12 October 2023, the ICRC stated: "Hospitals in Gaza risk turning into morgues". On 15 October 2023, WHO data showed there had been 48 reported attacks on healthcare facilities in the Gaza Strip, resulting in damage to approximately 24 hospitals and healthcare facilities, including six hospitals.[14] According to the World Health Organization, at least 521 people, including 16 medical workers, had been killed in 137 "attacks on health care" in Gaza by 12 November.[15] By 14 November 2023, only one hospital was still operating in the north of Gaza.[15] On 7 February 2024, the UN stated that only 4 of its 22 health facilities in Gaza remained operational.[16]

The IDF accused Hamas of military operations inside hospitals, including alleged attacks on IDF soldiers, weapon storage, fighters taking shelter, providing support for Hamas tunnels, human shielding, and holding hostages[17] Many of these claims, however, have been debunked under scrutiny from journalists.[18][19][20] According to The Guardian: "It's almost impossible to refute every accusation that has been made, but it's clear the intended and actual result of this campaign has been the systematic destruction of the healthcare infrastructure for Palestinians in Gaza".[21] Doctors Without Borders stated Israel had shown "complete disregard for the protection and safety of medical and humanitarian missions and their staff".[22]

By October 2024, the World Health Organization stated it had verified 516 attacks on healthcare in the Gaza Strip since October 2023.[23]

List of attacked facilities

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This section is an excerpt from Attacks on protected zones and civilians in Gaza § List of attacked healthcare facilities.[edit]

Impacts

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The repeated mass casualty events from Israel's hostilities stretched the response capacity of hospitals and all health facilities in southern Gaza to their breaking point, according to William Schomburg, the Gaza head of sub-delegation for the International Committee of the Red Cross (ICRC).[24] Patients with preexisting conditions, including cancer, diabetes, and other disabilities, were unable to receive necessary treatment as a result of the attacks.[25] Doctors Without Borders reported pregnant women and their children were unable to access care due to Gaza's decimated healthcare system, which posed severe and potentially lethal health risks.[26]

Killings and detentions of medical staff

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Killing of medical staff

[edit]
This section is an excerpt from Killing of health workers in the Israel–Hamas war § Attacks on health workers in Palestine.[edit]

On 15 October 2023, a total of 28 health workers had been killed and 30 recorded incidents of violence against health facilities, ambulances, and health workers since the bombing began.[27][28][29] By 16 November 2023 it was reported that more than 200 health care workers had been killed, per the Palestinian Ministry of Health, with some killed at hospitals, in ambulances, or at the sight of bombings, while others killed at home.[30] On 18 January 2024, Israel struck a building which was housing Medical Aid for Palestinians staff and their family members, causing several injuries.[31]

The Gaza Health Ministry stated on 9 February 2024 that 340 health workers had been killed since 7 October.[32] Meinie Nicolai, a director of Doctors Without Borders, stated that Israel had killed two humanitarian aid workers, and that neither the U.S. nor Israel had provided an explanation.[33] Reem Abu Lebdeh, a trustee on the UK board of directors of Doctors Without Borders, was killed by an Israeli airstrike in Khan Younis.[34] On 26 March 2024, the Palestine Red Crescent Society stated that 15 of its staff members had been killed since 7 October.[35] By 1 June 2024, the number had risen to 33.[36] In June 2024, Doctors Without Borders stated six of its workers had been killed in Gaza since 7 October.[37]

According to Al Jazeera, 160 medical facilities within the enclave have come under fire from the Israel Defense Forces, and 60 ambulances were disabled. Only four medical facilities remained operational in Gaza, but their survival is uncertain unless they receive the necessary aid. A total of 200 medical workers had reportedly lost their lives in the Strip.[38] In July 2024, a Palestinian doctor and his family were killed by an Israeli airstrike after complying with an Israeli evacuation order.[39]

More than 500 healthcare workers were killed between October 2023 and July 2024, either during assaults on hospitals or in strikes on homes, according to the United Nations.[40] In August 2024, Medical Aid for Palestinians reported that this equated to an average of two healthcare workers killed every day, with one in every 40 healthcare workers, or 2.5 percent of Gaza's healthcare workforce.[41]

Arrests of medical staff

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See also: Torture during the Israel–Hamas war
This section is an excerpt from Mass detentions in the Israel–Hamas war § Healthcare workers.[edit]

On 15 November 2023, reports emerged alleging detentions by Israeli forces at Al-Shifa Hospital in Gaza.[42][43][44][45] Doctors who spoke to Al Jazeera Arabic, one of the few international outlets able to access sources within the hospital,[42] stated that the detainees were blindfolded and stripped naked.[42][45] Mondoweiss cited Al Jazeera reports that "Israeli forces took captive dozens of displaced people, relatives of patients and the injured", and that the detainees were transferred to undisclosed locations.[45] China Daily, a Chinese state-run media outlet, reported on similar statements by the hospital's director, Mohammed Abu Salmiya, who referred to "dozens" of detentions at the hospital.[46] On 23 November, Abu Salmiya was himself arrested by Israeli forces, along with other medics.[47][48] As of 4 December 2023, the fate of Abu Salmiya remained unknown; Israeli authorities declined to answer questions by The Jerusalem Post, but "hinted" that he remained in Shin Bet custody.[49] He had not been charged with an offence.[49]

On 30 November 2023, the Palestine Red Crescent Society stated that the whereabouts of the head of Khan Younis Emergency Medical Center had been unknown for nine days, following his arrest by Israeli authorities.[50][51] On December 3, the Gaza Health Ministry stated that 34 medics in Gaza had been detained by Israel.[52] On 12 December 2023, the World Health Organization reported on the mass detentions of medical staff.[53] Adnan al-Bursh, the head of orthopedics at al-Shifa was arrested with two nurses.[54] On December 13, the British-organization Medical Aid for Palestinians stated 70 medics at the Kamal Adwan Hospital had been detained by the IDF.[55] On December 19, the Gaza Health Ministry stated that Israel was holding 93 healthcare workers "in inhumane conditions, under interrogation [and] under torture, starvation and extreme cold."[56] On 28 January 2024, the head of head of orthopedic surgery at Nasser Hospital was arrested.[57]

One paramedic arrested in Jabalia stated he and his colleagues were beaten in their sensitive areas, heads, and backs, and had rocks thrown at them.[58] A group of ten healthcare workers described being tortured in detention.[59] A doctor arrested while working at Ahli Arab Hospital in December 2023 described being shackled and blindfolded.[60] On 5 February 2024, the general manager and administrative director of al-Amal Hospital were arrested.[61] On 6 February, two medical volunteers were arrested while evacuating from the al-Amal Hospital.[62] Several medical workers were arrested at al-Amal on 9 February.[63] Eight more al-Amal hospital were arrested on 10 February.[64] On 19 February, the Red Crescent stated that twelve of its medics were continuing to be detained two weeks after Israel's raid on Al-Amal Hospital.[65] Citing the Health Ministry, UNOCHA reported on 20 February that 70 medical personnel had been arrested following the Nasser Hospital siege.[66]

On 3 March 2024, the Palestinian Red Crescent stated 14 of its staff members were detained, with their status or whereabouts unknown.[67] One staff member was released on 17 March after spending 36 days in detention.[68] Seven more staff were released on 28 March after being held for 47 days.[69] In September 2024, a Palestinian Medical Relief Society paramedic stated that during his arrest, he was stripped naked, zip-tied, blindfolded, and that Israeli soliders put an assault rifle against his head, doused him in gasoline, and threatened to set him on fire.[70]

On 3 May 2024, it was announced that Dr. Adnan Al-Bursh had died on 19 April 2024 while in Israeli captivity. Further details on his cause of death have not yet been given, but dozens of fellow detainees attest to the systematic torture of the doctor, and say it led to his death.[71]

Evacuations

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Northern Gaza

[edit]
See also: Gaza Strip evacuations § Hospitals

On 14 October 2023, Israel ordered the evacuation of 22 hospitals in northern Gaza. The WHO called the order a "death sentence" for the sick and wounded, while Doctors Without Borders condemned it as an attack on medical care and humanity.[72][73] The WHO, UNICEF, and IRC urged Israel to rescind the order, citing critical shortages and the overcapacity of hospitals in southern Gaza.[74][75][76] An urgent evacuation warning was also issued for al-Quds Hospital, which the WHO labeled "deeply concerning," stating it was impossible to evacuate without risking patient lives.[77][78]

Doctors in northern Gaza reported they could not comply with Israel's orders, as moving patients, including ICU newborns, would be fatal.[79] On 16 October 2023, Israel ordered the Al-Ahli Arab Hospital and northern Gaza to evacuate, but insufficient beds and transport made compliance impossible.[80][80] The next day, an explosion in the al-Ahli courtyard caused significant fatalities.[81] Despite bombings, Al Shifa hospital's director stated that medical staff would remain with patients.[82] On 12 November 2023, the IDF announced safe passages for hospitals, but the Gaza Health Ministry reported thousands of patients were unable to evacuate due to Israeli military encirclements.[83][84]

On 14 November 2023, Human Rights Watch stressed the impossibility of evacuating al-Shifa Hospital, citing fires, military operations, and blocked roads.[85] Nevertheless Israel attacked and raided the hospital, and at least 40 patients died during the hospital's siege and evacuation.[86] During the July 2024 evacuation of Gaza City, the al-Ahli Arab Hospital was also evacuated, with witnesses reporting quadcopters flying overhead as patients were evacuated on hospital beds.[87][88] In October 2024, Israel ordered the evacuation of three more hospitals in northern Gaza, with most medics leaving, except for a few who stayed behind with patients unable to be moved.[89][90]

Southern Gaza

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The Gaza European Hospital in Khan Younis, one of the last operational hospitals, evacuated patients, including those in intensive care and infants, to other facilities in July 2024.[91] WHO chief Tedros Adhanom Ghebreyesus confirmed the hospital was "completely empty" after surgeries were canceled and 400 patients and staff were evacuated.[92]

On July 2, the European General Hospital evacuated due to fears of an attack, leaving only Al-Aqsa Martyrs Hospital and a field hospital in Rafah able to perform reconstructive surgery. Dr. Ahmed al-Mokhallalati, Gaza's last reconstructive plastic surgeon, managed treatment for hundreds of patients, conducting up to 10 surgeries a day at the Rafah field hospital.[93] U.N. spokesman Stephane Dujarric stated that constant evacuation orders and hostilities further devastated Gaza's health system, making access to services increasingly difficult.[94]

Medical supplies and equipment

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A surgeon at Al-Ahli Hospital reported that, due to the lack of anesthesia, they resorted to amputations to save lives, causing severe pain for the wounded.[95] In July 2024, Israeli evacuation orders in northern Gaza strained medical facilities further, as they struggled to secure fuel and supplies.[96] Doctors Without Borders warned that without anesthesia, surgeries would become impossible.[97] Following the detection of poliovirus, WHO chief Tedros Adhanom Ghebreyesus highlighted the heightened risk of vaccine-preventable diseases due to the decimated health system, poor sanitation, and shortages.[98] On 31 July 2024, Tedros announced that the WHO would send one million polio vaccines to Gaza.[99]

Amy Kit-Mei Low, a Canadian doctor with Doctors Without Borders, stated that soap and hand sanitizer were being rationed due to supply shortages, preventing proper disinfection.[100] UNOCHA reported that Nasser Hospital faced severe shortages of blood units, medical supplies, and beds while managing mass casualty cases.[101] In August 2024, an American doctor stated that hospitals lacked gauze, soap, and syringes.[102] Al-Aqsa Hospital's spokesperson confirmed that they were missing basic medical necessities, indicating the collapse of Gaza's health sector.[103][104] By June 2024, hospitals in Gaza could not operate at full capacity due to damaged equipment.[105]

Epidemics

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See also: 2024 Gaza Strip polio epidemic and 2023 Israeli airstrikes on municipal services in the Gaza Strip

Scabies, chicken pox, skin rashes, and lice spread rapidly, worsened by starvation and famine in the Gaza Strip.[106] U.N. agencies repeatedly warned of the risk of cholera and other serious diseases becoming epidemics.[106] The spread of diseases was additionally exacerbated by the destruction of Gaza's municipal services, lack of water, and waste buildup.[107][108] WHO's head of health emergencies in the occupied Palestinian territories, Ayadil Saparbekov, stated that the crippled health system and poor sanitation was creating a "bad situation", even as the collapse of Gaza's waste collection system worsened disease spread.[109][110] UNRWA teams used pesticides to combat reptiles, rodents, and insects due to the sanitation breakdown, as doctors struggled to manage wounds infected with maggots[111][112]

In July 2024, the WHO reported over 103,000 cases of lice and scabies, 65,000 cases of skin rashes, and over one million cases of acute respiratory infections in Gaza.[113] More than half a million cases of acute diarrhea and over 100,000 cases of jaundice were recorded.[113] Aid workers also reported a surge in infections like skin ulcers and scabies.[114] In July 2024, poliovirus was detected, and a polio epidemic was declared in August 2024.[115][116] In response, the UN called for a temporary humanitarian ceasefire to conduct a vaccination campaign.[117] By August 2024, more than 100,000 cases of Hepatitis B and 40,000 cases of Hepatitis A were recorded, with the UN attributing the outbreaks to overcrowded shelters and lack of hygiene supplies.[118][119][120] UNOCHA found that women and girls comprised most cases of hepatitis A and gastrointestinal diseases.[121]

War crimes

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This section is an excerpt from Israeli war crimes in the Israel–Hamas war § Violations of medical neutrality.[edit]
Palestine Red Crescent ambulance destroyed by an Israeli airstrike

Israel is alleged to have broken medical neutrality, a war crime under the Geneva Conventions as hospitals are given special protection under international humanitarian law.[122][123] These attacks have been carried out in a manner that aid groups and international bodies are increasingly referring to as systematic.[124] According to Gaza officials, the IDF deliberately targeted ambulances and health facilities with airstrikes.[125][126] In a statement, the Palestine Red Crescent demanded "accountability for this war crime".[127] The International Federation of Red Cross and Red Crescent Societies, UNRWA, and Medecins Sans Frontieres reported the deaths of their medical personnel.[128][129] On 14 October, the World Health Organization said the killing of health care workers and the destruction of health facilities "denies civilians the basic human right of life-saving health" and is prohibited by International Humanitarian Law.[130][131] On 17 October, WHO stated 51 health facilities had been attacked by Israel.[132][133] On 4 November, the Gaza Health Ministry stated 105 medical facilities had been deliberately targeted.[134]

On 21 October, the Ministry of Health noted Israel had attacked 69 health facilities, 24 ambulances, put 7 hospitals out of commission, and killed 37 medical staff.[135] Health workers and aid groups said several hospitals in Gaza were hit by airstrikes and shelling. The Palestine Red Crescent Society accused Israel of "deliberately" carrying out airstrikes "directly around" Gaza's second-largest hospital, al-Quds Hospital, in north Gaza, to force them to evacuate the facility. The World Health Organization (WHO) found it impossible to evacuate the hospital. According to CNN, even those who evacuated south have not been safe.[136] On 30 October 2023, a Turkish-Palestinian Friendship Hospital, located in the south of Gaza, was struck by a "direct hit", causing damage and injuries.[137]

On 3 November, an Israeli airstrike hit an ambulance convoy departing from al-Shifa Hospital carrying, according to a Palestinian Health Ministry spokesman, 15-20 critically injured patients.[138] The Israeli military confirmed the strike, saying one of the ambulances was being used by a "Hamas terrorist cell", and was close to their position.[139] In response, Yanis Varoufakis noted, "Even if the ambulance was carrying a Hamas overlord, bombing it violates the Geneva Convention."[140] UN chief António Guterres stated he was "horrified" by the attack.[141] In prior weeks, Israel had released an animated video stating Al-Shifa hospital contained a hidden, top-secret underground military center.[142] This was flatly denied, with Hamas stating Israel was using "prefabricated" evidence to pre-empt a military strike on a hospital.[143] Laws of war provide limited protections to medical facilities used in such capacities.[144] HRW stated the strikes were apparently unlawful and should be investigated as a possible war crime.[145]

During the Siege of Gaza City, Israeli snipers reportedly fired on the intensive care unit in Al-Quds Hospital, killing one person and wounding 28.[146] Doctors in Al-Shifa Hospital reported snipers at the outskirts of the complex were firing at "any moving person".[147] Fabrizio Carbone, the Middle East regional head of the International Committee of the Red Cross, stated Israel's attacks on al-Shifa Hospital could not continue, stressing patients and hospital staff should be "protected in line with the laws of war".[148] In response to the Al-Shifa Hospital siege, Human Rights Watch stated Israel's actions against hospitals need to be investigated as war crimes.[149] Jennifer Cassidy, a legal expert at University of Oxford, stated Israel's siege on al-Shifa was a war crime "plain and simple".[150] Following an Israeli attack on Indonesia Hospital, the Indonesian Foreign Minister called it a clear violation of international humanitarian law.[151]

Photos of Palestinian healthcare workers killed during fighting in Gaza, 25 November 2023

On 18 November 2023, two people were killed while traveling in a clearly identified Doctors Without Borders evacuation convoy in Gaza City.[152] Doctors Without Borders termed it a "deliberate attack."[153] On 16 December, the Euro-Mediterranean Human Rights Monitor called for an international investigation into Israeli war crimes at the Kamal Adwan Hospital.[154] On 17 January 2024, Israeli fire damaged the Jordanian field hospital, leading the Jordanian army to call it a "flagrant breach of international law".[155] On 19 January, Jordan stated Israel had "deliberately" targeted the hospital.[156] The World Health Organization stated on 24 January it had recorded 660 Israel attacks on healthcare facilities, calling them "a flagrant violation of international humanitarian law".[157] On 31 January, Doctors Without Borders stated Israel had conducted "systematic attacks on health facilities" which they stated was unprecedented for their organization.[158]

On 8 February 2024, the Palestinian Red Crescent accused the IDF of deliberately killing one of their paramedics.[159] On 11 February, the Red Crescent accused the IDF of deliberately targeting and killing two of their paramedics sent to rescue Hind Rajab, calling the killing a war crime.[160][161] In response to an Israeli attack at the Al-Aqsa Hospital on 31 March 2024, WHO chief Tedros Adhanom Ghebreyesus stated, "The ongoing attacks and militarisation of hospitals must stop. International humanitarian law must be respected."[162] In May 2024, the Palestinian Red Crescent stated an Israeli attack on their ambulances near Rafah was a war crime.[163] Following the attack, WHO stated, "Health workers are protected under international humanitarian law".[164] In June 2024, the UN Human Rights Office discussed the killing of health workers in Gaza, stating, "These killings have occurred against the backdrop of systematic attacks on hospitals and other medical facilities in violation of the laws of war".[165] In July 2024, the government of Turkey stated that images showing Israel using the Turkish-Palestinian Friendship Hospital as a military base indicated violations of international humanitarian law and threatened to take Israel to court.[166]

Use of human shields by Hamas

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This section is an excerpt from Use of human shields by Hamas.[edit]

Hamas has been accused of using human shields in the Gaza Strip, purposely attempting to shield itself from Israeli attacks by storing weapons in civilian infrastructure, launching rockets from residential areas, and telling residents to ignore Israeli warnings to flee. Israel has accused Hamas of maintaining command and control bunkers and tunnel infrastructure below hospitals, with some of the accusations being supported by the United States, the European Union, and the United Nations Secretary General. Hamas has denied using civilians and civilian infrastructure, including hospitals,[167] as human shields.[168]

Israel has said that Hamas's actions have caused Israel to kill civilians as collateral damage.[169] Human rights groups have said that “even if Hamas were using human shields”, Israel must still abide by international law, especially the principle of proportionality.[170][171]

Neve Gordon, professor of international law and human rights and co-author of the 2020 book Human Shields: A History of People in the Line of Fire,[172] has stated that Israeli military and government claims of Hamas using Palestinian civilians as human shields "should be understood as a pre-emptive legal defence against accusations that Israel is committing war crimes and crimes against humanity in Gaza."[173] He also accuses state actors such as Israel of using human shielding allegations to hypocritically justify their own war crimes against civilians, adding: "This justification, however, functions only in one direction. When state actors kill civilians, it’s become standard to describe them as human shields. But when non-state actors attack military targets in urban settings, the civilians they kill are still recognised as civilians."[173]

Janina Dill, a laws of war professor at University of Oxford, stated, "Even if Hamas uses civilians as human shields, those civilians are entitled to full protection under international law unless they directly participate in the fighting".[174] Scholars in international law have cautioned that accusing Hamas of using human shields requires proving intent to shield a military target with civilians.[175]

Amnesty International investigated Israeli claims that Hamas used human shields during the 2008–2009 Gaza War and the 2014 Gaza War but found no evidence to support these claims. In their report on the 2008–2009 war, Amnesty stated they found no evidence of Hamas directing civilians to shield military assets or forcing them to stay near buildings used by fighters. They did find that Hamas launched rockets from civilian areas, which endangered civilians and violated the requirement to protect civilians from military action, but this does not qualify as shielding under international law.[176] In 2014, Amnesty reported they had no evidence that Hamas or other Palestinian armed groups intentionally used civilians as shields to protect specific locations or military assets from Israeli attacks. They suggested that Hamas's urging of residents to ignore Israeli evacuation warnings might have been intended to minimize panic and displacement, rather than to use civilians as human shields.[170] Human Rights Watch (HRW) also stated they found no evidence that Hamas used human shields during the 2009 conflict.[177]

During the Israel–Hamas war of 2023–2024, EU nations accused Hamas of using hospitals as human shields, while the UN Secretary General said "Hamas and other militants use civilians as human shields".[178][179] In 2023, HRW said that "Hamas and other Palestinian armed groups need to take all feasible precautions to protect civilians under their control from the effects of attacks and not use civilians as 'human shields.'"[180] In 2024, HRW reported at least two incidents where Palestinian fighters appear to have used Israeli hostages as human shields during the 2023 Hamas-led attack on Israel.[181] According to the New York Times, some Gazans showed opposition to their usage as human shields by Hamas and some have refused the entry of militants to some shelters.[182]

Reactions

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Doctors and nurses returning from Gaza stated they had "never seen anything like this".[183] In June 2024, the UN Human Rights Office discussed the killing of health workers in Gaza, stating, "These killings have occurred against the backdrop of systematic attacks on hospitals and other medical facilities in violation of the laws of war".[184] In July 2024, Justin Welby, the Archbishop of Canterbury condemned the forced closure and evacuation of the Al Ahli Hospital, stating, "In the face of intense Israeli bombardment, this closure puts injured and sick people in even greater danger".[185] Save the Children criticized Israel's July 2024 attacks on schools and hospitals, calling them "horrific" and stating the "healthcare and education systems are being decimated before our eyes".[186] Dr. Javid Abdelmoneim, a physician with Médecins Sans Frontières, discussed Gaza's healthcare system in August 2024 after returning from two weeks in the Strip, stating, "The system is on its knees. Nowhere is safe... The aid workers are also becoming sick, crippling the aid response".[187]

See also

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References

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