Primary healthcare service delivery during an active conflict: The 2023 Israel-Hamas War

In December of 2023, Project HOPE, an international humanitarian aid organization, opened a primary healthcare clinic in Deir al Balah, Gaza. The clinic was created in response to increased population healthcare needs during the 2023 Israel-Hamas war. This article describes the startup and case mix from the Project HOPE primary healthcare clinic in Deir al Balah, Gaza between December 2023 and June 2024. Opening the clinic required navigating several logistical, administrative, security, and technical challenges common to humanitarian contexts. Over a six-month period, the clinic conducted over 24,000 patient consultations; major morbidities included those due to communicable diseases (upper respiratory tract infections, skin diseases, acute watery diarrhea, etc.), as well as obstetric visits. Visits due to trauma and chronic diseases made up a low proportion of visits. Children between 6 months and 5 years of age and pregnant and lactating women were also assessed for their nutritional status using mid-upper arm circumference measurement. Prevalence of malnutrition varied over the study period with percentages in children increasing, while those in pregnant and lactating women decreased. Indirect morbidity and mortality due to lack of access to healthcare services during conflict is an often under-reported issue and Project HOPE’s reported experience in the Deir al Balah clinic may help to inform subsequent health interventions in Gaza and in other conflict-affected settings.