Doctors without tools and patients trapped: Israel has annihilated Gaza's healthcare system

BarcelonaThree years after the start of Israel's genocidal offensive on Gaza, Dr. Abdelrahman, an orthopedist at one of the few hospitals that remain partially operational in the Strip, explains to ARA the impossible conditions in which they work, without basic tools, with a systematically destroyed healthcare system and a population facing a chronic humanitarian crisis. Before the war, he worked at the Indonesian Hospital, in the north of the Strip, which was put out of service because it is located in the area under the control of the Israeli army. He has moved to the Nasser Medical Complex, in Khan Yunis, the largest one that continues to function in the south of the Palestinian enclave, where the majority of the population has been displaced by bombings on civilian areas.

“We still have qualified doctors to perform operations, but we do not have the tools or the most basic material to perform them,” he explains in a conversation via WhatsApp. Only 22 of the 34 hospitals in the Strip remain operational, and neither in the north nor in the south of the Strip is there any surgical bed available. Entire specialties have disappeared: in Gaza, open-heart surgeries, transplants, and radiotherapy can no longer be performed. At the Nasser Complex, Abdelrahman explains that even the most elementary materials are missing. “We do not have simple things: physiological saline, gauze, bandages, and many essential medicines and for chronic diseases.” According to the latest report from the Gaza Ministry of Health, 44% of essential medicines are at zero stock: due to the blockade imposed by Israel on the entry of goods into Gaza, anesthetics, chemotherapy drugs, and insulin are missing, which is essential for the 2,500 diabetic patients. Only 122 incubators remain operational, 40 fewer than before the war, and there are more and more babies born with low birth weight problems due to malnutrition and the mothers' stress, so they have to share incubators, with the evident risk of contracting lethal infections.

Blind doctors

One of the most serious consequences of the destruction is the loss of diagnostic capacity. 62% of diagnostic devices have been destroyed. “We prioritize cases to ensure the CT scanner remains available for emergencies,” explains Abdelrahman. “Many patients die because we do not have the tools to diagnose them properly.” Doctors have to work in the dark.

The lack of diagnosis is combined with an extreme shortage of surgical material. Abdelrahman lists the interventions he can no longer perform normally: total knee and hip replacements, arthroplasties, and arthroscopies. There is also a lack of intramedullary nails and anatomical plates to fix femur and tibia fractures. “Most of my patients have complicated fractures that, if not treated properly, will mark them for life,” he explains. And so, health problems become chronic. Injuries that could have been treated with a quick intervention end up in permanent pain, deformities, mobility difficulties, or disabilities.

Abdelrahman sees this every day among his patients. “Many have knee problems, such as osteoarthritis or ligament injuries, and a very poor quality of life. There is no solution for them. Only waiting to be able to travel if the war ends and we are allowed to leave this prison that is the Gaza Strip.” But leaving Gaza to receive treatment has also become a remote possibility. 2,027 patients have died while waiting for a medical evacuation; about 21,000 remain on the waiting list, and only 14% of the patients who needed to be evacuated have managed to leave. These are cases of cancer, complex traumatic injuries, heart diseases, and pathologies that cannot be treated in the Strip, and that wait for months or years for an authorization that may arrive too late.

Lack of healthcare personnel

The destroyed infrastructure is only part of the problem. A substantial part of the healthcare personnel has also been lost. The system is missing 2,074 medical professionals. There are only 1,363 doctors available: in three years, Gaza has lost a third of its doctors. Of the 70 gynecologists who worked in the Strip before the war, only 29 remain; of the 100 pediatricians, 69 remain. A collapsed system that must respond simultaneously to war trauma, pregnancies, premature newborns, oncology patients, diabetics, and infectious diseases, for a population of two million people, but with far fewer professionals, fewer beds, and less equipment than three years ago.

Abdelrahman describes his exhaustion and that of his professional colleagues. “Almost all of us suffer from burnout due to the enormous workload,” he explains. In addition to the grueling hospital shifts, they have to worry about finding food and a safe place for their families. “The main challenge is finding the balance between meeting the needs of our families and fulfilling our professional obligations, working overtime to try to help as much as we can,” he says. Even getting to the hospital has become an obstacle course. “There are no cars. And when you find one, the conditions are very uncomfortable. That is why we walk a lot: every day I walk at least seven kilometers due to a lack of transport”.

Conditions that cause illness

At the same time that the capacity of the healthcare system is decreasing, the needs of the population are growing. Respiratory and skin infections have soared, fueled by overcrowding, the destruction of water and sanitation networks, and the precarious living conditions of hundreds of thousands of displaced people. Child malnutrition has also increased, which weakens the immune system and multiplies the risk of complications from infections that would be treatable under other circumstances. “There are so many problems here. Words are never enough and cannot explain how hard our life is, especially for the healthcare staff,” summarizes Abdelrahman. “But we try to be strong and do everything we can.”