© 2025 Palestine Center for Public Policy
This policy brief analyzes the systematic destruction of Gaza’s healthcare infrastructure and the role of U.S. military aid in enabling strikes on hospitals, medical personnel, and emergency services. These attacks constitute violations of international humanitarian law and the U.S. Leahy Law, further deepening Gaza’s healthcare crisis. Urgent measures are required to safeguard medical facilities, ensure accountability for potential war crimes, and restore access to healthcare through international intervention and policy reform.
Gaza’s healthcare system has long operated under extreme duress, strained by years of blockades and recurrent Israeli military assaults since 2007. These conditions have severely degraded medical infrastructure and restricted access to essential healthcare services, exacerbating an ongoing humanitarian crisis. Prior to October 7, 2023, Gaza’s 36 hospitals operated at full capacity, providing 3,412 hospital beds for a population exceeding 2 million—amounting to just 1.55 beds per 1,000 individuals. This falls well below the World Health Organization’s minimum recommendation of 3 beds per 1,000, a standard that varies by a country’s income level.
Following October 7, 2023, a surge in U.S. military aid has directly funded weapons used in strikes on hospitals, medical personnel, and refugee camps, pushing Gaza’s already fragile healthcare system to the brink of collapse. The widespread destruction of medical infrastructure has had severe public health and societal consequences, including the reemergence of disease, declining birth rates, and rising infant mortality. Furthermore, the systematic targeting of medical institutions has significantly weakened the Gaza Health Ministry, hindering its ability to collect data, assess damage, and accurately determine the full scale of casualties.
The Gaza Health Ministry, a governmental civil body responsible for overseeing the region’s healthcare infrastructure, plays a critical role in maintaining medical services amid ongoing political and humanitarian challenges. Established after June 2007 in response to political divisions and the deteriorating health system, the ministry aimed to prevent the sector’s collapse while prioritizing social welfare and expanding access to comprehensive healthcare.
Over time, the Gaza Health Ministry developed a three-tiered healthcare system: (1) primary care clinics providing prenatal services, vaccinations, chronic disease management, diagnostic services, dental care, and general medical consultations; (2) secondary and referral services; and (3) tertiary care for specialized and advanced medical treatments. According to the UN Development Program (UNDP), the ministry managed half of Gaza’s hospitals, accounting for approximately 75% of hospital beds and overseeing 56 primary health clinics. The remaining facilities were operated by private entities, the United Nations Relief and Works Agency (UNRWA), or other non-governmental organizations.
Since October 7, 2023, the United States has provided over $17.9 billion in military aid to Israel, funding munitions such as 2,000-pound M-84 bombs and artillery shells. Adjusted for inflation, this represents the highest level of U.S. military assistance to Israel in a single year. The sharp increase in aid underscores the U.S. government’s steadfast support for Israel’s military operations in the aftermath of October 7. Former President Biden has publicly emphasized his administration’s unprecedented level of assistance to Israel, refusing to place conditions on arms transfers or limit the flow of weapons.
U.S.-supplied munitions have been used in strikes targeting healthcare workers, medical facilities, and refugee camps, further devastating Gaza’s already fragile health infrastructure. A Harvard study found that between October 7 and November 17, 2023, the Israeli military deployed 600 2,000-pound M-84 bombs in close proximity to hospitals, fully aware of their destructive capacity. On October 14, the Al Ahli Hospital sustained severe damage from a 155mm artillery illumination shell—standard U.S.-supplied munitions—before its eventual destruction. These weapons have played a direct role in the systematic targeting of Gaza’s healthcare system.
Beyond infrastructure damage, these attacks have deliberately targeted healthcare workers, making medical operations nearly impossible. Since October 7, over 1,000 Palestinian healthcare professionals have been killed, with many also detained and subjected to mistreatment. Reports from Doctors Without Borders (MSF) and the World Health Organization (WHO) document the deaths of hundreds of doctors, nurses, and paramedics in airstrikes on hospitals and ambulances. The Palestinian Red Crescent Society (PRCS) has also reported direct attacks on emergency responders, further limiting access to life-saving care. The widespread loss of medical personnel, combined with the destruction of healthcare facilities, has effectively dismantled Gaza’s health system.
The ongoing military blockade has further crippled the Gaza Health Ministry, depleting its resources, personnel, and operational capacity. This has severely obstructed efforts to collect data, assess damage, and determine the true scale of casualties. Additionally, Israeli and U.S. officials have sought to discredit casualty figures reported by the ministry, casting doubt on the scale of Palestinian losses and dismissing the humanitarian toll. This systematic denial of documented fatalities serves as a necropolitical tool—erasing Palestinian lives from the global narrative while justifying continued military operations. Restricting access to food, medical supplies, and humanitarian aid weaponizes survival itself, leaving Palestinian civilians trapped under siege. Despite these efforts to undermine reported casualty figures, assessments from the WHO, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), and Israeli intelligence agencies have affirmed their credibility, reinforcing the urgent need for accountability and policy intervention.
Public Health Implications
The systematic targeting of medical personnel and healthcare facilities, coupled with U.S. financial and diplomatic support for these operations, has resulted in severe public health consequences in Gaza. Under Article 56 of the Fourth Geneva Convention, occupying powers are obligated to ensure the protection and maintenance of medical and hospital establishments. However, Israel’s military actions—including airstrikes, sieges, and direct attacks—have led to the destruction of all major hospitals in Gaza, including Al Ahli Hospital, Al Shifa Hospital, and Al Naser Hospital, in clear violation of international law.
The collapse of Gaza’s healthcare system has left millions without access to critical medical services. Civilians now face life-threatening delays in receiving treatment for injuries, a complete breakdown of maternal and neonatal care, and the rapid spread of preventable diseases due to overcrowded shelters, unsanitary living conditions, and widespread water contamination. Without immediate intervention, the public health crisis will continue to escalate, leading to further loss of life and long-term health repercussions for the population.
Humanitarian Violations
International humanitarian law, as established by the Geneva Conventions, mandates the protection of medical personnel and the unobstructed provision of healthcare in armed conflicts. These laws explicitly prohibit attacks on medical workers, facilities, and transport, ensuring civilians have access to life-saving care. However, Israel’s military operations have repeatedly violated these principles.
A notable example is the case of Dr. Adnan al-Bursh, a leading orthopedic surgeon at Al Shifa Hospital, who was detained along with other medical personnel in an Israeli military prison. He endured severe physical and psychological abuse, ultimately leading to his death—an incident emblematic of broader systemic violations against healthcare workers.
Beyond personnel, medical units and emergency transport have also been systematically targeted. As of February 2024, at least 120 ambulances had been completely destroyed, while others were deliberately obstructed from reaching critically injured civilians. These attacks on healthcare infrastructure have drawn widespread condemnation from the international community and have been classified as “grave human rights violations”.
The World Health Organization (WHO) has repeatedly called for an immediate ceasefire in Gaza, citing the destruction of essential medical services and the urgent need for humanitarian intervention. On October 24, 2023, WHO emphasized the necessity of a humanitarian ceasefire to ensure the safe delivery of medical supplies and fuel to Gaza’s remaining healthcare facilities. Without immediate action, the ongoing assault on Gaza’s healthcare system will continue to exacerbate the humanitarian crisis.
Legal Violations: International and Domestic
A report by the UN Human Rights Commission has documented numerous instances in which Israeli security forces have deliberately targeted medical personnel, detained and tortured healthcare workers, and attacked medical transport while intensifying the siege on Gaza. Additionally, restrictions on medical permits have severely limited civilians' ability to seek life-saving treatment outside the territory. These actions constitute war crimes and “crimes against humanity”, including the crime of “extermination” under international law.
These violations have been the basis of legal proceedings in international courts. Notably, the International Court of Justice (ICJ) is currently hearing a case brought by South Africa, accusing Israel of committing genocide in Gaza. The case underscores growing global legal scrutiny of Israel’s military actions and the humanitarian crisis they have created.
The United States' continued military aid and diplomatic backing of Israel’s actions also raise serious legal concerns under domestic U.S. law, particularly the Leahy Law. This legislation prohibits U.S. military assistance to foreign security forces if the Secretary of State possesses “credible information” that those forces have committed “gross violations of human rights”—which includes the deliberate targeting of medical facilities. Evidence confirms that U.S.-supplied munitions have been used in airstrikes against hospitals, constituting a clear violation of this statute.
In response, several U.S. lawmakers, including Senator Bernie Sanders and Representative Cori Bush, have urged the administration to halt military aid to Israeli units accused of human rights violations. However, despite these efforts, the U.S. Senate has repeatedly blocked legislative measures aimed at restricting arms sales to Israel, allowing military support to continue despite clear legal and ethical concerns.
The United States' military aid, which funds the weapons responsible for the destruction of Gaza’s healthcare infrastructure, has had profound and lasting effects on the physical, social, and mental well-being of Palestinian society. The collapse of Gaza’s health system has led to the resurgence of preventable diseases, exacerbated the health challenges faced by women and other vulnerable populations, significantly increased infant mortality rates, and triggered widespread psychosocial distress.
Furthermore, the deliberate obstruction and weaponization of humanitarian aid by the United States and Israel have contributed to forced starvation and severe malnutrition, compounding the public health crisis. These actions have long-term consequences for both individual and community health, undermining the resilience of Palestinian society and intensifying the humanitarian emergency in Gaza.
Reemergence of Disease
The destruction of sanitation and sewage infrastructure, combined with widespread displacement, has severely hindered the ability of Palestinians in Gaza to access essential vaccinations, including the polio vaccine. Prior to October 7, 2023, Gaza had been declared polio-free since 1999, with a vaccination coverage rate of 99%. However, the ongoing U.S.-backed military strikes on healthcare facilities and the imposition of military blockades have disrupted the flow of vaccines into Gaza and limited their administration, causing the vaccination rate to fall to 90% by 2024.
As a result, Vaccine-Derived Poliovirus (cVDPV) was detected in wastewater samples from two sites in Gaza—Khan Younis and Deir al-Balah. This led to the first confirmed case of polio in a 10-month-old infant in August 2024. In response, the World Health Organization (WHO) called for a critical humanitarian pause to facilitate the urgent administration of polio vaccines, particularly for children.
Localized humanitarian pauses, facilitated through cooperation between WHO, UNRWA, UNICEF, and the Palestinian Ministry of Health, enabled the safe vaccination of over 160,000 children. However, these efforts have proven insufficient to prevent further transmission, and Gaza remains highly vulnerable to polio outbreaks due to continued limited access to clean water, sanitation, and waste disposal services. The ongoing public health crisis underscores the need for sustained, comprehensive interventions to combat the spread of vaccine-preventable diseases in the region.
The Health of Women and Vulnerable Populations
The ongoing bombardment of Gaza has disproportionately affected the health of women and other vulnerable populations. Women and children account for nearly half of the deaths in Gaza, though these figures are often underreported. More than 162,000 women are suffering from or at risk of non-communicable diseases (NCDs), including hypertension, diabetes, cardiovascular disease, and cancer. The disruption of medical care in Gaza has exacerbated these conditions, leading to long-term complications and, in many cases, preventable deaths.
The destruction of hospitals, clinics, and medical infrastructure, coupled with severe shortages of medications and healthcare personnel, has left many women without access to essential life-saving treatment. Pregnant women are particularly vulnerable, facing heightened risks due to malnutrition, lack of prenatal care, and unsafe birthing conditions, all of which have contributed to an increase in maternal and infant mortality. Additionally, the severe restrictions on medical evacuations and limited access to emergency obstetric care have made preventable complications more likely to result in fatalities. Without immediate humanitarian intervention, these challenges will continue to deteriorate, leading to further long-term public health consequences for women in Gaza.
The crisis in Gaza has also severely impacted individuals with disabilities. Prior to October 7, 2023, approximately 21% of households in Gaza had at least one member with a disability, representing around 58,000 people. Since the onset of the conflict, more than 1,000 children have suffered limb loss, making Gaza home to one of the highest rates of child amputations per capita. This surge in injuries, combined with limited access to rehabilitation and follow-up care, has placed immense strain on an already overwhelmed healthcare system.
The frequent displacement of people, volunteers, and humanitarian workers has made it increasingly difficult to provide essential services to those who need follow-up care, particularly for people with disabilities. Furthermore, evacuation orders often fail to consider the specific barriers faced by individuals with disabilities in identifying safe areas, accessing essential services, and obtaining necessary assistive devices. As a result, people with disabilities are at a heightened risk of death or serious injury, facing greater protection challenges during the ongoing conflict.
Although international human rights conventions mandate the establishment of protected safe zones for vulnerable populations, including those with disabilities, these zones have been targeted in attacks and lack access to basic services, further exacerbating the risks faced by disabled individuals in Gaza. Immediate action is required to ensure their protection and to provide adequate medical and humanitarian assistance.
Psychosocial Effects
The ongoing exposure to bombings, forced displacement, and the collapse of social systems in Gaza has significantly increased the demand for mental health services, while also exacerbating the psychological toll on the population. Research has shown that the military escalation has led to a sharp rise in post-traumatic stress disorder (PTSD), depression, anxiety, and other mental health disorders, needs that cannot be adequately addressed due to the destruction of Gaza's already fragile mental health infrastructure.
Mental health professionals have reported a particularly alarming surge in mental health issues among women and children, who have been profoundly affected by the loss of life, forced displacement, and extreme food insecurity. Over 80% of Gaza’s children are exhibiting symptoms of PTSD and severe psychological distress, further deepening the humanitarian crisis. The lack of mental health resources and trained professionals, combined with the ongoing conflict, has left these urgent psychological needs largely unmet, placing immense strain on individuals and communities across Gaza. Immediate intervention and the rebuilding of mental health services are crucial to addressing this growing crisis.
Role of Local Governance
U.S. funding cuts to Palestinian governance in both Gaza and the West Bank, in addition to direct military support, have further undermined the region’s health system. These cuts have forced local authorities to reduce essential health programs, thereby limiting access to routine medical care, maternal health services, and treatment for chronic diseases. The Palestinian Ministry of Health, already under strain from the ongoing blockade and military bombardments, faces increased pressure as foreign aid withdrawal makes it more difficult to maintain public health programs and emergency response efforts.
In the West Bank, movement restrictions, settler violence, and attacks on healthcare infrastructure have further destabilized health services. Hospitals and clinics are experiencing significant shortages of medical supplies due to military checkpoints and continued funding reductions, severely impacting their ability to provide essential treatments. Additionally, Palestinians living in 1948 territories face systemic discrimination in healthcare access, marked by chronic underfunding in Arab-majority areas and stark health disparities compared to Jewish Israeli citizens. U.S. diplomatic and financial support for Israeli policies perpetuates these inequities, exacerbating health disparities and restricting Palestinians' access to adequate medical care.
The escalation of U.S. military aid to Israel and its support for military operations have contributed to an unprecedented public health crisis with severe repercussions for Palestinian society, both in Gaza and the West Bank. These operations, which have targeted hospitals, healthcare workers, and essential healthcare infrastructure, represent a direct violation of both U.S. domestic law and several international legal frameworks. The impact of these strikes extends well beyond the immediate loss of life and casualties; they have profound long-term consequences for public health, the provision of women’s healthcare, and the overall well-being of the Palestinian population.
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