The data is clear: Gaza’s healthcare system is being pushed to the brink.
In just 60 days of war, the number of functioning hospitals has dropped by more than half – from 36 to 15 – because of Israeli strikes and a lack of resources. None of the hospitals in northern Gaza have the capacity to perform surgeries, and only six out of 24 have basic services.
Of the hospitals that are still able to function, 12 are concentrated in central or southern Gaza. And they’re becoming the backbone of the entire healthcare system.
During a temporary ceasefire, some aid was able to enter and be distributed around Gaza. Data collected by the World Health Organization (WHO) and Health Cluster shows a slight increase in hospital functionality during the period immediately before the pause in fighting.
As fighting resumed after a temporary ceasefire and Israel expanded its ground offensive in southern Gaza, pressure on hospitals and their staff has risen significantly.
“Every day you felt you were in quicksand where you had to more and more difficult decisions based on availability rather than based on clinical need,” said British-Palestinian doctor Ghassan Abu Sittah, who spoke with Sky News in London after working for several weeks at al Shifa and al Alhi hospital in northern Gaza.
The 15 hospitals that are still operational are only “partially” functioning, according to the WHO. This means they do not have all the resources they need because of a lack of medical supplies or personnel. This was the case even before the war because of Israel’s blockade on the flow of goods that has been in place since Hamas took power in 2007.
But over the past two months, Gaza’s medical system has deteriorated dramatically.
Three hospitals are minimally functioning, only able to provide basic services or first aid, and 18 are not functioning at all.
By the WHO’s definition, hospitals are rendered out of service when patients cannot reach them, health workers cannot properly work, if hospitals are under attack, or if there is a lack of resources, overflow of patients, and exhausted staff.
Overcapacity
“Those able to admit patients are delivering services well over their intended capacities,” said Dr Tedros Adhanom Ghebreyesus, director-general of the WHO during a news conference on 29 November. “The health system at the moment is extremely vulnerable.”
The total bed capacity in Gaza has gone down from 3,500 to only 1,500, according to the WHO. Hospitals are further crowded by Palestinians seeking shelter from the fighting.
At Nasser Hospital in Khan Younis, people are being treated on the floor.
Five miles away, the European Hospital is operating at triple its capacity.
“Nasser and the European Hospital are the two that are trying to cope with the big numbers of patients and the injured coming from the north and also in the south,” said Dr Guy Shalev, executive director of non-profit Physicians for Human Rights Israel, which helped run training for medical staff in Gaza before the war.
His team spoke to the director of the European Hospital, Dr Youssef al Aqqad, who said the conditions at both hospitals, with so many injured patients and a lack of supplies, are exacerbating an already dire situation.
Khan Younis in southern Gaza, where many Palestinians have fled to from the north, is experiencing a surge in violence.
The Israel Defence Forces (IDF) said it has moved to the third phase of fighting, operating against what it claims are Hamas strongholds in the south.
“The same thing which happened in the north is now happening in the south,” Helen Ottens-Patterson, Médecins Sans Frontières’ former head of mission in Gaza, told Sky News.
Attacks on healthcare
Since the start of the war on 7 October, 74 health facilities have been destroyed or damaged and 95 health workers have been killed, according to Sky News’ analysis of data collected by Insecurity Insight, a group that gathers data on attacks on healthcare around the world.
In Israel, one hospital had to suspend its services due to an attack, and nine health workers were killed over the same period, according to the data.
Insecurity Insight’s definition of a health facility incorporates pharmacies, clinics, laboratories, as well as hospitals. Attacks, destruction or damage are harder to define.
“You also have the difficulties for the health system that come from the destruction of the wider infrastructure,” said Christina Wille, director of Insecurity Insight, explaining its data collection methodology.
“If the electricity is knocked out, or if there are problems with the salination system. The definition really is the denial of healthcare.”
International law
One reason hospitals have been getting caught in the crosshairs of this war is that Israel claims it has evidence that Hamas has been hiding command centres beneath certain medical facilities such as al Shifa hospital, and using hospitals as human shields, which Hamas has repeatedly denied.
Hospitals and medical infrastructure have protected status under international humanitarian law. However, they can lose those protections if they are used in a way that is harmful to the enemy, according to the International Committee of the Red Cross.
Legal and human rights experts say Israel has yet to provide sufficient evidence to prove Hamas was using these hospitals to justify its operations inside medical facilities.
“What we do have a lot of evidence of is that the IDF didn’t do anything to protect the civilians inside the hospital,” said Leonard Rubenstein, a professor of public health and human rights at Johns Hopkins University.
There are now more than 42,000 Palestinians who have been injured and nearly 16,000 who have been killed in the war so far, according to the Hamas-run Gaza Health Ministry.
It followed Hamas’s 7 October attack, in which 1,200 people were killed and 240 more were abducted and taken into Gaza.
The next phase
Field hospitals have been set up by Jordan and the United Arab Emirates.
The Biden administration has also pledged more aid and funding to Gaza, which will include support for an NGO-operated field hospital, according to a statement from the United States Agency for International Development (USAID).
But aid workers say those facilities won’t be enough to support the needs of the wounded and sick.
“They have a lack of surgeons, so it’s more dressings, basic things. And they don’t have a lot of beds,” said Ottens-Patterson of Médecins Sans Frontières.
“It seems to be very chaotic, so there’s no real systematic rationalization of where aid should go or where the priorities are. The needs are so overwhelming.”
The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.