MSF GAZA: Three years on, Israel is asphyxiating Gaza and dismantling the means of survival

In the past year, the physical trapping of people in Gaza has been made increasingly definitive by the establishment of Israel’s Yellow Line. Originally presented as a temporary, first-phase military withdrawal position and a key part of maintaining the so-called ceasefire – it is now reinforced by military positions, berms and ongoing demolitions and has continued to move west, squeezing people into a smaller and smaller area. Israeli forces now occupy approximately 65 per cent of Gaza, using the line to draw a clear border around this area. ​

As the Yellow Line moves, the threat to people living nearby becomes increasingly immediate, compounded by the uncertainty of approaching a line that is not clearly or consistently demarcated. People risk being shot by Israeli forces when they approach it, and MSF teams continue to treat people with gunshot wounds sustained nearby. Its encroachment is also disrupting the delivery of essential assistance: MSF water trucking has had to stop when shooting occurs near communities living close to the Yellow Line. ​

“The Yellow Line cannot be treated simply as a line on a map.” says Amande Bazerolle, MSF head of emergency response in Gaza, Palestine. "It has become a mechanism of encirclement and ethnic cleansing, while cutting communities off from the infrastructure, healthcare, water and other essentials they need to survive.”

Nor is violence confined to the areas around the Yellow Line. In June and July alone, despite a so-called ceasefire, MSF teams treated more than 1,200* cases of violent trauma across Gaza, including blast injuries, burns, gunshot wounds and injuries resulting from physical assault. Over the past three years, our teams have treated more than 200,000 trauma cases*, including injuries resulting from intentional physical violence, while Israel’s military offensive has killed more than 74,000 people, including more than 20,000 children.

As Israel confines Palestinians into increasingly limited areas, families are being pushed into overcrowded and unlivable conditions, without sufficient access to clean water, sanitation, shelter or healthcare. These conditions are contributing to the spread of disease. MSF teams have treated more than 11,000 cases of skin diseases such as scabies this year alone, while seeing more than 1,500 cases of chickenpox in June and July. MSF distributed around 2.1 million litres of drinking water per day in August, yet the scale of need remains far beyond what can be met under these restrictions. ​

“Most people have less than six litres of domestic-use water per day and limited access to basic hygiene items such as soap and detergent,” says Dr Murad Asaliyya, medical activities manager in Gaza. “We are treating gastroenteritis, acute respiratory infections, a lot of skin conditions, hepatitis, bacterial skin infections, scabies and lice. At the same time, we are facing severe shortages in terms of medical supplies. Even the cream we need to treat scabies has been restricted by the Israeli authorities.”

Over the past three years, access to healthcare has deteriorated dramatically, with hospitals increasingly running out of basic supplies and patients unable to access essential medicines and treatment. Restrictions on essential supplies such as engine oil and spare parts are also crippling the infrastructure needed to keep hospitals, ambulances and water systems running, with generators already breaking down and water-trucking operations reduced. ​

The destruction of Gaza’s healthcare system, damage to more than 80 per cent of all structures in Gaza¹, alongside the lifelong physical and mental health impacts of repeated violence and displacement, will extend far beyond the present and prevent any meaningful recovery for years to come.

Nor is this crisis limited to Gaza. Since 2023, violent settler attacks, military operations and raids on homes, displacement camps and agricultural land, illegal settlement expansion, displacement, home demolitions and movement restrictions have rapidly escalated across the West Bank and East Jerusalem, particularly this year. Patients at MSF clinics tell teams about homes being demolished by Israeli forces, attacks by settlers and livestock being stolen. The policies of violence, harassment and forced displacement affecting Palestinians extend beyond Gaza, causing further fragmentation of the occupied Palestinian territory.

“It will take generations to recover from the harm that has already been done over the past three years, and in the preceding decades, while the excruciating consequences of Israel's ongoing genocide are still being felt every day,” says ​ Bazerolle. “Destruction, displacement and deprivation have become normalised - practices Israel is carrying out with impunity. Governments must act now to ensure Israel stops the destruction and killing, prevents ethnic cleansing, and stops denying Palestinians the means of survival.”

*This refers to cases not patients, including new or follow up consultations.

Gaza: Three years of destroying the conditions for life

Following Hamas’ attacks on 7 October 2023, Israel launched a massive military offensive across the Gaza Strip, causing widespread and systematic destruction of essential civilian infrastructure. Three years later, more than 73,000 Palestinians have been killed and over 173,000 wounded, according to the Gaza Ministry of Health. The cumulative physical toll and mental trauma caused by extreme violence, the loss of family members, homes and memories, repeated forced displacement, and inhumane living conditions will scar generations.

Over three years, Israel’s military campaign has devastated Gaza’s health system, while Palestinians have faced mass displacement, starvation, repeated attacks, growing restrictions and the destruction of essential infrastructure and access to healthcare. These images document the widespread suffering of Palestinians in Gaza, and how the conditions for providing and receiving healthcare have progressively deteriorated.

Over the past three years, MSF teams have provided Palestinians with surgical care, wound and burn care, malnutrition screening and treatment, maternal and paediatric care, and other vital services at a time of urgent need. MSF currently runs or supports four hospitals, while supporting four general healthcare centres and working in five clinics and four medical points, both in the northern and southern part of the Strip.

Three years later, attacks on healthcare facilities and restrictions on the entry of vital supplies have severely constrained the provision of medical care. Hospital generators, ambulances, water pumps and water trucks depend on engine oil and spare parts to keep running. Yet Israeli authorities continue to block their entry into Gaza, disrupting services that people rely on to survive.

Nearly 2,300 health and humanitarian workers have been killed since the 7 October, including 15 of our MSF colleagues.

Nasser had become one of the few remaining hospitals able to provide emergency surgical care in southern Gaza. Hospitals and health facilities came under extreme pressure, as wounded patients arrived in unprecedented numbers while thousands found shelter inside and around them. ​ ​

Three years on, WHO reported that 94% of hospitals in Gaza had been damaged or destroyed, with only 19 of the Strip’s 36 hospitals still operational, many providing only limited services.

During the first months of the Israeli military offensive many families were displaced repeatedly, particularly from the northern and middle areas of the Strip. In early 2024 Rafah was already hosting about 1.5 million people who had sought refuge there. Subsequently the Israeli forces heavily destroyed also Rafah. ​

Medical evacuations from Gaza remain extremely limited. WHO estimates that 18,500 patients need specialised medical care that is unavailable there but are not allowed to leave. More than 900 patients have already died while waiting to be evacuated for treatment.

Since 7 October, 82 per cent of structures in Gaza have been damaged, with two thirds of them destroyed according to UNRWA. Thousands are forced to live in dangerous conditions with limited access to clean water and toilets. Nearly 90 per cent of Gaza’s water and sanitation infrastructure has been damaged or destroyed, including desalination plants, boreholes, pipelines and sewage systems.

After months of the Israeli government’s siege and restrictions on food and aid, the Integrated Food Security Phase Classification (IPC) formally confirmed famine in Gaza on 22 August 2025. MSF teams identified the first cases of child malnutrition in January 2024. Between then and March 2026, MSF admitted 4,950 children under 15 for acute malnutrition, 98 per-cent of whom were under five, while 3,482 pregnant and breastfeeding women were enrolled in outpatient nutrition programmes. Three years on, malnutrition has relatively stabilised amid the so-called ceasefire, but the situation remains extremely fragile, with people facing restricted access to food and essential supplies.

Israeli authorities dismantled the UN-led humanitarian aid distribution system and replaced it by GHF in areas under Israeli military control and “secured” by private American armed contractors. Between 7 June and 24 July 2025, MSF health centres near GHF sites received 1,380 injured people, including 28 dead bodies, and treated 174 people with gunshot wounds. One year on, MSF still treats people that received life-changing injuries and trauma at GFH sites.

OCHA estimates that 90 per cent of Gaza’s population has been displaced multiple times. Since October 2025, Gaza became increasingly fragmented by an unclearly marked and constantly shifting military-controlled “yellow line”, which divided areas under different levels of Israeli military control. The Israeli military is estimated to fully control 58.9 per cent of the Strip, severely restricting movement and access for civilians and humanitarian actors. When the unmarked buffer zone, known as the “orange line”, is also taken into account, the area affected rises to an estimated 64.9 per cent of Gaza.

Since 1 January 2026, MSF’s registration in Israel has been withdrawn, preventing international MSF staff from entering Gaza and blocking MSF supplies from entering the territory. All international staff were required to leave by the end of February. The Israeli authorities had ordered 37 aid organisations, including MSF, to cease operations in Gaza and the West Bank by 31 March. MSF has continued its work through 1,500 Palestinian staff registered with the Palestinian Authority, with international staff supporting the response remotely from Amman.

Between late 2024 and early 2026, during a period of severe restrictions on food and humanitarian aid, an analysis of MSF medical data found higher rates of prematurity and mortality among babies born to mothers affected by malnutrition during pregnancy, as well as high rates of miscarriage.

Despite the so-called ceasefire, Palestinians continue to face daily violence and injuries. Israel’s genocidal campaign in Gaza has left an estimated 43,000 people with life-changing injuries, with more than 50,000 requiring long-term rehabilitation. The Ministry of Health has documented approximately 6,000 amputations, including 1,500 children. Rehabilitation services are severely overstretched, while specialised equipment remanins extremely difficult to obtain.