Gaza’s Health System Under Siege: The Ethical, Operational and Humanitarian Implications for Regional Health Security

Abstract Since 2007, Gaza’s health system has operated under prolonged blockade and recurrent military assaults, leading to its near-total collapse after the escalation of hostilities in October 2023. Repeated attacks on healthcare infrastructure, personnel, and supply chains have dismantled tertiary care and severely weakened emergency, preventive, and public health services. Of the 36 hospitals that once functioned in Gaza, only a small number remain partially operational, with drastic losses in hospital beds, essential equipment, and trained staff. All of the above have largely impacted access to advanced medical care. Gaza has never experienced a higher number of casualties since the start of the war, including deaths and injuries in a situation where medications, fuel, and other supplies have become scarce. Communicable diseases have broken out due to overcrowding, malfunctioning sanitation systems, and disrupted vaccination campaigns. Antibiotic scarcity and poor infection-control measures have increased the spread of microorganisms. This Humanitarian catastrophe extends beyond its immediate effects, as the destruction of Gaza’s health system is threatening regional public health, increasing political instability, and affecting medical neutrality. Coordinated regional and international action to safeguard healthcare, restore supply chains, strengthen disease surveillance, and ensure accountability for attacks on health services in conflict settings is key to addressing the crisis.