Once a house of healing, the al-Shifa complex in northern Gaza has turned into a battleground, threatening the lives of patients, doctors, and premature babies. The Israeli army’s invasion of the hospital complex, following a series of assaults on Gaza’s health infrastructure, is a stark illustration of much larger concerns; namely, the strategic weaponization of health by Israeli forces in serving specific military objectives. The deliberate targeting of health infrastructure, manufactured scarcity of medical supplies and fuel, and restricted access to basic necessities (including water, food, and vital aid) are all different means through which the destruction of healthcare has been used as a weapon of war against the population of Gaza. The deterioration of public health in Gaza—enabled and imposed by Israeli violence—has sought to amplify the scale of human losses inflicted upon civilians in the strip and push survivors into exodus.
A history of the weaponization of health in Gaza: A chronicle of de-development
The concentrated attacks against healthcare facilities and personnel witnessed in the aftermath of October 7 are deeply rooted in a history of weaponization of health by Israeli occupation forces. The strip’s healthcare system has been chronically crippled by an unlawful 16-year blockade, which restricted access to medical supplies, equipment, and material, among other vital necessities. Severe engineered shortages of essential equipment and specialized staff have fundamentally undermined the capacity of the Gazan health sector to develop. This makes it incredibly hard for the sector to accommodate the rising healthcare needs of the population.
Severe engineered shortages of essential equipment and specialized staff have fundamentally undermined the capacity of the Gazan health sector to develop
Patients requiring access to specialized treatment outside of the strip have routinely been prevented from exiting. In 2021, over 36 percent of requests for medical permits have either been refused or left unanswered by Israeli authorities, condemning patients with urgent conditions to preventable deaths. Additionally, regular flare ups of violence punctuating the dynamics in Gaza have featured a purposeful and repeated targeted destruction of health facilities and ambulances.
In 2006, the Israeli invasion of Gaza caused the destruction of various civilian infrastructural landmarks, including the strip’s main power plant. In addition to direct civilian casualties, the lack of clean water caused the rapid spread of waterborne diseases, while limited public health resources represented a severe threat to the lives of thousands of patients requiring urgent or chronic care. Two years later, about 34 health facilities were damaged or destroyed after Israeli forces launched the military campaign “Operation Cast Lead” in December 2008, while those not targeted still struggled to provide adequate care due to severe water, electricity, and medical supply shortages. Positioned snipers also opened fire on civilians and doctors attempting to evacuate patients from al-Quds hospital, after it had been heavily bombed. Similarly, 2014 was a particularly violent year in Gaza, during which major hospitals were shelled and repeatedly targeted by missiles and airstrikes, including al-Quds and al-Aqsa hospitals. The May 2021 offensive was equally characterized by the bombing of vital civilian infrastructure, including hospitals, clinics, laboratories, and pharmacies, at a time when the healthcare sector was already overwhelmed by the COVID-19 pandemic.
Attacks on civilians and on civilian objects are indeed “discriminate,” in the sense that they specifically target vital infrastructure to inflict mass casualties and serve military objectives
These bombings have often been described in the media as “indiscriminate.” As a matter of fact, attacks on civilians and on civilian objects are indeed “discriminate,” in the sense that they specifically target vital infrastructure to inflict mass casualties and serve military objectives, in unbridled violation of international humanitarian law and norms.
The lack of legal consequences faced by Israel, as well as other states that have engaged in similar human rights infringements such as Syria and Russia, has undoubtedly provided a legal reassurance to Israeli forces to continue its assaults on healthcare infrastructure.
Health besieged: Targeted destruction of health facilities under blockade
UN human rights experts have warned that the latest episode of violence perpetrated by Israel in Gaza amounts to an ethnic cleansing of Palestinians. The Gaza Strip has turned into a mass graveyard, and memories and hopes of the population have been destroyed. The mass displacement of more than 1.8 million Palestinians—80 percent of the strip’s population—has shown that no area is considered safe. Survivors, many of whom have sustained debilitating physical injuries and psychological wounds, are facing severe shortages of fuel, electricity, clean water, and food, with the continued threat of bombing.
Presented as a response to Hamas’ attack on October 7, all-consuming airstrikes have killed more than 15,800 Palestinians, destroyed more than half of Gaza, and annihilated any sense of safety by establishing as legitimate targets even the most sanctified sites protected by international humanitarian law. This includes medical facilities, repeatedly targeted by Israeli forces alongside residential areas, bakeries, markets, and other landmarks of civilian life. Between October 7 and November 23, about 364 distinct attacks on healthcare facilities have been recorded by the World Health Organization, across all occupied Palestinian territories. These attacks were indeed also launched in the West Bank, where violent incursions and incidents directed against healthcare facilities and personnel have been overshadowed by the events unfolding in Gaza. Direct casualties attributed to these attacks include 541 deaths and 730 injuries, a likely underestimation of the actual damage resulting from the destruction of the very infrastructure used to provide much-needed life-saving care.
All-consuming airstrikes have killed more than 15,800 Palestinians, destroyed more than half of Gaza, and annihilated any sense of safety by establishing as legitimate targets even the most sanctified sites protected by international humanitarian law
Most of the acts of violence directed against healthcare have taken place in Gaza. From the very early days of October, healthcare facilities have been either targeted by airstrikes, besieged, caught in the line of fire, or threatened to be targeted. This includes the forced evacuation of al-Awda Hospital in Jabalia on October 13, a day before the Palestinian Red Crescent Society received the order to evacuate al-Quds hospital in Gaza City, despite it being one of the few remaining functional facilities at the time providing critical care. Other medical facilities such as the al-Wafa Medical Center for the Elderly Care in al-Zahra, south of Gaza City, and Abu Yousef al-Najjar Hospital in Rafah were also forced to evacuate, with the latter also sustaining heavy damages from shelling. The director of al-Wafa hospital was later killed when the Israeli army targeted the hospital during another attack in November. In northern Gaza, Beit Hanoun Hospital also ceased operations due to Israeli bombardment, while the Durrah Children’s hospital in the east of the strip had to be evacuated after being targeted with white phosphorus.
Timeline of the escalation of violence against Gaza’s hospitals and clinics
Yet, what truly ignited public opinion engagement across the region and beyond was the al-Ahli hospital blast on October 17. The explosion, targeting a facility overcrowded with victims of uninterrupted Israeli airstrikes and with internally displaced people (IDPs) seeking shelter, thwarted diplomatic initiatives already underway, and marked a significant escalation. The infamous conference by health ministry spokesperson Ahsraf al-Quda, in the attack’s immediate aftermath, was held amid the backdrop of slain and maimed bodies, where he announced over 800 casualties. This moment, if anything, epitomized the threat looming over health facilities, and the perseverance of healthcare personnel to stand against it. Trading blame, both Hamas and Israeli authorities denied responsibility. Israel cast blame on a misfired rocket from the group Palestinian Islamic Jihad. While Israeli arguments were initially taken at face value by most of the Western mainstream media, contradicting evidence soon cast doubt upon the veracity of the IDF’s claims. In addition, there were repeated orders from Israeli forces to evacuate the hospital in the few days leading up to the blast.
This moment, if anything, epitomized the threat looming over health facilities, and the perseverance of healthcare personnel to stand against it
While it is impossible to ascertain who was responsible for this specific attack, incriminating evidence about Israeli forces’ targeting of other hospitals across the strip hints to the incorporation of this strategy in Israel’s military repertoire. Several airstrikes were directed against medical facilities whose GPS coordinates had been shared by the United States with Israeli authorities under a deconfliction mechanism compiling a no-strike list of sites providing humanitarian or medical aid, including the al-Awda hospital, where medical staff were killed.
While attacks were predominantly carried out from the air, they also transformed in time to include armed incursions. The al-Shifa Medical Complex, the enclave’s main surgical facility that was already on the brink of collapse, was attacked in early November. Ambulances stationed in front of the hospital evacuating patients toward the Rafah crossing were targeted, even though the medical convoy had informed the International Committee of the Red Cross of its itinerary. The IDF claimed responsibility for the attack in a statement that accused Hamas of transferring operatives and weapons in ambulances. Several days later, Israeli forces raided the hospital, accusing the group once again of using it as a military base. Despite a lack of evidence, troops besieged and stormed the facility, where, in addition to the 650 patients receiving care, close to 40 premature babies and over 2,300 displaced Palestinians were sheltering. Snipers opened fire on patients and doctors, including those trying to evacuate the hospital, hampering access to urgent medical care. Doctors, including the hospital’s director, were kidnapped, and are currently still held in illegal detention.
Following a systematic targeting of ambulances leaving and entering hospitals, fuel shortages, power outages, and decreased medical and food supplies, death rates spiked in Gaza’s hospitals. This was particularly pronounced amongst patients in intensive care, including neonatal care. Yet, as damages sustained by most hospitals and clinics constrained healthcare options available for critically-injured patients, many had to evacuate to southern Gaza. Their evacuation occurred amidst growing assaults on the remaining semi-functional medical facilities that were left in the north. After this evacuation, the Israeli army besieged the Indonesian Hospital, which was the last remaining medical compound that was still treating patients in northern Gaza, leading an armed assault which left the hospital in ruins. If anything, this demonstrates a sustained commitment to the destruction and evacuation of health facilities. By November 21, all hospitals in northern Gaza were completely out of service, and bed occupancy rates reached 190 percent. Similarly, the killing of over 73 healthcare workers has drastically reduced the human resources available to provide care, severely jeopardizing the Palestinians’ right to health.
Contingent strategies employed to undermine health and human security
The repeated patterns of these attacks indicate that the damages inflicted on Gaza’s already precarious health system and the systematic murder of medical staff are part of a broader strategy seeking to weaponize healthcare. To understand its underlying motives and strategic rationale, it is necessary to study these acts of violence within broader multidimensional efforts to undermine Gaza’s public health.
Beyond overt destruction, the disruption of patient care through other means, such as withdrawal of fuel and power sources, engineers an exacerbated public health crisis. Fuel shortages hamper the maintenance of essential public health services, such as the operation of medical equipment like incubators, life assistance, and ambulances. These conditions jeopardize the quality and availability of healthcare services, and directly contribute to patient death, particularly those with chronic diseases such as cancer or kidney failure. Similarly, the withdrawal of medical supplies and the blockade preventing essential medicine from entering the strip have contributed to a notable surge in preventable mortality; this is largely due to difficulties in maintaining basic infection prevention and control measures. The risks of contracting infections arising from trauma, surgery, wound care, and childbirth substantially increased, posing a particular threat to immunocompromised patients. Additionally, patients, including children, have died in agonizing circumstances, often while undergoing invasive surgeries without anesthesia. Doctors have been forced to operate and amputate injured patients without any anesthetic drugs, due to the lack of medicine, in harrowing images of needless suffering.
Doctors have been forced to operate and amputate injured patients without any anesthetic drugs, due to the lack of medicine, in harrowing images of needless suffering
While the material destruction or disruption of health capital mainly affects the supply of health services, other contingent strategies more acutely affect the demand for health services. In addition to the current war, the strict humanitarian aid blockade contributes directly to the emergence of an array of health conditions, aggravating pre-existing health vulnerabilities. Despite international and regional attempts to provide humanitarian aid to Gaza, the effective delivery of vital aid, including food and water, has been severely restricted. The Rafah, Kerem Shalom, and Erez crossings, which previously allowed the entry of about 500 humanitarian aid trucks per day, remained closed for days on end, prompting conditions for the mass dehydration and starvation of Gazans. During the temporary truce between November 24 and November 30, the number of trucks allowed to enter Gaza returned to 40 percent of its state before the conflict; after October 7, it had been a mere 4 percent of pre-conflict levels. Lack of sanitation services and access to clean water amidst forced displacement and overcrowding further exposes the population to infectious disease. Over 1.8 million IDPs across Gaza are surviving in severely overcrowded shelters with poor access to hygiene facilities, clean water, reliable nutrition, and heat, despite the cold weather.
A perfect storm for the outbreak of epidemics
These conditions raise significant concerns about the rapid spread of epidemics, especially waterborne diseases like cholera or severe diarrhea. Cases of scabies, lice, chickenpox, skin rash, hepatitis A, and upper respiratory infections have been reported to be on the rise, in a context of disrupted vaccination campaigns and disease surveillance systems worsened by the communication blackout. These figures are likely a conservative estimate of the number of contaminated patients as the ability to detect, monitor, and respond to outbreaks is presently severely diminished.
An equally important component of the overt and covert targeting of the health of Palestinians in Gaza are the consequences arising from the use of white phosphorus by Israeli forces, as documented by Amnesty International and Human Rights Watch. This chemical substance, prohibited under international humanitarian law, has significant implications for both human health and the environment, as it can cause severe burns, profound scarring, respiratory distress, long-term health issues, as well as psychological distress. Additionally, soil contamination can also decrease agricultural output, and even cause soil infertility, thereby more determinedly threatening Gaza’s long-term food and health security.
A tool to facilitate forced displacement and ethnic cleansing
The repeated targeting of crucial lifelines in Gaza serves several objectives: the production of mass violence to inflict casualties at a large scale, the weakening of civilian resistance, and the forcible displacement of populations to facilitate ground invasions in urban settings.
More fundamentally, the weaponization of health negates the right to exist and resist
The hospitals targeted, especially al-Shifa, were the last ramparts against death; the only sites with (albeit limited) resources necessary to preserve and save life. They were strongholds of resistance, not in the political and military sense, but in terms of their resistance to succumbing to an impending onslaught. Their destruction, therefore, only amplifies the scale of human losses by depriving victims of the only means of surviving sustained injuries from indiscriminate bombing, or receiving adequate care for the health conditions resulting from deteriorating living standards. UN human rights experts have warned about the mass ethnic cleansing of Palestinians, referring explicitly to the inhumane conditions imposed on civilians in Gaza. Even if the intentional degradation of public health circumstances does not lead to death, it can cause debilitating health conditions that amputate a population’s ability to lead a healthy and productive life or contribute to national socioeconomic or political development.
More fundamentally, the weaponization of health negates the right to exist and resist. It is a means of collectively punishing a population and discouraging or deterring any form of resistance, whether peaceful or violent. However, retaliating against a civilian population not only contradicts the basic tenets of international humanitarian law, but also perpetuates structural power imbalances borne out of the asymmetry of forces between the colonizer and the colonized. By instilling fear and physical—as well as psychological—trauma, the weaponization of health is instrumentalized to forcibly displace Palestinians, by means of rendering the enclave inhabitable, inhospitable, and hostile. We cannot, and must not, let this happen.
Salma Daoudi is a researcher and Dphil candidate in International Relations at the University of Oxford, specializing in international security and global health, with a regional focus on the Middle East and North Africa. Her research primarily revolves around the weaponization of health in Syria and its repercussions beyond the locus and temporality of violence.