While most of our Palestinian colleagues have moved to the south of the Strip, a handful of our doctors and nurses have chosen to remain in northern Gaza. They continue to offer their support to the wounded, including in some MSF-supported facilities and in collaboration with local healthcare staff.  

As of 11 March, we have colleagues providing care in three hospitals: Al Aqsa hospital, Rafah Indonesian Field Hospital, and Al-Emirati Maternity Hospital. We are also working in one general healthcare facility, Al-Shaboura clinic, and two health posts in Al Mawasi, in the Rafah area.  

Most of our teams are in the South of Gaza, while we are still supporting Al-Awda Hospital in northern Gaza. Our teams provide surgical support, wound care, physiotherapy, outpatient consultations and mental health services.

On 14 November, a new MSF team of 15 people – composed of surgeons, anaesthetists and intensive-care specialists, with some coordination and logistical support – entered southern Gaza via the Rafah crossing from Egypt. People in the team come from different countries from all over the world.   

Our staff were forced out of Al-Shifa hospital on 18 November due to repeated attacks by Israeli forces. Two nurses returned to the premises to assist with medical procedures on a voluntary basis, before leaving in early February as strikes approached the hospital again. Some medical activities resumed on 6 January, with three operational theatres. Two UN convoys, carrying our international staff, reached the hospital on 22 January and 11 March to provide fuel and medical supplies. A few our staff have been providing dressings care at our former MSF clinic since January.

In Khan Younis, Al-Nasser Hospital, was the largest hospital in Gaza after Al-Shifa was brought to a standstill by Israeli military operations and was gradually transformed into a camp for displaced people, and still houses thousands of people. The area surrounding Al-Nasser hospital has been under evacuation orders since 23 January, following weeks of intense bombing and fighting. This prompted 90 per cent of staff to leave, including most MSF staff, though a handful decided to remain on the premises.  

International mobile staff left on 26 December. The remaining staff describe shortages of everything from beds to anesthetics, fuel, food and water.  

By late January, 150 patients too sick to move are trapped inside the hospital, the emergency room is open but would be unable to cope with large influxes of wounded patients. On 13 February, Israeli forces gave an evacuation order to the displaced people in the hospital, stating that medical staff and patients could stay, and one caretaker per patient. However, two days later, remaining MSF staff were forced to flee and leave patients behind after a shell struck the orthopaedic department in the early hours of 15 February.

Access to the European Gaza Hospital is increasingly difficult due to insecurity along the route. Staff have been unable to reach the hospital on at least two occasions. Our plastic surgeon and a small team of nurses are treating 20 to 30 patients daily for dressing changes and are performing surgeries. On 6 January, MSF staff had to evacuate Al-Aqsa hospital due to fighting around the premises and evacuation orders that made MSF’s pharmacy store inaccessible. Three MSF-supported staff remained, working autonomously.  

On 6 January, we had to evacuate Al-Aqsa hospital due to fighting all around the premises and evacuation orders that made our pharmacy store inaccessible. On 6 February, our teams returned to Al-Aqsa and prepared the premises for a full return to previous activities. The following day, wound care and rehabilitation resumed.  A total of 2,498 wound care dressings were done between 7 February to 7 March and 83 per cent of these wounds are from war-related trauma.

On 10 March, in Al Martyrs, our team started wound care and malnutrition screening activities at the clinic. In the first day of activities, we tended to 40 wounded people and screened 40 children for malnutrition, four of whom presented with severe acute malnutrition.

On 9 December, our team in Rafah reopened Al-Shaboura clinic, which had been closed since the beginning of the war, where we treated over 130 patients on the first day.  

We are also supporting local health authorities where we can with donations of medical supplies. We have donated over 50 tonnes of medication and medical supplies to several clinics and health posts.  

We are supporting the Al-Emirati maternity hospital with medical supplies and staff including gynaecologists, nurses and hygienists who are working around the clock. 

Our teams built an extension of the maternity department in the parking lot of the hospital to increase the postpartum department’s capacity to 26 beds, as of 10 March, allowing more patients to receive proper monitoring post-delivery. In February, the team performed 1,144 admissions, most of them to post-partum or post c-section women.

Between 7 October and 21 December, 286 healthcare workers were killed in the Gaza Strip. Fifty-seven ambulances were hit and damaged according to the WHO.

Our teams are supporting the outpatient department at Rafah Indonesian Hospital with wound dressing, physiotherapy, and other small procedures to relieve the patient load from Al-Nasser, European and Al -Najaar hospitals. Inpatient activities were scaled up to 60 beds in January and include one procedure room to do small surgical interventions.

Our teams are also supporting two water distribution points near Al-Mawasi health post and in the informal camp for people we who have beendisplaced. Distribution began on 30  January  and provides 15,200 litres of water to 5,067 people six days a week, which works out to almost three litres per person per day.

As of 14 March, our water and sanitation teams provided an average of 220,000 litres of clean and safe water per day to more than 40,000 people in nine locations in Rafah. Considering the immense needs, the amount of water distributed is just a drop in the ocean.

In the West Bank, we are maintaining activities focused on emergency care, and mental health care in Hebron, Nablus, Tulkarem and Jenin.  

Hebron:  Our teams are dedicated to delivering medical care through 10 mobile clinics, providing support to four general healthcare centres, implementing and supporting capacity in maternity and emergency room services at Halhoul Hospital, enhancing emergency room capacity at Moktaseb Hospital, offering mental health support, conducting capacity building in emergency response, and advocating for and protecting individuals in need.

Our mental health services including psychological first aid, counselling and psychotherapy continue to be offered to people, including a hotline system for people in need of medical, mental health or social services, who can be referred to the appropriate facility.

Our teams have progressively expanded our response to provide healthcare to people who are unable to reach medical facilities. As of November 2023, six new locations were added for our mobile clinics to reach, making a total of 10 locations covering the areas outside and inside Hebron's old city, but also in the remote villages of Masafer Yatta in the southern West Bank.

We have provided donations of medical equipment and kits to Alia hospital, to community focal points in Beit Omar, Al-Rshaydeh, and to the emergency care centre in Um El-Khair. We’ve also provided training for staff in Al Mohtaseb hospital located in Hebron old city.

In addition to the expansion of medical activities since 7 October, our teams have increased health promotion activities in the community, and the distribution of relief items, hygiene kits and food parcels to displaced Gazans, and West Bank residents affected by violence and forcible displacement.

Nablus: Psychological first aid group sessions are being conducted in three districts in Nablus, Tubas, and Qalqiliyeh.

Jenin & Tulkarem:  Our team supports the emergency room at Khalid Suleiman Hospital in the Jenin refugee camp and Thabet Hospital in Tulkarem governorates. We donated drugs and equipment to seven general healthcare centres for emergency deliveries anticipating that roads will be blocked and that women giving birth will not be able to reach the hospital.  Training for the medical staff of these centres enables them to take care of patients in emergencies.  

In the refugee camps of Nur Shams in Tulkarem and Jenin Camp, we donated first aid bags to volunteer paramedics to stabilise patients during active hostilities and keep them alive until they reach the hospitals.

Currently, we have a rear base in Egypt to facilitate the transit of our internationally mobile teams and supplies. Our teams in Egypt are ready to send more medical supplies into Gaza if allowed to safely do so. We are in contact with the Egyptian authorities and the relevant organisations  to start activities in Egypt and provide healthcare for injured or sick Palestinian people allowed to exit Gaza if needed. 

The situation in Gaza has been described by our teams as ‘catastrophic’. The health system has collapsed. Most of Gaza’s hospitals are out of service, as the electrical power and water have been cut off due to a lack of fuel and due to the damage from strikes. Those that are running are continuously under attack, as are ambulances. Patients and medical staff are being injured and killed.  

There are very little medical supplies. Surgeons in Al-Shifa hospital have been operating without anaesthetics or painkillers. Contact with our staff is sporadic; we frequently lose contact with them.  

The repeated calls by the Israeli forces to evacuate the entirety of the northern Gaza Strip is outrageous; it is a policy of forcible transfer of civilians and patients to make the north of Gaza a free-fire zone. These evacuation orders to hospitals are a death sentence for the gravely sick and injured and implies that medical workers should leave their patients behind. Civilians who remain in the north are still civilians and must be protected as such.

We were able to send over 100 tonnes of medical supplies, mainly surgical and dressing kits, into Gaza in five deliveries between October and February. However, bringing supplies into Gaza has been extremely difficult due to administrative barriers, movement restrictions, and a large backlog of trucks at the border.

The bombing of Gaza is relentless. One of our colleagues, Mohammed Al Ahel, a laboratory technician, was killed on 6 November when the area near his house was bombed. Two of our staff, Dr Mahmoud Abu Nujaila and Dr Ahmad Al Sahar, and a third doctor, Dr Ziad Al-Tatari, were killed in a strike on Al-Awda hospital on 21 November. As Israel orders Gazans to flee south, it simultaneously continues its campaign of bombardments in the south, leaving people with no safe place to go.   

A state of siege has been imposed by the Israeli government on all of Gaza, including the withholding of food, water, fuel and electricity. More than 1 million people have had to flee to the south, where they’re crammed into a small area. The displaced are sleeping in rough conditions, with dangerously little levels of food and water; people have been drinking salty water. There is no electricity and hygiene conditions are extremely poor; some shelters have one toilet for every 600 people. These conditions drastically increase the likelihood of disease outbreaks.

Israeli armed forces have announced the West Bank as a closed area. Most checkpoints across the West Bank remain closed, exacerbating movement restrictions on people and affecting their ability to access basic services, including food, and medical care.

In West Bank towns, people are experiencing an explosion of violence against them. Jenin has been particularly hard hit, with bombings and incursions by Israeli forces in the refugee camp killing and wounding dozens of people.

Over 5,000 Gazan workers have sought refuge in the West Bank. An unspecified number of Palestinians from Gaza were previously arrested by Israeli Forces when Israeli authorities cancelled their permits and many of them are still missing.

In Jenin, our teams report treating patients who showed signs of being tied up and beaten, reportedly by Israeli forces.

Our medical teams at Jenin hospital have witnessed Israeli forces shooting at the hospital itself, while they’ve also treated medical staff who were shot by soldiers while still in an ambulance. Israeli forces also prevent the ability of ambulances to move around, blocking entrances to the refugee camp.  

In Hebron, families have been displaced after violence from Israeli settlers and forces, including having their homes burnt down. Patients in Hebron old city, known as H2, are facing challenging access to our mobile clinic when it’s there, due to extreme restrictions on movements.

These attacks on medical care MUST stop.

We are asking for:

• We ask world leaders and organisations to exert their influence in favour of a ceasefire that will spare the lives of Gazans and restore the flow of humanitarian aid.
• We ask Israel to lift the siege to allow increased and continuous humanitarian supplies to cross into Gaza. 
• Protection for civilians and healthcare personnel and facilities on both sides, at all times; hospitals and ambulances are not targets.
• Basic guarantees of safety to enable our teams to move to provide humanitarian and medical services.
• Access to people in need of medical care and humanitarian aid, including the sick and wounded.
• People to be afforded safe access to essential supplies like food and water and health facilities.
• Increased essential humanitarian supplies like medicine, medical equipment, food, fuel and water must be allowed to enter the Gaza enclave.
• Those who wish to leave must be able to do so safely without prejudicing their future option to come back.
• In the West Bank, for Israeli authorities to put an end to the violence and forced displacements of Palestinians.
• Israeli authorities must stop implementing restrictive measures in the West Bank that impede the ability of Palestinians to access basic services, including medical care.
• Airdrops and sea routes are no alternative to aid delivery by land.