In January 2025, a group of medical workers at Al-Shifa Hospital in Gaza City started restoration efforts in concert with humanitarian aid organizations on the hospital, which had been destroyed in April 2024 amid continuous Israeli bombardment and siege. By that point, the only functioning part of the hospital—once the largest medical complex in Gaza—was the emergency department, which had reopened several months earlier as a triage space meant simply to keep people alive.
“We converted the maternity ward into a surgical ward,” Dr. Mohammead Abu Salmiya, the hospital’s director, tells The Progressive. “We reopened dialysis, operating rooms, and emergency care. By Allah’s grace, we recovered about 50 percent of al-Shifa’s capacity—but with catastrophic shortages.”
Currently, al-Shifa serves all of Gaza City and North Gaza, and has become the main referral center for critical injuries and complex medical cases throughout the entire north. For that population, which is nearly 800,000 people, it has approximately 300 beds, ten operating rooms, twenty intensive care units, and forty-eight dialysis stations. As Abu Salmiya says, “There is nowhere else to go.”
Despite ongoing efforts to rebuild the hospital, the losses remain devastating. Before the genocide, al-Shifa had three CT scanners; today, it has none. Its MRI and x-ray machines are scarce and damaged and laboratory equipment has been destroyed. The neonatal intensive care unit was wiped out entirely.
“There are no cardiac catheterizations in Gaza anymore,” Abu Salmiya says, referring to a procedure involved in heart and blood vessel testing and treatment. “Any surgery that requires surgical microscopes no longer exists. Heart surgery does not exist. Chest surgery does not exist.”
Al-Shifa is one of many hospitals that have been targeted by Israel in its attack against Gaza’s health care system—an attack that Abu Salmiya says is not the collateral damage of war, but an intentional, systematic destruction designed to perpetuate a genocide. By the time the ceasefire was announced last October, Gaza’s hospitals were no longer hospitals in any meaningful sense. After two years of Israeli bombing, they were amputated systems struggling to keep people alive without electricity, medicine, equipment, or protection.
“This was a methodical attack on the entire health system,” Abu Salmiya says. “It was a war on medicine itself.”
Dr. Munir al-Bursh, director general of Gaza’s Health Ministry, reported that, as of October, Gaza had thirty-eight hospitals, all of which have been directly targeted by Israeli attacks during the genocide. Of those, he said the ministry has been able to partially rehabilitate only sixteen hospitals, while the other twenty-two have been rendered completely inoperable. As of December, only two hospital buildings in Gaza remained fully intact, and only three of all health service delivery units were fully functioning, according to the Health Resources and Services Availability Monitoring System.
Today, Gaza’s health system remains paralyzed. Even during the so-called ceasefire, Israel continues to block the entry of large quantities of essential medicines and medical supplies into Gaza. According to Palestinian health authorities, around 70 percent of cancer medications are barred from entering and 90 percent of medical supplies and medications needed for orthopedic patients and the wounded are unavailable. The Israeli occupation also prevents the entry of sterile gauze, premature infant formula, and many other essential medicines. In addition, there is a standing prohibition of new medical imaging equipment, including x-ray and diagnostic machines, as well as laboratory and sterilization devices, which Israel has claimed could be exploited by Hamas for military use. Doctors are unable to perform intensive surgeries or advanced interventions.
In May 2025, the the World Health Organization (WHO) reported that the shutdown of hospitals had severed access to essential, life-saving care, including neurosurgery, cardiac treatment, and cancer care. Gaza’s public health officials and international humanitarian organizations have warned of an imminent collapse in the health care services provided to patients across the region, citing a severe and dangerous depletion of essential medicines and medical supplies.
In the ruins of this medical system, survival has become a form of resistance—and medical decision-making, an impossible moral calculus. Abu Salmiya says hospitals have received no more than 25 percent of what is required to function safely. Without medicine and proper supplies, doctors are left presiding over thousands of critically ill or injured patients they know they cannot save. He describes the conditions as “medical genocide.”
“We, as doctors, often find ourselves standing helplessly before them, unable to provide even the most basic medical care,” Abu Salmiya says. “Cancer patients die waiting. Heart patients die without surgery. They die in front of our eyes. Doctors stand helplessly and can do nothing.”
In central Gaza, al-Aqsa Martyrs Hospital has become another frontline of endurance. Since October 2023, the hospital—which also became a makeshift shelter for displaced families—has been directly targeted twice by Israeli strikes and further damaged by strikes on nearby buildings, forcing entire sections of the hospital out of service. As a result, its infrastructure has buckled, and the area’s sanitation system has collapsed. Combined with Israel’s blockade of medical supplies, the hospital’s medical services deteriorated.
“There is no international law, no humanitarian law, no human rights. There are no red lines in this genocide,” says Dr. Khaled al-Nabrisy, the hospital’s head of planning and information.
At al-Aqsa, al-Nabrisy describes a facility stretched beyond any medical definition of safety. But despite the bombardment, staff displacement, electricity outages, and shortage of supplies like gauze and sterilization equipment, the hospital never fully shut down.
“We describe it as a ‘standing hospital,’ ” al-Nabrisy says. “It provided services at the bare minimum, but it did not collapse.”
Staying open came at a cost: Elective procedures were halted, diagnostic equipment failed, and care for chronic conditions—including diabetes, heart disease, and kidney failure—collapsed. Electricity was, and remains, a life-or-death struggle. Outages repeatedly shut down generators due to fuel shortages and lack of maintenance. Without fuel, incubators, intensive care units, dialysis machines, and operating rooms cannot function. Still, emergency care continued.
“We had to choose who might live. Others died because we lacked equipment,” al-Nabrisy says. “In some cases, we feel completely helpless because we lack the most basic resources—particularly cancer cases and patients, including women and children, who urgently need medical referral outside Gaza.”
As of November 2025, WHO reported that more than 16,500 people, including 4,000 children, were in urgent need of medical evacuation from Gaza. Al-Nabrisy says at least 1,100 have already died waiting for permission to leave. The reopening of Southern Gaza’s Rafah crossing will allow some Palestinians in Gaza to medically evacuate to Egypt—but only 150 people will be allowed to exit each day. At the same time, Israel banned Doctors Without Borders from operating in Gaza and the West Bank, a decision that the organization’s head said will be "catastrophic" for the people of Palestine.
Throughout the war, medical personnel faced an impossible choice: stay to care for their patients or flee to safety with their families. Among those who remained, many were killed. In a report released in October, the U.N. Office for the Coordination of Humanitarian Affairs found that since October 2023, more than 1,700 health care workers, including doctors, nurses, paramedics, and technicians, have been killed; that’s an average of more than two killed every day. At al-Aqsa, twenty-six hospital staff members have been killed, according to al-Nabrisy. Many other medical professionals have left Gaza, creating a devastating brain drain.
“The loss of a medical worker is the loss of the health system itself,” al-Nabrisy says.
Others have been detained illegally from inside their hospitals. According to Abu Salmiya, about 350 medical personnel were detained and approximately 120 remain in Israeli detention—including Dr. Hussam Abu Safiya, who refused to abandon his patients during a military ambush at Kamal Adwan Hospital. Abu Safiya has been detained by Israel for more than a year, during which he has endured severe abuse and medical neglect. In November 2023, Abu Salmiya was detained and held without charge for seven months; in December of that year, al-Shifa’s head of orthopedics was detained and later died in Israeli military detention as a result of torture.
“For two complete years, medical teams never rested,” Abu Salmiya says. “They were displaced, starved, bombed. Some treated patients while knowing their own children had been killed. They buried their own children, then returned to work. Their resilience is what prevented the forced displacement of Gaza’s population.”
The surviving health care workers have worked under conditions that defy medical ethics as taught in textbooks.
“These people didn’t just do their jobs,” he continues. “They prevented the collapse of Gaza itself.”
International humanitarian law, including the Fourth Geneva Convention, explicitly protects hospitals and medical staff. Yet in Gaza, Abu Salmiya says, these laws were ignored entirely.
“In this genocide,” Abu Salmiya says, “international humanitarian law proved it cannot protect hospitals. Instead of being protected, hospitals became targets. This has never happened at this scale in history.”
Both doctors describe Gaza’s medical collapse not as a tragedy, but as an intentional component of genocide, and insist that history will remember Gaza’s medical workers not as victims, but as witnesses.
“What happened is a systematic, deliberate, ongoing crime,” al-Nabrisy says. “[Medical workers] wrote history with their blood.”
For now, few of Gaza’s hospitals remain open—not because they are functional, but because doctors and other health care providers refuse to leave their patients.
“No health system [in modern history] has ever been targeted like this and survived,” Abu Salmiya says. “Yet ours did.”