Opinion

No healthcare system could cope with the volume and complexity of the injuries we’re treating in Gaza

Humanitarian law is effectively being buried under the rubble of Gaza alongside thousands of children, women and men, writes Isabel Simpson, executive director of Médecins Sans Frontières Ireland

Hospital staff treat an injured youth at the Al-Aqsa Martyrs Hospital in Deir al-Balah, central Gaza Strip, on April 9th, 2024. Photograph: AFP/Getty

Isabel Simpson
Wed Apr 10 2024 - 18:36

Within days of Israel’s declaration of war in Gaza, airstrikes damaged several hospitals and a clinic supported by Médecins Sans Frontières/Doctors Without Borders (MSF). Another strike hit an ambulance carrying the wounded in front of a hospital where our surgical team was working.

Amid what was already an all-out assault on Gaza, this was an early indication that Israel was waging a war with total disregard for the rules intended to protect civilians, humanitarians and healthcare workers during conflict.

Following the attacks, MSF called in this newspaper for “medical facilities to be respected” and for Israel’s assault to not “under any circumstances lead to the collective punishment of the population”. We feared Israel’s conduct would not only create massive civilian casualties but would also severely hamper the humanitarian and medical response to the unfolding catastrophe.

We did not know then the full extent of the horrors and human suffering that lay in store for the people of Gaza and the humanitarians dedicated to helping them.

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Now, six months on, we have not only witnessed Israel’s unjustifiable killing of more than 33,000 people (many of them women and children), but also an unprecedented rate of attacks against health facilities and medical personnel. At least 200 humanitarians have been killed in Gaza since October, including five of our colleagues in MSF, by Israeli airstrikes, gunfire or shelling while they worked or took shelter.

Hospitals have been reduced to rubble, while ambulances and vehicles have been targeted and destroyed. Gaza’s largest hospitals, Al-Shifa in the north and Nasser in the south, are now in ruins.

We are witnessing Israel continually breach the rules of war intended to protect civilians and humanitarians amid conflict. In full view of a mainly complicit international political system, international humanitarian law is effectively being buried under the rubble of Gaza – alongside thousands of children, women and men.

Palestinian forensic and civil defence personnel recover human remains at Al-Shifa hospital, Gaza's largest, which has been badly damaged in Israeli strikes, on April 8th, 2024, as Israel's war against Hamas continues. Photograph: AFP/Getty

Furthermore, we are witnessing a flagrant disregard for provisional measures on the prevention of genocide from the International Court of Justice (issued in January and March). These measures are intended “to prevent the killing” and “serious bodily harm” of Palestinians in Gaza, and “to enable the provision of urgently needed humanitarian assistance”.

A recent attack by Israeli forces not only resulted in the killing of seven staff from World Central Kitchen bringing food to starving people in Gaza (Israeli forces say they dismissed two officers and reprimanded senior commanders in response), but also contributed to the paralysing of vital aid efforts by some organisations in Gaza.

We know first-hand how dire the hunger situation is from our staff in the north of Gaza who tell us that, to survive, people are stewing grass or mixing human food with animal feed. Medics in Rafah who specialise in intensive care are retraining to respond to the new reality of malnourished children presenting at our medical facilities. Staff must make impossible choices about hospital beds for the seriously injured or malnourished.

The Government of Ireland must now increase all diplomatic and political efforts at its disposal to push for an immediate and sustained ceasefire

Our dedicated Palestinian and international medical teams are working in an ever-decreasing area in the Gaza Strip. In Rafah, many of our colleagues live in tents alongside the 1.5 million people crammed into an area about the same size as Galway city. They still show up to work every day to provide vital surgical and medical services.

Most of the injuries we are seeing in Rafah are caused by the impact of explosions. Our patients are in buildings or tents when bombs hit their homes. They get trapped under rubble, and fires break out. People get crush injuries to the abdomen or the thorax. Amputations are often required for the legs and arms of the injured. On top of that, patients suffer severe burns over large parts of their bodies.

At an additional wound station set up in the parking lot of one hospital, an MSF colleague described it as a “conveyor belt” of wounded people seeking care for “horrendous injuries caused by modern weapons that maim and kill indiscriminately”. Many patients die in agony and pain that cannot be medicated. No healthcare system in the world can cope with the volume and complexity of the injuries that we’re seeing along with the conditions that already exist in Gaza.

We have brought in hundreds of tonnes of vital medical supplies to support our work, but far more aid needs to reach hospitals and health centres across Gaza.

Humanitarian assistance is much more than just counting trucks. It is about moving supplies around safely, and about security at the point of distribution. Functioning hospitals are more than four walls and a roof. They need water, electricity, fuel and communications. They need trained, qualified staff who can remain in the health facility long enough to provide continuity of care for complex fractures and infected wounds.

Israel must stop its indiscriminate bombings and attacks on humanitarian workers. The systematic destruction of medical facilities across the Gaza Strip must stop. Hospitals are not a target. All humanitarian workers should be protected under international humanitarian law. Nothing justifies attacks on patients and health workers. An Israeli offensive on Rafah would lead to an even more severe catastrophe and must not take place.

The Government of Ireland must now increase all diplomatic and political efforts at its disposal to push for an immediate and sustained ceasefire, and use its influence in Europe to convince states that support Israel, as well as US and UK, to prevent more deaths and injuries and to scale up the full flow of humanitarian aid on which the survival of the population of Gaza depends.

This unprecedented human suffering in Gaza must end now.

Isabel Simpson is executive director of Médecins Sans Frontières/Doctors Without Borders (MSF) Ireland. MSF provides medical assistance and surgical care, injury, wound treatment and psychological support to people in Gaza and the West Bank. MSF is an independent, neutral, humanitarian medical humanitarian organisation providing healthcare in over 70 countries worldwide

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