MSF operations in Gaza

AL-AQSA HOSPITAL, DEIR AL-BALAH

Status: Active MSF operations

After leaving on January 6 due to fighting near the premises and Israeli forces' evacuation orders, the MSF team returned to Al-Aqsa Hospital in February to resume activities including acute trauma surgery, advanced wound care, post-operative wound care, physiotherapy, health promotion, and mental health support. We provided 5,800 wound dressings between February 7 and April 4, including 83 percent caused by war-related trauma.  

In May, Al-Aqsa Hospital saw a massive influx of patients due to relentless fighting and bombing amid the Israeli offensive in Rafah. On May 10 and 11 alone, 46 of the 117 patients brought to the emergency room died as a result of their injuries. These mass casualty incidents are becoming more frequent. On May 27, Al-Aqsa received many casualties from bombardments in Nuseirat (approximately 30 patients, and four deaths while the MSF team was there).

NASSER HOSPITAL, KHAN YOUNIS

Status: Active MSF operations

Nasser Hospital is now the main surgical center in Gaza as Al-Shifa Hospital is no longer functional. In mid-February, MSF staff were forced to flee Nasser and leave patients behind after a shell struck the hospital and Israeli forces ordered the evacuation of the facility before raiding it. One MSF staff member was detained and released after nearly two months.

After Israeli troops withdrew from Khan Younis, MSF visited the hospital in April to assess the possibility of resuming activities. In mid-May, in collaboration with the Ministry of Health, MSF relaunched operations in Nasser, focusing on orthopedic surgery and the burn unit. We have also been working in the maternity, NICU, and pediatric wards since May 25. We have opened an outpatient department for wound care (burns and trauma), providing dressings and physiotherapy sessions.

AL-AWDA HOSPITAL, NORTHERN GAZA

Status: Evacuated (though MSF and MSF-supported staff continue to work autonomously)

The last remaining main hospital in northern Gaza is barely functional. A strike on the hospital on November 21, 2023 killed at least five hospital staff, including two MSF doctors, while they were caring for their patients. In December, Israeli forces besieged the hospital and one of our colleagues was wounded inside after a sniper reportedly fired on him. When Israeli forces took control of the hospital after heavy fighting, they detained all men and boys over 16 years old, with six MSF staff among them. After interrogations, most were sent back into the hospital and have been working there autonomously since. Our colleagues in northern Gaza report shortages of all kinds of goods and difficult working conditions. 

AL-NAJJAR HOSPITAL, RAFAH

Status: MSF operations suspended

MSF discontinued surgical activities at Al-Najjar Hospital on February 29 and wound care activities on March 14. The team of five Palestinian staff (three surgeons and two nurses) had been working at the hospital since January 22, performing surgeries and wound care.

AL-SHIFA HOSPITAL, GAZA CITY

Status: Destroyed

Following a 14-day operation by Israeli forces that ended on April 1, Al-Shifa Hospital was left in ruins and is no longer functional. It is not possible for MSF to resume our activities at Al-Shifa in the near future.

EMIRATI HOSPITAL, RAFAH

Status: MSF operations suspended 

In early May, MSF handed over activities to the Ministry of Health due to the security situation amid the ongoing offensive in Rafah, and to relocate resources based on needs, as many people have fled Rafah to Al-Mawasi and Gaza’s Middle Area. Before leaving, MSF teams were supporting the hospital with medical supplies and staff including gynecologists, nurses, and hygienists working round-the-clock shifts, providing postpartum care and management of pregnancy complications.

EUROPEAN GAZA HOSPITAL, KHAN YOUNIS

Status: MSF operations suspended

MSF left the European Gaza Hospital in early March, as access was becoming more difficult each day due to insecurity. On at least two occasions, staff could not reach the hospital. Prior to MSF's departure, our plastic surgeon and nurses saw 20 to 30 patients per day for wound dressings, and worked in the operating theater providing debridement, flap surgery, and sutures. Many patients were children with trauma and severe burn injuries that have become infected due to the lack of access to medical care. While MSF initially continued to collaborate with the facility for patient referrals to Rafah Indonesian Field Hospital, referrals are no longer possible as access to the hospital is very limited.

RAFAH INDONESIAN FIELD HOSPITAL, RAFAH

Status: MSF operations suspended

On May 12, MSF had to halt activities at Rafah Indonesian Field Hospital due to Israeli forces’ offensive in Rafah, as we could no longer guarantee the safety of patients. Before evacuation, MSF supported the inpatient department, operating theater, and outpatient department in collaboration with the Ministry of Health.

We treated patients in post-operative care (trauma and burn cases), all showing war-related wounds, to relieve the patient load at the European Gaza Hospital and Al-Najjar Hospital. In the 60-bed hospital’s operating theater, surgeons undertook approximately 35 procedures per week. Outpatient care ran six days a week, with about 130 consultations a day, and our teams provided dressing changes for wounds, physiotherapy, and counseling. The 22 patients who remained at the hospital when MSF evacuated were referred to other facilities. 

AL-MAWASI HEALTH POST, RAFAH 

Status: Active MSF operations

At Al-Mawasi Health Post, MSF staff are providing outpatient services including general consultations, vaccination, reproductive health care services, wound dressing, mental health services, and health promotion. Our teams carry out 6,000 consultations per week and systematic malnutrition screenings.

Of 5,000 screenings since January, we detected 57 cases of severe acute malnutrition, and 149 cases of moderate acute malnutrition. We have provided care to 31 severely malnourished children and 78 with moderate malnutrition in the outpatient therapeutic feeding center. MSF teams have provided more than 22,000 medical consultations, including 9,000 pediatric patients and 13,000 adult patients. 

MSF CLINIC, GAZA CITY

Status: Active MSF operations 

MSF has repaired our clinic near Al-Shifa Hospital in Gaza City after it was damaged and has since resumed activities. The team focuses on wound dressings and physiotherapy. Depending on the security situation and operational possibilities, MSF aims to send more supplies to the north and start scaling up activities in the coming weeks.

AL-MAWASI HEALTH POST, KHAN YOUNIS 

Status: Active MSF operations

MSF supports the Culture and Free Thought Association (CFTA) in providing pre- and postnatal care as well as sexual and reproductive health care. Our teams provide general consultations, management of non-communicable diseases, malnutrition screening and treatment, wound dressings, and physiotherapy. The most common illnesses and injuries seen in patients in Al-Mawasi include upper respiratory infections, acute diarrhea, hypertension, and skin diseases.

AL-HEKKER PRIMARY HEALTH CARE CENTER, AL-HEKKER

Status: Active MSF operations

In mid-April, MSF opened a new primary health care center in Al-Hekker to provide outpatient services, including general consultations, vaccination, reproductive health care, wound dressing, health promotion, and mental health care such as psychological first aid, individual and family therapy sessions, and psychoeducation. The team has carried out 250 consultations per day. 

KHAN YOUNIS PRIMARY HEALTH CARE CENTER, KHAN YOUNIS

Status: Active MSF operations

The Khan Younis Primary Health Care Center opened on May 6. Given the massive influx of displaced people fleeing Rafah to an already-packed humanitarian zone and the lack of health facilities to cover trauma needs, we are scaling up activities.

MARTYRS PRIMARY HEALTH CARE CENTER

Status: Active MSF operations

On March 10, an MSF team started providing wound care and malnutrition screenings at the Martyrs Primary Health Care Center. 

AL ATHAR PRIMARY HEALTH CARE CENTER, KHAN YOUNIS 

Status: To be opened in June

Al Athar Primary Health Care Center will open in June to cover the needs of displaced people who have set up their tents in the area.

AL-SHABOURA CLINIC, RAFAH 

Status: MSF operations suspended

On December 9, 2023, MSF restarted our work at Al-Shaboura Clinic in Rafah, gradually scaling up activities. In early May, MSF suspended operations at Al-Shaboura Clinic due to insecurity from the ongoing Rafah offensive and to ensure the delivery of medical assistance where it’s most needed. The clinic has since closed and staff and resources have been moved to other facilities. 

Until May, MSF teams were providing outpatient services including general consultations, vaccination, reproductive health services, wound dressing, mental health services (including psychological first aid, individual and family sessions, and psychoeducation), and health promotion activities. Teams were also performing systematic malnutrition screenings of children under five years old and pregnant and lactating women. 

TRAUMA STABILIZATION POINT, TAL AL-SULTAN, RAFAH

Status: Permanently closed

On May 14, MSF opened a trauma stabilization point in Tal Al-Sultan, Rafah—a basic facility where patients receive initial treatment before being referred to hospitals for specialist and/or surgical care if needed. On the night of May 26, teams at the trauma stabilization point recorded 180 wounded patients and 28 dead after Israeli airstrikes hit a camp sheltering displaced people in a "safe zone” designated by Israel. Most of the patients we treated had shrapnel wounds, fractures, traumatic injuries, and burns.

During the night of May 27, the trauma stabilization point was forced to close due to heavy bombardments and ground forces operating in the area. All patients were transferred and staff were able to safely evacuate.  People in need of care will now directly be taken to the field hospitals that remain open in Al-Mawasi. We are looking for other strategic locations that could benefit from a trauma stabilization point. 

MARTYRS, BENI SUHAILA, AND MASCAT CLINICS

Status: MSF activities suspended

After Israeli forces ordered the evacuation of the area on December 1, we were forced to end our support for Martyrs and Beni Suhaila clinics, where we had been providing basic health care, wound dressing, and mental health consultations.

Drinkable water is scarce in Gaza—even more so than before this war. We provide about 300 400,000 liters of water per day at 30 distribution points in Al-Mawasi and Khan Younis. In Rafah, we provide about 300 cubic meters of clean water each day and are trying to increase this quantity. On March 28, MSF set up a new desalination plant in Al-Mawasi.  

MSF has partnered with Palestinian NGOs since February 2024. Through our partnership with PARC (Agriculture Development Association), we are implementing water and sanitation activities in camp shelters in Deir al-Balah and Khan Younis. This includes building latrines for more than 30,000 people across six camps, distributing hygiene kits for 2,400 families, and providing clean drinking water to more 25,000 people per day. The partnership also includes equipping a camp hosting people with disabilities with needed sanitary facilities, such as accessible latrines and showers. 

MSF has delivered about 200 tons of medical supplies each month, including medicines, surgical kits, logistical items, and humanitarian aid. As of the end of May, MSF has brought in a total of 76 trucks of supplies, into Gaza through the Rafah crossing point. However, bringing supplies into Gaza has been extremely difficult due to administrative barriers, movement restrictions, and lack of crossing options. Since the Rafah crossing closed in early May, there has been a significant decrease, from 24 trucks in March to only two trucks in May. 

• Over 400 MSF staff in Gaza 
• More than 6,000 consultations per week at Al-Mawasi Health Post in Rafah
• 78 trucks carrying essential supplies sent into Gaza as of the end of May
• 5,000+ patients screened for malnutrition at Al-Mawasi Health Post in Rafah
• 400,000 liters of water provided per day at 30 water distribution points in Al-Mawasi and Khan Younis
• 130 consultations per day and 35 surgical procedures per week at Rafah Indonesian Field Hospital before ceasing activities in May due to Israeli forces’ Rafah offensive
• 180 wounded and 28 dead patients recorded at the trauma stabilization point MSF supports in Tal Al-Sultan after Israeli airstrikes hit a camp sheltering displaced people in a designated safe zone on May 26
• 5,800 wound dressings provided at Al-Aqsa Hospital between February 7 and April 4 
• 250 consultations per day at Al Hekker Primary Health Care Center 
• 36,000 medical consultations, including more than 15,000 pediatric cases, conducted at Al-Shaboura Clinic
• Latrines built in six camps housing more than 30,000 people
• 2,400 families received hygiene kits
• 25,000+ people provided with clean drinking water per day

The ceasefire resolution passed by the UN Security Council on March 25 was not implemented, which renders it little more than political theater. Israeli forces continue to carry out widespread attacks that disproportionately impact civilians. Palestinians in Gaza are suffering every day from an all-out destructive military campaign that blatantly ignores the rules of war. 

The duty of treating the sick and wounded—and the correlating protection of medical personnel and facilities—is at the core of international humanitarian law. Yet, since the beginning of this war, MSF has seen a pattern of systematic attacks against medical facilities and civilian infrastructure. Our staff and patients have had to leave 13 different health structures and have endured 26 violent incidents including airstrikes damaging hospitals, tank fire at agreed deconflicted shelters, ground offensives on medical centers, and firing at convoys. These attacks show the failure of deconfliction measures in a war fought with no rules.  

Attacks against hospitals and civilians must stop now. According to OCHA, as of May 27, out of the 36 main hospitals that used to serve over 2 million Gazans, only 16 remain partially functional, with severe limitations on the types of services they can deliver. According to OCHA and the Gaza Ministry of Health, as of May 27, 493 health workers have been killed since October 7, 2023, including five MSF staff members.

The ongoing Israeli offensive on Rafah is making the delivery of humanitarian assistance and provision of medical care nearly impossible. The closure of the Rafah crossing is jeopardizing the lifeline for thousands of people and humanitarian response, leaving stocks including fuel, food, medicines, and water dangerously low, and people trapped amid renewed fighting. The urgency to get more aid and supplies into Gaza is only getting more desperate. At this time, MSF is not able to bring in any supplies into Gaza from the south.  

The Israeli government's policy of deliberate deprivation, only allowing a trickle of food and water to enter the Strip, will inevitably lead to death by starvation in Gaza. The Integrated Food Security Phase Classification (IPC) has released a report warning that famine is imminent. We are seeing the impacts of widespread food insecurity and hunger. However, access restrictions by Israeli authorities prevent us from responding at scale. The situation is already alarming, and we cannot afford to wait for the emergency to get worse before taking action.

What aid reaches Gaza has been instrumentalized to create an illusion of safety, maintain minimal service provision in so-called “safe zones,” and uphold the pretense of Israel’s adherence to International Humanitarian Law (IHL). We find that what Israel communicates is very different from the very little aid we see getting into the Strip.

On May 16, the US military announced that a temporary floating pier was anchored to the Gaza shoreline to increase the amount of aid getting into Gaza. This is a glaring distraction from the real problem: Israel’s indiscriminate and disproportionate military campaign, punishing siege, and ongoing offensive on Rafah. Israel needs to facilitate rather than block the flow of supplies. This is not a logistics problem; it is a political problem. While bringing aid in through this temporary pier, administered by the US military, is sub-optimal and a sign of a failure, rather than success, we are open to all and any options to get supplies into Gaza, as the situation for people trapped in the Middle Area, and the south, is becoming particularly dire.

The opening of Rafah crossing would be the most effective and desperately needed solution given its proximity to people in-need of assistance and by facilitating a larger flow of aid compared to other routes. 

On January 26, the International Court of Justice (ICJ) issued provisional measures for Israel to take to prevent a plausible genocide in Gaza, including allowing humanitarian aid into the Strip. Yet we are witnessing a worsening situation in Gaza and indiscriminate attacks on civilians, medical and aid workers, and health facilities continue. On May 24, the ICJ ordered Israel to halt its offensive on Rafah and reopen the Rafah crossing.  

All states that support these actions by Israel are morally and politically complicit. We call all on governments, particularly the US, UK, and allied EU member states, to do whatever in their power to influence Israel and stop supporting the ongoing siege and bloodshed.

There are over 83,000 wounded people and very few hospitals left to provide them with the care they need. Among the wounded are thousands of patients requiring complex and sustained medical care that is not available in Gaza. The closure of the Rafah crossing with Egypt has completely halted medical evacuation of patients since May 7. Since then, 600 patients have been scheduled to be evacuated but are currently held up. An estimated 14,000 patients in Gaza require medical evacuation, and this number is expected to increase due to the diminishing capacity of the health system compounded by the ongoing escalation in fighting. 

Israel must resume issuing medical referral permits for treatment in the West Bank and Jerusalem for severe cases that cannot be treated in Gaza. All medical referrals, patients, and their caregivers must be guaranteed safe, voluntary, and dignified return to Gaza.  

In the Hebron area, MSF teams are running mobile clinics, providing mental health support, building capacity for emergency response, and working on advocacy and protection in addition to supporting hospitals and four health care centers. 

Current activities focus on providing medical care through 15 mobile clinics, support to four primary health care centers, implementation and  support for the maternity ward, increasing capacity in the emergency room at Halhoul Hospital, and increasing emergency room capacity at Al-Mohtaseb Hospital, as well as mental health support, capacity-building for emergency response, and advocacy and protection. We support various hospitals with donations and first-aid kits distributed at community focal points in Beit Ummar, Al Rshaydeh, and the emergency care center in Umm al Kheir. We support and trained medical staff at Al-Mohtaseb Hospital, Halhoul, Dura, and Yatta Hospital in the Hebron area. 

As the disruption to medical access has increased since October 2023, MSF is progressively expanding our response to bring health care to people who are unable to reach medical facilities. Our mobile clinics now reach a total of 15 locations in and around Hebron's Old City, as well as in Dura and the remote villages of Masafer Yatta in the Southern West Bank. In addition to expanding medical activities since October 7, the MSF team has increased health promotion activities in the community, and the distribution of relief items, hygiene kits, and food parcels to internally displaced people and West Bank residents affected by violence and forcible displacement. In the past four months, MSF distributed 44 family food parcels to internally displaced people, filling the gap while they register for long-term assistance from NGOs or governmental sources. MSF also supports the displaced community also by delivering portable toilets and pipe installations. 

In 2024, MSF increased the number of mobile clinics in the Hebron district to 15 to meet the increasing needs in the community. Between January and March 2024, our team provided over 6,000 outpatient consultations and around 1,400 individual mental health sessions, including assessments of new patients and follow-up consultations across the various locations. In Hebron, our teams have adapted and expanded activities to ensure continuous access to care for the most vulnerable and isolated patients. 

MSF continues to provide psychological individual, family, and group therapy as well as psychiatric consultations in Nablus, Qalqiliya, and Tubas despite challenging circumstances, particularly with regard to restrictions of movement in the area by Israeli forces, which were already a disruptive factor but have intensified since October 7. Furthermore, in collaboration with the Palestinian union of social workers and psychologists, MSF started the third cohort of intern training for eight psychologists in March. The interns will undergo 770 hours of theoretical and practical training at MSF’s clinic. 

Between the months of December 2023 and March 2024, with Palestine Red Crescent Society (PRCS), MSF trained around 450 new PRCS volunteers, as first aid provider and first responder, in the governorates of Nablus, Tubas, and Qalqilya 100 more volunteers will be trained up to end of December (First responder training + kits). In the last week of April, MSF began a training for doctors and nurses in the ER in three different hospitals (Nablus, Tubas and Qalqilya, in order to increase the capacity of Ministry of Health staff for them to respond to trauma cases. 

As a continuity of cooperation between MSF and PRCS, during the months of June, July and August, MSF will provide a specialized Trauma training for around 98 PRCS, medical and paramedical volunteers, from the governorates of Nablus, Tubas, and Qalqilya.

MSF teams are currently building capacity (through training) in the emergency rooms of Ministry of Health hospitals in Jenin (Khalil Suleiman Hospital) and Tulkarem (Thabet Thabet Hospital) governorates. We are also supporting and training medical and paramedical staff, primarily in ambulances, to provide first aid and lifesaving services in and outside the hospitals in case access to the premises is obstructed. 

We equip volunteer paramedics in Jenin, Tulkarem, and Nur Shams refugee camps with donations and training so they can stabilize patients during active hostilities in case ambulances are not able to reach them. In December, we started supporting the Ministry of Health’s emergency plan by setting up stabilization points in pre-existing health facilities and training staff in trauma care. 

MSF is also providing mental health care, with group sessions and psychological first aid. We facilitate crisis intervention sessions and psychological first aid trainings for medical staff, and provide individual consultations at Khalil Suleiman Hospital. Additionally, we support Gazan workers who have been stranded in the West Bank since October 7.