MSF: Gaza Uninhabitable, Turned to Rubble, People No Longer Recognize Their Homes

While the ceasefire in Gaza, Palestine, was implemented on 19 January, after 15 months of all-out war on the people trapped there, all components of society have been destroyed making it almost uninhabitable. Médecins Sans Frontières (MSF) teams are now able to reach the north of the Strip – which was previously besieged by Israeli forces – to assess the medical and humanitarian needs. The situation is appalling; there is nothing left.

Our colleagues no longer recognise their own neighbourhoods, hospitals have been razed, and people are settling in the rubble of their homes with no other shelter to face the winter conditions. Caroline Seguin, MSF’s emergency coordinator, shares insights and photos from the ground.

1. What is the situation in north Gaza?

In the North Governorate, the level of destruction is total, it’s a flat land. I’ve never seen anything like it in my life. Our Palestinian colleagues are no longer able to recognise their own neighbourhoods, some were in shock, others literally collapsed.

In Gaza City we were already shocked by the level of destruction, but then we went north to Jabalia, we couldn’t say a word. There is nothing there anymore. Only ruins and the smell of death everywhere because of the dead bodies still trapped under the rubble.

2. What is the state of the health system?

There is no health system anymore in the northern part of the Strip. Kamal Adwan hospital has been razed, while Al Shifa, Al Awda and Indonesian hospitals are seriously damaged and only partially functioning. We were utterly shocked to observe that in Indonesian hospital every medical machine seemed to have been deliberately destroyed; they were smashed to pieces, one by one, to make sure no medical care could be provided anymore. You have to ask, what is the motivation of such action? These machines are made to save people’s lives, mothers, fathers, children. It’s devastating to see the state of these hospitals.

The provision of medical care is largely insufficient compared to the needs of the hundreds of thousands of people living in the area. For example, between North Governorate and Gaza city, there are only six paediatric intensive care beds compared to 150 before the war and the number of patient hospital beds has plummeted from 2,000 to 350.

3. Are supplies reaching north Gaza?

The flow of vital supplies has improved since the ceasefire, but the level of needs is so high that people are still lacking basic items. The need for food, water, tents and shelter materials in this area remains critical. Water shortages are a real challenge given the high level of damage to water facilities and because they are in inaccessible locations in the buffer zones.

Our teams have started water trucking activities in Jabalia and Beit Hanoun and they repair damaged boreholes, but this is a temporary solution and is not sufficient for the massive needs. The problem is that because of the war we have located our activities in the south and it now takes time to redeploy them to the north.

After four weeks since the implementation of the ceasefire, we are still not seeing the massive scale up of humanitarian aid needed in northern Gaza. The humanitarian community is failing to provide vital services to a population in dire need of humanitarian and medical support. Both Israel and international actors need to urgently ensure the delivery of vital supplies such as shelter and food and to increase the capacities for its distribution.

4. What is the reality for people in northern Gaza today?

People are living in dire conditions. They try to settle as best they can on the ruins of their houses but it’s extremely difficult. The winter weather means people have to face very cold temperatures, heavy rains and strong winds, and they don’t even have walls around them to protect themselves. They don’t have access to healthcare, decent housing or water.

However, the conditions they had to face during the 15 months of war, being displaced and living in tents were even worse. After this hardship, people need to reunite with their loved ones and want to stay and rebuild their lives. Many of them have no intention of leaving. It is essential to ensure consistent, safe, and secure delivery of humanitarian assistance to people who have suffered unimaginable trauma.

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Gaza: Life in a Death Trap – An MSF Report

  • A new report from MSF highlights how repeated Israeli military attacks on civilians in Gaza, and the systematic denial of humanitarian assistance are destroying the conditions of life.
  • Our teams are seeing clear signs of ethnic cleansing as Palestinians are forcibly displaced, trapped, and bombed.
  • The health care system lies in ruins and medical staff – including MSF’s – have been detained or killed.
  • We call for an immediate ceasefire and for states to leverage their influence to alleviate the suffering of people and enable a massive scale-up of aid in Gaza.

Repeated Israeli military attacks on Palestinian civilians over the last 14 months, the dismantling of the health care system and other essential infrastructure, the suffocating siege, and the systematic denial of humanitarian assistance are destroying the conditions of life in Gaza, Palestine, according to a new Médecins Sans Frontières (MSF) reportGaza: Life in a death trap. MSF is urgently calling on all parties, once again, for an immediate ceasefire to save lives and enable the flow of humanitarian aid. Israel must stop its targeted and indiscriminate attacks against civilians, and its allies must act without delay to protect the lives of Palestinians and uphold the rules of war.

“People in Gaza are struggling to survive apocalyptic conditions, but nowhere is safe, no one is spared, and there is no exit from this shattered enclave,” says Christopher Lockyear, MSF secretary general, who visited Gaza earlier this year.

Brutal War

“The recent military offensive in the north is a stark illustration of the brutal war the Israeli forces are waging on Gaza, and we are seeing clear signs of ethnic cleansing as Palestinians are forcibly displaced, trapped, and bombed,” says Lockyear. “What our medical teams have witnessed on the ground throughout this conflict is consistent with the descriptions provided by an increasing number of legal experts and organisations concluding that genocide is taking place in Gaza.”

“While we don’t have legal authority to establish intentionality, the signs of ethnic cleansing and the ongoing devastation – including mass killings, severe physical and mental health injuries, forced displacement, and impossible conditions of life for Palestinians under siege and bombardment – are undeniable,” Lockyear adds.

In response to the horrific attacks carried out by Hamas and other armed groups in Israel on 7 October 2023 – in which 1,200 people were killed and 251 people were taken hostage – Israeli forces are crushing the entire population of Gaza. Israel’s all-out war on Gaza has reportedly killed more than 45,000 people, according to the Ministry of Health, including eight MSF colleagues. The number of excess deaths related to the war is likely much higher due to the impacts of a collapsed health care system, disease outbreaks, and severely limited access to food, water, and shelter. The United Nations estimated earlier this year that more than 10,000 bodies remained buried under the rubble.

Denied

Israeli forces have on numerous occasions prevented essential items such as food, water, and medical supplies from entering the Strip, as well as blocked, denied, and delayed humanitarian assistance, as documented in the report. Some 1.9 million people—90 percent of the entire population of the Strip—have been forcibly displaced, many forced to move multiple times.

Fewer than half of Gaza’s 36 hospitals are even partially functional, and the health care system lies in ruins. During the one-year period covered by the report – from October 2023 to October 2024 – MSF staff alone have endured 41 attacks and violent incidents, including airstrikes, shelling, and violent incursions in health facilities; direct fire on our shelters and convoys; and arbitrary detention of colleagues by Israeli forces. MSF medical personnel and patients have been forced to evacuate hospitals and health facilities on 17 separate occasions, often literally running for their lives. Warring parties have conducted hostilities near medical facilities, endangering patients, caretakers, and medical staff.

Meanwhile, Palestinians’ physical and mental health injuries are overwhelming, and the needs continue to grow. MSF-supported facilities have carried out at least 27,500 consultations for violence and 7,500 surgical interventions. People are suffering from war wounds as well as chronic diseases, made worse when they cannot get access to essential health care services and medicines. Israel’s forced displacement has pushed people into unbearable and unhygienic living conditions where diseases can spread rapidly.

Worsening Health

As a result, MSF teams are treating high numbers of people for illnesses like skin diseases, respiratory infections, and diarrhoea – all of which are expected to increase as winter temperatures drop. Children are missing out on crucial immunisations, leaving them vulnerable to diseases like measles and polio. MSF has observed an increase in the number of malnutrition cases, however it is impossible to carry out a full malnutrition screening in Gaza due to widespread insecurity and the lack of proper deconfliction measures.

As medical care options dwindle in Gaza, Israel has made it even more difficult for people to be medically evacuated. Between the closure of the Rafah crossing in early May 2024 and September 2024, Israeli authorities have only authorised the evacuations of 229 patients—which amounts to 1.6 percent of those who needed it at that time. This is a drop in the ocean of needs.

The situation in northern Gaza is especially dire following Israel’s recent scorched earth military offensive that has depopulated large areas and reportedly killed almost 2,000 people. The northern part of the Strip, particularly Jabalia camp, has been besieged again by Israeli forces since 6 October 2024.

Israeli authorities have dramatically reduced the quantity of essential aid authorised to enter the north. In October 2024, the amount of supplies reaching the whole Gaza Strip hit its lowest point since the war escalated in October 2023: a daily average of 37 humanitarian trucks entered in October 2024, well below the 500 humanitarian trucks entering before 7 October 2023.

Mass Destruction

“For more than a year, our medical staff in Gaza have witnessed a relentless campaign by the Israeli forces marked by massive destruction, devastation, and dehumanisation,” says Lockyear. “Palestinians have been killed in their homes and in hospital beds.”

“They have been forcibly displaced time and time again to areas that are not safe or healthy,” says Lockyear. “People cannot find even the most basic necessities like food, clean water, medicines, and soap amid a punishing siege and blockade.”

MSF calls on states, particularly Israel’s closest allies, to end their unconditional support for Israel and fulfil their obligation to prevent genocide in Gaza. Nearly a year ago, on 26 January, the International Court of Justice (ICJ) ordered Israel to take “immediate and effective measures to enable the provision of urgently needed basic services and humanitarian assistance to address the adverse conditions of life faced by Palestinians in the Gaza Strip.” Israel has taken no meaningful action to comply with the court order. Instead, Israeli authorities continue to actively block MSF and other humanitarian organisations from providing lifesaving assistance to people trapped under siege and bombardment.

States must leverage their influence to alleviate the suffering of people and enable a massive scale-up of humanitarian assistance across the Gaza Strip. As the occupying power, Israeli authorities are responsible for ensuring the rapid, unimpeded, and safe delivery of humanitarian aid at the level sufficient to address people’s needs. Instead, Israel’s blockade and continued obstruction of aid have made it close to impossible for people in Gaza to access essential goods, including fuel, food, water, and medicines. At the same time, Israel has decided to effectively ban the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), which is the largest provider of aid, health care, and other vital services for Palestinians.

Sustained ceasefire

MSF repeats our call for an immediate and sustained ceasefire. The total destruction of Palestinian life in Gaza must stop. MSF is also calling for immediate and safe access to northern Gaza, to allow the delivery of humanitarian aid and medical supplies to hospitals. While MSF continues to provide lifesaving care in central and southern Gaza, we call on Israel to end its siege on the territory and open vital land borders, including the Rafah crossing, to enable a massive scale-up of humanitarian and medical aid.

The MSF report notes that even if the Israeli military offensive on Gaza ended today, its long-term impacts would be unprecedented, given the scale of the destruction and the extraordinary challenges of providing health care across the Strip. A staggering number of war-wounded people are at risk of infection, amputation, and permanent disability, and many will require years of rehabilitative care. The cumulative physical toll and mental trauma caused by the extreme violence, loss of family members and homes, repeated forced displacement, and inhumane living conditions will scar generations.

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‘Death is Everywhere’ – Dr Mohammad Obeid

Testimony from Médecins Sans Frontières (MSF) orthopaedic surgeon, Dr Mohammed Obeid, sheltering in Kamal Adwan hospital, north Gaza – gathered on 22 October 2024.

“There is death in all types and forms in Kamal Adwan hospital and north Gaza. The bombardment does not stop. The artillery does not stop. The planes do not stop. There is heavy shelling, and the hospital is targeted too. It just looks like a movie; it does not seem real.

About five days ago, my house was hit. They completely blew up the roof and water tanks, but we were at the ground floor and only one person got injured, thank God. We left a few times, moving to different areas, my family and neighbours were terrified. I sheltered in Kamal Adwan hospital with my wife and children, and I am now working here, where I can treat numerous patients.

There are no words to describe the situation in Kamal Adwan hospital: it is disastrous. The hospital is completely overwhelmed. There are injured people everywhere, outside and inside the hospital, and we do not have medical and surgical equipment to treat them.

Ambulances cannot move. We cannot reach the bodies of the people killed and cannot save the injured ones who lie in the streets. Many of them died before reaching the hospital, and others died inside the hospital as we could not treat their wounds.

We have 30 people dead inside the hospital, and around 130 injured patients who need urgent medical care. Medical staff are exhausted, and many are injured as well. We feel hopeless. I just don’t have words.

We call on all the countries in the world to consider north Gaza, and to lift the blockade that has led to the death of so many people.”

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‘Fleeing My Home Under Airstrikes and Fire’

Maryam Srour, a field communications manager for Médecins Sans Frontières (MSF) from Beirut, Lebanon, reported from a car as she fled, describing scenes of chaos in the southern suburbs of Beirut.

On Friday 27/09/2024, we heard and felt a huge series of blasts while we were in meetings at the office.

We wrapped up work and got stuck in heavy traffic. I had just relocated to a safer place since the bombing around Beirut and across the country intensified on Monday. When I reached my new home around 10 p.m., my relatives had already joined us – leaving their homes, thinking it would be safer where we were.

From my balcony, I saw dozens and dozens of people walking in the streets carrying what they could, plastic bags, backpacks, or nothing. People in the southern suburbs around ours had received evacuation orders from the Israeli armed forces. We saw people fleeing on foot, some walking with sticks, young and elderly. Some people were in cars. We were not in the neighborhood that was targeted but we heard drones and planes. We felt them close by.

Suddenly, there was darkness all around and bombing started everywhere. There was heavy smoke and people in the streets were coughing. I was with my mum, brother and sister, and trying to figure out what to do next. Are the roads safe? Where do we go?

I had just left my house in *Dahieh—* the southern suburb of Beirut—a few days ago because of the heavy bombardments and moved to this one. We thought we would be safer here. Now we had to leave again. I grabbed a bag of essential items I had at hand. We were told that it’s better to bring mattresses, so we stuffed two in our car and took a pack of water bottles. I didn’t know what to do. There were fires everywhere following the airstrikes, and I heard a huge blast. We heard, felt and saw the strikes. Our building was shaking. There was a huge blast in a place with no advance warning for evacuation.

Surrounded by fire and smoke, I was repeating to myself, “all we need is a plan and to take action, a plan and take action; do not wait here.” We just left the place as fast as we could. I don’t know what happened to my own house, or the new house. We kept calling around and drove for a couple of hours before we figured out where to go. Around 5 a.m, we found a place on the other side of the mountains.

We were very lucky that we left when we did because the fires after the airstrikes were still raging where we had been. We just needed a place to rest a little, to see where to go next, and we still haven’t slept.

Some people are still in cars. Now we’re watching the news and shocking footage of what is happening. I know that my colleagues, MSF teams, are in the field, supplying water by trucks to shelters and schools in Beirut and Mount Lebanon, where displaced families are staying. Some people are lying down on the sidewalks. MSF managed to provide 86,000 liters of water in 24 hours, and is also distributing kits containing basic hygiene and relief items, as well as mattresses to the displaced people.

Our mental health teams are on the streets providing psychological first aid to people who are traumatized and to people seeking refuge in schools. I am used to being a humanitarian worker, but now I am also a person displaced by air strikes in my own country. We are in a safe place, for now.

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