Causes and consequences of overcrowding in emergency departments and its impact on patients’ care at main governmental hospitals in Gaza Strip: a cross-sectional study

Emergency department (ED) overcrowding is a growing challenge in many healthcare systems, particularly in resource-limited settings such as the Gaza Strip. It negatively affects patient care quality, staff performance, and overall hospital efficiency. This study aimed to identify the main perceived causes and consequences of ED overcrowding in major governmental hospitals in Gaza and to assess its perceived impact on healthcare delivery. A descriptive cross-sectional study was conducted among 289 healthcare professionals, including doctors (59.2%) and nurses (40.8%), working in the EDs of Al-Shifa Medical Complex, Nasser Medical Complex, European Gaza Hospital, and the Indonesian Hospital. Data were collected using a structured, self-administered questionnaire that assessed demographic characteristics, perceived causes, and consequences of overcrowding. Statistical analysis was performed using SPSS, employing descriptive statistics, independent t-tests, and one-way ANOVA to determine significant differences among participants’ responses. The most frequently perceived causes of overcrowding included the high number of non-emergency cases presenting to EDs (91%), inadequate staff salaries (90.8%), limited bed capacity (88.2%), and insufficient staffing (86.8%). Significant differences in perceptions were observed according to gender, profession, years of experience, workplace, and department (p < 0.001). The main perceived consequences were increased staff stress and workload (79.6%), reduced job satisfaction (82.6%), delayed patient care (76.8%), and increased risk of violence toward staff (82.6%). Overcrowding in Gaza’s emergency departments is perceived as a complex and multifactorial problem that may affect healthcare delivery and staff wellbeing. Addressing this issue may require systemic interventions such as improving triage protocols, enhancing staffing and resource allocation, strengthening coordination between pre-hospital and ED services, and promoting public education on appropriate ED use to ensure timely and effective patient care.