The Destruction of the Healthcare System in Gaza has left the Chronically Ill there without a Solution
Michal Feldon
Since the outbreak of the war in Gaza in October 2023, the Gazan health system has been almost entirely destroyed. Over the two years of war, most attention to Gaza’s health issues has focused on trauma—how many people were killed and how they died—as well as on shortages of medical equipment and the partial or total collapse of medical institutions, which made it impossible to provide adequate care during mass-casualty incidents. Another frequently reported issue has been the spread of infectious diseases. Owing to poor sanitation, the overcrowded and unsanitary living conditions of displaced people living in tents, and shortages of vaccines, several severe outbreaks of communicable diseases occurred, including respiratory illnesses, gastrointestinal diseases, and dermatological infections. In contrast, there is very little information regarding mortality and morbidity from chronic diseases during this period. The limited data we have come from a small number of scientific articles and first-hand reports by medical professionals in Gaza.
On the eve of the war, there were approximately 350,000 adult patients in Gaza with chronic diseases, most suffering from hypertension and diabetes, as well as 12,500 cancer patients. During the war, these patients were affected primarily by disruptions to the continuity of their medical treatment. No updated numerical data on patient numbers are currently available, yet what we do know is that at the time the ceasefire came into effect, only 13 of Gaza’s 36 medical centers remained partially operational. According to the Palestinian Ministry of Health, a month into the ceasefire, shortages in Gaza still stood at 55 percent for medicines and 65 percent for medical equipment. Many drugs—including various kinds of antibiotics, insulin, Eltroxin (for hypothyroidism), and antiepileptics—have been entirely unavailable in the Strip for a very long time. Additionally, more than 20,000 patients whose urgent medical evacuation has been approved by the Palestinian Ministry of Health and the World Health Organization are still waiting to be evacuated.
An article published in June 2025 surveyed nearly 1,000 adult patients with six chronic diseases – the most prevalent of which were hypertension, type 2 diabetes, and heart disease – and presented highly troubling findings. 98 percent of respondents reported they were displaced at least once during the war, forcing them to switch clinics or treating physicians, or both; 70 percent reported needing to travel long distances to access medical care; nearly all reported a decline in quality of life, disrupted sleep, and the absence of any physical activity, as well as healthy, regular nutrition. Most patients were unable to consistently maintain their regular medication regimens, and 25 percent had no access to their usual medicines for periods of over two months. 40 percent attributed their difficulties in adhering to prescribed treatment to the unavailability of medications, while about 20 percent cited medications’ high prices as the primary obstacle. Half of the epilepsy patients surveyed reported uncontrolled seizures due to medication shortages, while one-quarter of asthma patients required hospitalization for uncontrolled asthma attacks. Numerous diabetes patients requiring insulin were forced to visit hospitals several times a day for injections, which they couldn’t obtain independently.
Children with asthma in the Gaza Strip could not receive symptomatic treatment for shortness-of-breath attacks outside hospitals, due to the lack of electricity for nebulizer devices. In addition, spacer devices—small plastic chambers that connect via mask to inhalers and are essential for proper inhaler use in children—were unavailable throughout the Strip. Because it was impossible to obtain nebulized medication, or even standalone Ventolin inhalers, many children had to be treated with systemic steroids—a temporary measure that is not only unjustified, but is also likely to cause significant harm over time. UN reports further indicate that the condition of asthma patients, both children and adults, deteriorated dramatically due to the use of plastic and cardboard as fuel for cooking and heating.
The June 2025 article did not address patients suffering from cancer or kidney failure. Prior to the war, the Gaza Strip had about 1,000 dialysis patients and 450 kidney transplant recipients. Gaza’s relatively high proportion of kidney transplant recipients is a result of the fact that roughly half of dialysis patients died during the 2008-2009 Gaza war because they could not reach their dialysis centers regularly. At that time, foreign doctors volunteering in Gaza surmised that kidney transplant recipients had better survival chances than dialysis patients. In the current war, however, most kidney transplant recipients have been unable to obtain the immunosuppressive medications required to prevent graft rejection. Lacking immunosuppressants and adequate hydration, amid high infection risks, the chances of survival or avoiding graft rejection are slim. A study of 105 dialysis patients published in July 2025 yielded somewhat more encouraging results. Despite the majority of the patients in the study being displaced and residing in a displacement camp in Deir al-Balah, approximately 70 percent maintained three weekly dialysis sessions, and 80 percent obtained all prescribed medications. Notably, only three medical centers in Gaza managed to provide dialysis services during the war, and the study’s patients had received treatment at Shifa Hospital, which ceased operations in September 2025.
Treatment for children with cancer had already been impossible in Gaza before the war, primarily due to the shortage of pediatric haemato-oncologists and appropriate medications. Such children were referred for care to the West Bank or Israel. Since the onset of the war, several hundred children with cancer have successfully exited Gaza for treatment abroad. Prior to the war, most adult cancer care was provided at the Turkish-Palestinian Friendship Hospital, which was forced to close early in the war due to fuel shortages and was destroyed in an airstrike in March 2025. Many cancer patients were subsequently transferred to the European Hospital in Khan Younis, which also ceased operations in May 2025 following extensive shelling.
What of chronic diseases that may not be immediately life-threatening, yet for which inadequate treatment can lead to premature mortality over time? One example is Familial Mediterranean Fever (FMF), a genetic disorder prevalent in the region that causes acute episodes of fever, abdominal pain, and arthritis. Attacks resolve within one to two days, but each such attack increases the risk of cumulative kidney damage. Colchicine—the standard treatment, an inexpensive and commonly available medication—reduces the frequency of attacks and prevents long-term kidney injury. There are approximately 10,000 FMF patients in Gaza. However, colchicine was nearly inaccessible during the war. In an August 2025 article, a Palestinian writer described her cousin’s suffering due to the shortage, writing that “[w]hile the world watches the bombs fall and the bodies pile up, it barely notices what it means to live with chronic conditions that became unbearable in wartime. FMF is too mundane for headlines. It is slow, inward, silent—like the suffering of so many in Gaza.”
Since the ceasefire, efforts to reconstruct Gaza’s health system have begun. Full reconstruction costs are estimated at around $7 billion. Some of this reconstruction is largely cosmetic—Shifa Hospital, for instance, has been renovated and rebuilt; other aspects of the health system’s rehabilitation depend on the importation of delayed medicines and medical equipment; and still others will likely take years, such as the training of health workers who will take the place of the approximately 1,800 Gazan health workers killed or detained since October 2023. Similarly, the long-term consequences of disrupted care for chronic patients will become apparent only over time. Many chronic diseases cause gradual and cumulative harm that manifests only in the long run, such as untreated hypertension leading to myocardial infarction or stroke, or diabetes resulting in eye and kidney damage. Meanwhile, only minimal medical documentation was feasible in Gaza during the war. A comprehensive assessment of war-related excess mortality and morbidity will require substantial teams to conduct extensive surveys and statistical analyses.
Michal Feldon is a senior pediatrician