In the past seven months the healthcare system in the Gaza Strip has been systematically dismantled. According to OCHAThe United Nations Office for the Coordination of Humanitarian Affairs (OCHA) is a body established by the General Assembly to strengthen the international response to complex emergencies and natural disasters., 24 hospitals in Gaza, Palestine are now out of service, while 493 health workers have been killed. Each medical centre or humanitarian delivery system has been or is being destroyed, to be replaced by less effective, improvised options.

There is no telling what the indirect human cost in deaths and long-term injuries will be as a result of aid and treatment having been denied. Staff and patients from Médecins Sans Frontières (MSF) have had to leave 12 different health structures and have endured 26 violent incidents (3.7 per month on average), which includes airstrikes damaging hospitals, tanks being fired at agreed deconflicted shelters, ground offensives into medical centres, and convoys fired upon. MSF has yet to receive accountability or any admission of responsibility for the killings, maiming, or the dehumanisation of our staff and patients.

While the past seven months have been devastating for communities in the Gaza Strip, the West Bank, and in Israel, from a medical humanitarian perspective, the violence faced by Palestinians in Gaza and the West Bank far pre-date 7 October. It is important to recall that there was already a humanitarian crisis in the Gaza strip, caused by Israel’s 16-year blockade of the enclave.  

On 6 October 2023, MSF was running medical humanitarian activities in Palestine, specifically in Hebron, Jenin, Nablus, Masafer Yatta, and the Gaza Strip. On that day, our colleagues were tending to patients in Gaza wounded by so-called butterfly bullets, fired by Israeli snipers at people as they protested in the days and weeks prior to the war that engulfed the region on 7 October. We were also treating 87 patients for long-term injuries (down from an original patient cohort of almost 900), sustained in the Great March of Return escalation in 2018 and 2019.

Our medical staff were also continuing to treat patients wounded in the war of 2021, sparked by the seizure and settlement of property in Sheikh Jarrah, East Jerusalem, and resulting in the gravest escalation since 2014 with thousands of Palestinians displaced, massive levels of destruction, and hundreds killed.

The attacks of 7 October and the collective punishment that followed represent a paradigm shift in the way MSF has been able to operate in Palestine. Without operations in Israel, the first thing our colleagues witnessed on 7 October were Israeli airstrikes in Gaza, immediately following Hamas attacks estimated to have killed some 1,200 people with the taking of 253 hostages. On 8 October, MSF offered support to the Israeli Ministry of Health, which ultimately was not accepted.

For MSF colleagues in Gaza who had been running projects focused on orthopaedic and reconstructive surgery, physiotherapy, burn care, psychological healthcare, and research and treatment for antimicrobial resistance in Gaza, it was not immediately clear what would become of our patients, how we could ensure their continuity of care, or what we would be able to do for those wounded in this new escalation.

However, what did become clear was that the increasing disrespect and disregard of medical humanitarian action and the destruction of health facilities and staff shelters, along with the killing of colleagues and patients, made it nearly impossible for MSF to negotiate the protection we usually seek in conflict settings.  

Below is a timeline of attacks on MSF or MSF-supported medical facilities and medical practitioners in Palestine since 7 October. It is important to note that where responsibility for these attacks is now verified, they have been attributed; however, often we are unable to say with certainty where attacks come from.

The location of MSF or MSF-supported supported medical facilities, shelters and movements that have been hit or attacked had been communicated to the main parties to the conflict in Gaza prior to their attacks. Yet, these facilities and movements have not been respected nor protected, and many civilians have been killed and injured.

Timeline of attacks

• 7 October – immediately following Hamas’ attacks, Israeli forces struck Indonesian hospital in Beit Lahia and an ambulance in front of Nasser hospital in Khan Younis, killing a nurse and an ambulance driver and injuring several others.
• 10 October – an Israeli airstrike damaged MSF’s Gaza clinic in Gaza City; no staff or patients were injured.
• 11 October – an airstrike hit close to Al-Awda hospital in Jabalia, where MSF has been operating since 2018; some ceilings caved in as a result of the blast, but the structural integrity of the hospital was maintained, and it continued to function.
• 13 October – Israeli forces gave two hours’ notice to evacuate MSF-supported Al-Awda hospital. Our medical colleagues wheeled patients on gurneys into the street in an effort to get them to other hospitals, with little success. MSF condemned the evacuation order and highlighted the need to protect medical workers and patients. Eventually staff and patients remained in the hospital.
• 17 October – in Gaza City, a strike hit the parking lot of Al-Ahli Arab hospital, where an MSF doctor was operating, reportedly killing hundreds of people. In the days leading up to the incident, the hospital director had received warnings from Israel.  MSF condemned this strike and initially attributed responsibility to Israel. However, even today it remains uncertain who bears responsibility for this act. An independent investigation is the only way to determine the responsibility for this attack.
• 30 October - a projectile hit the MSF-supported Turkish-Palestinian Friendship hospital south of Gaza City, causing damage to the building. The hospital stopped functioning when it ran out of fuel on 1 November.
• 3 November - an Israeli airstrike outside Al-Shifa hospital in Gaza City hit and destroyed an ambulance convoy, which also killed many people. MSF unequivocally condemned this attack.
• 15 November – Israeli ground troops stormed Al-Shifa hospital. All remaining MSF staff had left the hospital about one week earlier.

• 18 November - an MSF convoy seeking to evacuate staff and their families was fired upon, killing two people including an MSF colleague. All elements point to the responsibility of the Israeli army for this attack. Two days later, an Israeli bulldozer and heavy military vehicles destroyed the MSF cars from the convoy in full view of our colleagues sheltering in the MSF guesthouse in Gaza City. The vehicles also damaged the MSF clinic by ramming its perimeter wall, which collapsed. Part of the clinic caught fire as a result.
• 21 November - a strike on Al-Awda hospital killed Dr Mahmoud Abu Nujaila and Dr Ahmad Al-Sahar from MSF, and another doctor, Dr Ziad Al-Tatari. While we have spoken to all parties to the conflict, seeking accountability for these killings, none has been forthcoming, and it is not possible to say what happened with absolute certainty. An independent assessment should be conducted onsite to determine responsibility for this.
• 24 November - as the only vehicles available to the staff and their family members sheltering in the MSF guesthouse and clinic in Gaza City had been destroyed, our teams based in the south of the Gaza Strip sent more vehicles to Gaza City to attempt another evacuation. However, they were also hit by bullets while approaching the MSF clinic and the movement was cancelled. Later, they too were destroyed by the Israeli forces in the early hours of 24 November.
• 1 December - a temporary truce between Israel and Hamas in the Gaza Strip took effect from 24 November 2023 to 30 November 2023. Hours after the truce ended, a blast damaged Al-Awda hospital.
• 5 December - MSF staff in Al-Awda reported that the hospital was facing a total siege. In the following days, two members of medical staff at the hospital (not MSF staff) were reportedly shot and killed by snipers outside.
• 12 December - an MSF surgeon was injured inside Al-Awda hospital by a shot fired from the outside.  
• 14 December - in Khalil Suleiman hospital, Jenin (West Bank), our colleagues supporting the hospital witnessed Israeli forces shoot and kill a teenage boy in the hospital compound, following the abuse of paramedics who were forced to strip and kneel in the street.

• 17 December - Israeli forces took control of Al-Awda hospital after a 12-day siege. Males over 16 years old were taken, stripped, and interrogated – six MSF staff among them. After the interrogations, most of them were then sent back into the hospital and told not to move. The same day, Israeli tracer bullets hit the maternity ward of Nasser hospital. One patient was killed, others were wounded.
• 6 January – MSF had to evacuate Al-Aqsa hospital in Deir al-Balah as fighting between Israeli forces and Palestinian armed groups approached. Israeli evacuation orders also put MSF’s hospital pharmacy inside the exclusion zone, making it inaccessible. A sniper bullet was fired through the intensive care unit wall on 5 January.
• 8 January – an Israeli tank shell struck the MSF “Lotus” shelter in Khan Younis, killing the five-year-old daughter of an MSF member of staff and wounding three people. Over 125 MSF staff and their families were then relocated to Rafah.
• 22 January - Nasser hospital in Khan Younis was surrounded by fighting, bombing, and subjected to evacuation orders. Airstrikes killed people as close as 150 metres from the hospital’s entrance, according to MSF staff present.
• 15 February - a shell struck the orthopaedic department at Nasser hospital; staff members fled the compound leaving behind several patients. One member of MSF staff was detained at a checkpoint by Israeli forces and has since been released.
• 20 February - an Israeli tank fired at an MSF shelter in Al-Mawasi, Khan Younis, killing the daughter-in-law and wife of one of our colleagues, and injuring seven people.
• 2 March - a shell struck a shed next to the main entrance of the MSF-supported Al-Emirati hospital in Rafah, killing two people and injuring several more.

• 13 March – the Israeli military conducted operations in Jenin (West Bank). At the MSF-supported Khalil Suleiman hospital, people standing in the hospital courtyard were fired on. Six people by the emergency room door were wounded, two of whom later died. 
• 27 March – an airstrike hit a greenhouse near Al-Shaboura clinic, an MSF-supported facility in Rafah. Several people were reportedly killed in the attack, despite a United Nations Security Council Resolution requiring a ceasefire being passed on 25 March. No MSF staff or patients were hurt.
• 31 March – an Israeli airstrike hit the yard of MSF-supported Al-Aqsa hospital compound just outside of the emergency room, where many internally displaced people were sheltering. Many people were killed and injured. After the attack, part of the MSF team had to stop providing care.  
• 1 April – after a 14-day long operation by Israeli forces in and around Al-Shifa hospital, the hospital was left in ruins and out of service. An MSF clinic in the hospital’s vicinity was also badly damaged. Hundreds of people were killed, including medical staff, and mass arrests of medical staff and other people took place in and around the hospital.
• 21 April - an MSF-trained paramedical volunteer was shot in the leg while on duty during a three-day incursion in Tulkarem and Nur Shams refugee camps in the West Bank. Due to the hostilities, it took him seven hours to reach the hospital.
• 6 May - an MSF-supported stabilisation point was stormed during a violent raid by Israeli forces in Tulkarem and Nur Shams camps in the West Bank. Volunteer paramedics trained by MSF were harassed and no longer feel safe in providing lifesaving care to patients.

At the time of writing, Israeli forces have begun their offensive on Rafah, southern Gaza Strip, and on parts of the north of the enclave, and issued several evacuation orders. The offensive and the evacuation orders further reduce access to healthcare in an already decimated health system, leaving people almost no options for even basic medical care.

Between 6 and 12 May, we had to suspend our activities at Al-Shaboura clinic, handed over our activities at Al-Emirati hospital, and were forced to close our activities in Rafah Indonesian Field hospital as we could not guarantee the security and safety of patients and our staff with the ongoing offensive.

In view of this extensive timeline of reprehensible actions, MSF once again calls on all parties to respect and protect healthcare facilities, healthcare workers and patients in Gaza and the West Bank. An immediate and sustained ceasefire must be implemented in Gaza now to put an end to the suffering of people and the destruction of Gaza. We demand an immediate and unfettered flow of aid into the entirety of the Gaza Strip. We demand accountability for our colleagues and their family members who have been killed and wounded, and for patients.