Israel's military campaign has left Gaza's medical system near collapse

Before Israel's invasion of the Gaza Strip last year, Dr. Mahmoud Al-Reqeb worked in one of the Palestinian territory's largest hospitals and had a private clinic, caring for women throughout their pregnancies.

Now, he lives in a plastic tent in Rafah, a Palestinian border town where roughly half of Gaza's population has sought refuge, and treats patients for no charge in another tent. Living under Israeli bombardment, with shortages of food and clean water, the pregnant women he serves struggle to find basic safety and nourishment, let alone prenatal care.

Since the Israeli military began bombarding Gaza six months ago following the Hamas-led October 7 attack, its forces have wrecked entire hospitals, struck ambulances and killed or detained hundreds of health care workers. Israeli restrictions on goods entering Gaza have prevented lifesaving medical supplies from reaching patients, according to aid groups. And shortages of fuel, water and food have made it difficult for medical workers to provide basic services.

The result has been the near collapse of a health care system that once served Gaza's population of more than 2 million. By late March, of the 36 large-scale hospitals across Gaza, only 10 were "minimally functional," according to the World Health Organization.

Israeli officials say that medical centers have been targets because Hamas fighters embed themselves within and under the facilities, and that it is the only way to root out the armed group. Hamas and medical workers have denied this accusation. Aid groups, researchers and international bodies have increasingly been calling Israel's dismantling of Gaza's medical capacity "systematic."

"If you engineered the destruction of a health care system, you would end up exactly where we are today," said Ciarán Donnelly, a senior vice president at the International Rescue Committee, an aid group that has been operating in Gaza.

Donnelly said he had worked in the humanitarian aid sector for two decades and could not think of any other war in which a medical system has been so thoroughly crushed so quickly.

Asked for comment, the Israeli military referred to previous statements it has made about Hamas fighters' embedding themselves in facilities. Evidence examined by The New York Times suggests Hamas has used Shifa Hospital -- which the Israeli military has raided -- for cover, stored weapons inside it and maintained a lengthy tunnel. The Israeli military has not presented similarly expansive evidence about most of the other health care centers it has attacked.

Al-Reqeb's old facility, Nasser Hospital, was raided by Israeli troops in February. When he goes to his new job, at an Emirati-funded hospital -- one of the few facilities in Gaza providing specialized gynecological and obstetric services -- he is one of fewer than 10 doctors treating 500 patients a day with a "severe lack of supplies, staff, medicine and equipment," he said.

"I was very shocked when I realized the level of damage the medical system is suffering," Al-Reqeb, 33, said in a telephone interview. "It is completely destroyed."

In November, Human Rights Watch called for Israeli attacks on medical facilities and personnel to be investigated as war crimes. Doctors interviewed by the Times said at the time that they were performing surgeries without anesthesia and confronting filthy wounds infested with maggots because of a lack of fresh water and iodine. A WHO database has recorded more than 800 "attacks on health care" in Gaza and the West Bank.

The devastation of the medical system has rippled throughout Gaza. Cancer patients have had to halt chemotherapy. People with kidney failure have lost access to lifesaving dialysis. Pregnant women have gone without the monitoring that could help identify life-threatening conditions like preeclampsia.

"Sometimes I cry," said Dr. Zaki Zakzook, an oncologist who was once one of Gaza's preeminent cancer doctors and now lives in a tent with his family in Khan Younis. "I'm watching my patients being executed, slowly and gradually."

Zakzook has been able to do little for his patients since the war forced the closing of the cancer hospital where he worked, he said. He now sees patients at a hospital in the south but no longer gives them chemotherapy, fearing that doing so would weaken their immune systems at a time when the medical system is unable to cope with infection, he said. Instead, he offers palliative care, such as painkillers.

"I'm trying to do my best, others are trying the same, but what can we do?" he said.

In February, Israeli forces stormed Nasser Hospital, a large facility in Khan Younis. They shelled the hospital's orthopedic department and detained dozens of health care workers, according to Doctors Without Borders, an aid group whose staff members witnessed the attack.

"The evidence at our disposal points to deliberate and repeated attacks by Israeli forces against Nasser Hospital, its patients and its medical staff," the organization wrote. The Israeli military said it had been searching for Hamas fighters and the bodies of Israelis taken captive during the Oct. 7 attack.

In March, the Israeli military raided Shifa Hospital for a second time, killing nearly 200 people it called terrorists. Israeli troops left widespread devastation in their wake after extended gunbattles with Palestinian militants in and around the complex. It said its troops had come under fire inside and around one of the hospital's buildings. Gaza authorities said 200 civilians had died in the raid. Neither statement could be independently verified.

After the raid, the hospital premises were littered with dead bodies and shallow graves, according to the World Health Organization, which led a team this month to evaluate the hospital's condition.

In a statement after its visit to the facility, the WHO said the hospital was "an empty shell," with no patients and most of its equipment "unusable or reduced to ashes."

"There's increasing evidence that a red cross or red crescent actually puts a target on you, rather than the other way around, and it is just an appalling degradation of human values," said Dr. Tim Goodacre, a surgeon who has been traveling to Gaza for years to help train Palestinian doctors and volunteered at a hospital there in January.

Before the war, Abdulaziz Saeed's 63-year-old father was expecting to receive a kidney transplant in March. Saeed and his mother had both been approved as potential donors. Then the war began. The doctor who was to perform the operation was killed, Saeed said, and "all our plans have been canceled."

His family now shares its home with dozens of displaced people in the city of Deir al Balah, and his father, who previously needed three dialysis sessions a week for renal failure, is able to receive only one a week at Al-Aqsa Martyrs Hospital.

"The biggest issue is the lack of medical staff," Saeed said. "There used to be three specialized doctors in the kidney department. Two of them were killed, and the third is unreachable."

Anas Saad, 24, a nurse who works at the hospital, said many of his colleagues had quit after the repeated attacks on medical facilities.

"This is no longer a safe place," Saad said. "I am doing my best to help people survive. However, it is becoming extremely risky, as hospitals can be stormed or bombed anytime."

Dr. Tanya Haj Hassan, an American pediatric intensive-care doctor, recently entered Gaza as part of a team of foreign doctors to volunteer at the hospital. She described "apocalyptic" scenes, including a girl who, she said, died after an Israeli bulldozer ran over a tent, crushing her, and a boy in a wheelchair whose entire family had been killed but who believed that his parents were coming to get him because "nobody has the heart to tell him." Her account could not be independently verified.

The entirety of Gaza "just feels like it was hit by a nuclear bomb," she said. "The reality is, they've taken out hospital at a time. 'Hospital at a time' -- I can't believe I'm even saying those words."