The World Health Organization has warned that Gaza’s health system is being pushed “beyond breaking point” as Israeli ground operations and enforced evacuations squeeze hospitals, clinics and ambulances, BBC reported.
The agency’s director-general, Dr Tedros Adhanom Ghebreyesus, described a situation where frontline medical services are being rendered non-functional not only by direct damage but by the military presence and restricted movement that prevent staff, patients and supplies from reaching care.
Northern Gaza hospitals lie at the centre of immediate concern. Kamal Adwan, the Indonesian Hospital and al‑Awda — located in the Beit Lahia and Jabalia areas — are inside or very near an Israeli-declared evacuation zone. Kamal Adwan was reported out of service after nearby hostilities. The Indonesian Hospital has been effectively inaccessible because of the presence of armed forces around its compound. Al‑Awda remains open but its director told the BBC the facility was “totally under siege”, with staff unable to move freely and unable to accept referrals from elsewhere.
The words “totally under siege” capture more than a single blocked access point. Medical staff report armed drones, tank fire and ground forces operating within a few hundred metres of hospital grounds. A surgeon at al‑Awda described drones firing in the hospital’s outer areas and tank shots within 400–500 metres. Ambulance crews say they have been shot at while transporting patients and supplies between hospitals; one paramedic described windshields being hit by bullets. These reports are consistent with a pattern in which not only direct strikes but also the pervasiveness of military operations make care delivery impossible.
The WHO has documented that even when hospitals are not physically struck, the presence of hostilities or an occupying force frequently prevents staff and patients from crossing checkpoints or moving through contested territory. That restriction alone can rapidly convert a functioning facility into one that is clinically non-operational. The organisation emphasises that hospitals and healthcare personnel have special protection under international humanitarian law. Those protections may be lost only under narrow circumstances, such as when a hospital is being used to launch attacks or store weapons — allegations the Israeli military has made in some instances, and Hamas has denied.
Médecins Sans Frontières (MSF) reported that at least 20 medical facilities across Gaza have been damaged or forced partially or completely out of service in the preceding week. Damage comes from air strikes, ground operations and written evacuation orders. MSF characterised the cumulative effect as deliberate asphyxiation of Gaza’s health system and demanded an immediate halt to actions that it said were annihilating healthcare infrastructure. The charity described the small volume of aid allowed into Gaza in recent days as insufficient and suggested the deliveries were a smokescreen rather than a substantive relief effort.
The situation in Khan Younis, in southern Gaza, shows how specialised services are collapsing. The European Hospital — the territory’s only centre providing neurosurgery, cardiac care and cancer treatment — has been out of service since 13 May. That day, its courtyard and surrounding area were struck; Israeli authorities said the attack aimed at an underground bunker allegedly harbouring a senior Hamas military figure. The hospital’s closure means patients requiring complex surgery, intensive care, or continuous cancer therapy no longer have local access to those services. Field hospitals, while important, cannot replicate the full range of tertiary care that the European Hospital offered: they lack cardiac surgery, intensive care capacity and long-term oxygen generation systems.
Nasser Hospital in Khan Younis has also suffered recent strikes. It was hit on 13 May, an attack that killed two people and destroyed beds in a burns unit. Its medical warehouse was hit again and critical WHO supplies were reportedly destroyed. A British surgeon working at Nasser has warned that if the facility is evacuated or cut off, there will be nowhere adequate to send many of the complex surgical patients. She stated that even a combination of field hospitals would not replicate the surgical capacity, intensive care or oxygen supply of a hospital like Nasser. The warning is clinical rather than political: losing a tertiary or regional hospital in a setting of mass casualties dramatically increases avoidable deaths across a broad range of conditions.
The Indonesian Hospital has been hit by hostilities severe enough that most patients left after staff casualties and infrastructure damage. Only 15 people — patients and staff — remained inside as of the WHO’s most recent reporting. An NGO connected to the Indonesian facility reported that its generator had been struck by a quadcopter drone at night, triggering a large fire and a blackout. Those inside described acute shortages of water and dwindling supplies of food. One patient was reported in a serious condition and the background of phone calls from inside the facility contained the sounds of crashes and nearby gunfire. The international humanitarian principle that medical generators, water supplies and related equipment are protected facilities appears to be compromised repeatedly in these incidents.
Across Gaza, government and aid agency figures show rapidly mounting civilian tolls and displacement. The Hamas-run health ministry reports more than 600 deaths and 2,000 injuries in the past week alone. The United Nations estimates tens of thousands have been newly displaced as the Israeli military resumes an expanded ground offensive. Israel announced a total blockade of Gaza on 2 March and resumed offensive operations two weeks later, ending a two‑month cessation of major hostilities. Israeli leaders say the aim is to pressure Hamas to release remaining hostages; Israeli officials stated they would allow a “basic” amount of food into Gaza to avert famine. Yet the UN reports it has been unable to collect dozens of lorries of supplies permitted by Israeli authorities, and humanitarian groups say the quantity of aid allowed so far is far below what’s needed.
That mismatch between permitted aid and operational delivery matters clinically. Hospitals depend not only on occasional shipments of food but on continuous supplies: intravenous fluids, antibiotics, anaesthetic agents, oxygen, blood products, sterile dressings and functioning generators for surgery and intensive care. MSF, WHO and local hospital directors all report critical shortages of medicines, oxygen and consumables. Loss of oxygen supply, for example, quickly converts otherwise survivable respiratory or surgical cases into fatal ones. Damage to generators and fuel shortages compound the risk: ventilators, oxygen concentrators and refrigeration for blood all require power.
Ambulance services face acute danger. A paramedic who was transporting personnel and food between al‑Awda and Kamal Adwan said his ambulance was shot at and that another vehicle was hit at the windscreen. No one was injured in that incident, but the same paramedic was later unable to re-enter the hospital because of the risk of Israeli fire. Without safe transport routes, triage fails. Patients with severe trauma cannot be evacuated to definitive care. Pregnant women in labour lose access to obstetric services. Children and chronically ill patients miss life‑saving treatment. The WHO and humanitarian bodies have repeatedly flagged ambulance protection as integral to any functioning emergency response.
International humanitarian law provides specific safeguards for civilians, medical personnel and facilities during armed conflict. Hospitals ordinarily retain protected status unless used for hostile acts. The Israeli Defence Forces (IDF) say their operations adhere to international law and that when they have targeted hospitals it is due to their improper use by Hamas. Independent verification of such claims is complicated by the intensity of fighting, restricted access for international monitors, and contradicting local and military narratives. The WHO and medical NGOs stress that even where military necessity is claimed, parties must take all feasible precautions to avoid harming civilians and ensure continuity of care for wounded and ill people.
Medical staff in Gaza are operating under extreme pressure. Many have been displaced from their homes; some have been killed; others are working around the clock with inadequate supplies and intermittent electricity. The mental and physical toll on clinicians is enormous. Field reports describe exhausted surgical teams managing mass casualties, improvising when anaesthetic agents run low, and using manual ventilation when power failures cut oxygen supply. The cumulative effect of sustained mass-casualty work without resupply is deterioration in the standard of care and increased mortality from treatable conditions.
Clinical capacity outside hospitals is also deteriorating. Primary care clinics and outpatient services face closure from damage and staff shortages. Chronic disease management has been disrupted: dialysis, insulin-dependent diabetes care, chemotherapy and palliative services are all at risk. Interruptions in vaccination programmes increase the risk of infectious disease outbreaks in overcrowded displacement sites. Water and sanitation breakdowns magnify that risk. When health services collapse, the indirect mortality from non-trauma conditions — asthma, cardiac failure, infections, obstetric complications — can quickly outnumber deaths caused directly by hostilities.
Humanitarian logistics are complex amid active hostilities. Even when military authorities agree to allow aid convoys, agencies must secure safe passage, coordinate with local partners, and ensure distribution reaches those most in need. Aid convoys that are permitted at one point may be bottled up at checkpoints, delayed, or redirected. Security risks deter international staff from entering high-conflict zones, leaving local healthcare workers to sustain services with dwindling resources.
Limitations of reporting must be recognised. Much of the casualty and hospital status data come from local health authorities and international agencies with limited physical access to many sites. Verification of particular incidents, such as claims of hospitals being used for military purposes, is difficult. Media reports rely on interviews with medical staff, eyewitnesses and officials from all sides; these sources can reflect immediate perceptions shaped by fear and trauma. Independent, on-the-ground investigations by neutral external teams are often constrained by safety and access. Those constraints complicate attribution of specific attacks and the precise sequence of events leading to hospital dysfunction.
Even so, the clinical picture is stark: specialised services have shut down; regional hospitals face evacuation; oxygen and essential medicines are in short supply; ambulances operate at extreme risk; and supply chains cannot replenish the inventories that keep operating theatres and intensive care units functioning. The human impact is comprehensible in bedside terms: children deprived of cancer care, mothers without safe delivery services, trauma patients without surgical theatres, and critically ill patients who cannot be maintained on mechanical ventilation when generators fail.
The international community’s role has two obvious clinical priorities. First, ensure safe, unobstructed, sustained humanitarian corridors so medical supplies, fuel and personnel can reach hospitals. Second, guarantee protection for medical personnel, ambulances and facilities under international law, with immediate de‑escalation around medical infrastructure. Both priorities require operational guarantees on the ground, not only written permits. Medical agencies say temporary, small-scale deliveries do not replace persistent resupply.
As military operations continue and displacement grows, the fragile health system faces additional threats: outbreaks of infectious disease in crowded shelters, rising malnutrition where food access is curtailed, and long-term loss of trained medical staff who may flee the territory. Rebuilding clinical capacity after such a collapse will take months or years and depends on sustained, secure access for supplies and reconstruction.
Clear, immediate steps would minimise avoidable morbidity and mortality. Protect hospitals from military operations. Establish and respect no‑fire zones around medical facilities. Permit continuous deliveries of oxygen, medicines, blood products and fuel. Provide secure transport for ambulances and medical teams. Allow neutral monitoring and independent verification of incidents affecting health infrastructure.
The available evidence shows a health system already near collapse in parts of Gaza. With regional referral hospitals out of action, supply depots destroyed and staff under siege, critical care and complex surgical services are disappearing. The clinical consequences are measurable in rising preventable deaths and untreated chronic illness.
Without immediate, reliable humanitarian access and the protection of medical services, the emergency will deepen and the death toll will continue to climb.
