The Broken Promise of Gaza’s Health System Reconstruction
VIEWPOINT
Isabella Frigerio, Mohamed Abu Hilal, Andrew Gumbs, Umberto Cillo, Gaya Spolverato, and Alessandro Vitale
On October 10, 2025, a ceasefire in Gaza was greeted as a promise that the work of rebuilding could finally begin. Nine months later, that promise has curdled into a more familiar Palestinian experience, the disillusionment of waiting. Scholars of Gaza’s health system describe its history as one of protracted, cyclical destruction and deferred repair: eight wars since 2008, each followed by partial, donor-dependent reconstruction before the next assault.[1] This ceasefire has not broken that pattern. The war that began with the atrocities of October 7, 2023, remains part of any honest account of what must end. Beside this, the collapse of the health system has acquired a momentum of its own.[2] Between October 7, 2023, and December 30, 2025, at least 3,057 incidents of violence against or obstruction of health care were recorded in the occupied Palestinian territory, more than 95% attributed to Israeli forces; in Gaza alone, health facilities were damaged 435 times, at least 746 health workers were killed and 361 arrested.[3] At least 14 Gazan doctors, including Hussam Abu Safiya, former director of Kamal Adwan Hospital, remain in Israeli detention without charge under the Unlawful Combatants Law; broader estimates put the number of detained Gazan health workers at more than 80, and independent human rights organizations have documented cases of torture and medical neglect among them.[4] Despite the ceasefire, attacks have been documented through 2026.[5]
Reconstruction requires hospitals to be rebuilt and supply chains to be restored, but a functioning health system also needs a social relation—defined as the continuity of trust and access between patients and caregivers—which has been severed at an unprecedented scale. As of September 2026, Médecins Sans Frontières reported that only 24% of Gaza’s hospitals and monitored health facilities were even partially functional, with primary care centers among the worst affected, while more than 20,000 people were awaiting evacuation for medical care unavailable in Gaza.[8] By late August 2026, just over 13,000 had been evacuated.[9] Many also carry the burden of more than 6,000 amputations sustained in this war, over 5,000 of which the World Health Organization (WHO) has verified as traumatic; for these individuals, disability may be a permanent status, sustained by the continued obstruction of care.[10]
The wider literature on post-conflict health system reconstruction assumes, implicitly, that a war ends and a linear process of rebuilding begins. Gaza’s history does not fit that model. What we think deserves a name of its own is arrested reconstruction: when rebuilding is repeatedly initiated, interrupted, and reversed, so that institutional capacity, unlike physical infrastructure, never has the chance to accumulate.
A further observation follows from our own clinical practice. Metrics of reconstruction—the proportion of hospitals classed as functional—are structural and binary: A building either has staff, power, and supplies, or it does not. Such metrics capture emergency and trauma capacity reasonably well, because trauma care can resume the day a generator restarts. But they capture almost nothing about the capacity to treat complex and chronic disease, surgical oncology among them, which depends on multidisciplinary teams and continuity of follow-up that take years, not months, to rebuild. This produces what we would call a clock mismatch, in which the pace of disease progression does not slow to match the pace of reconstruction. A resectable tumor becomes unresectable; compensated cirrhosis decompensates while the relevant hospital is, by every published metric, being rebuilt. An entire cohort of patients with treatable disease today risks missing their treatable window before meaningful surgical capacity returns, an attrition invisible to conventional reconstruction indices. Any credible framework needs a second metric alongside facility functionality: time to capacity for complex disease, not just time to reopening.[11]
The conditions that make care possible are structured by forces reaching far beyond the clinic. What Paul Farmer termed structural violence—the way poverty, displacement, and the deliberate distribution of resources become embodied as illness and death—operates independently of any single act of bombardment, and outlasts it.[12] In and around Gaza City, WHO now estimates that nearly 90% of Gaza’s water and sanitation infrastructure has been damaged or destroyed, with roughly 80% of the population dependent on trucked water; households survive on a fraction of the 50–100 liters of water per person that WHO considers a minimum for health, and tens of thousands of hepatitis A cases have been recorded, nearly 40,000 in United Nations Relief and Works Agency facilities alone within the first year of war and far more since.[13] A February 2026 Amnesty International and HelpAge International survey of 416 older Gazans shows what such figures mean for a single life: 76% live in tents, and 79% have been displaced more than three times since October 2023, cut off from medication, food, and the networks that once absorbed hardship.[14] Illness in Gaza cannot be separated from the social fabric torn to produce it. Treating the former while ignoring the latter is medical pragmatism dressed as neutrality.
The economy of promised reconstruction has an anthropology of its own. In February 2026, the newly formed Board of Peace secured US$17 billion in pledges for Gaza’s recovery, against a projected need of US$71.4 billion over the next decade in a joint assessment by the World Bank, United Nations, and European Union. By May, only around 1% of the pledged amount had actually been transferred, with reports indicating that the official reconstruction fund held no money at all and donor contributions instead flowed through a private JPMorgan account outside standard transparency requirements, while several donors delayed disbursement amid regional fallout from the Iran conflict.[15] In its May 2026 report to the United Nations Security Council, the Board of Peace itself acknowledged that “the gap between commitment and disbursement must be closed with urgency.” Donor funds continue to be routed around, rather than through, the Palestinian Ministry of Health, entrenching short-term parallel structures managed by nongovernmental organizations rather than strengthening durable local institutions, a pattern repeated in Syria and Afghanistan.
None of this is resolved by logistics alone. Gaza’s health system was structurally fragile long before October 2023, shaped by a 17-year blockade and an occupation that has determined nearly every social determinant of health for five decades.[16]
Meanwhile, the moral attention that briefly made Gaza’s genocide and healthocide impossible to ignore is fading, a phenomenon Judith Butler has termed “unequal grievability,” whereby some losses become politically consequential while others pass with barely a ripple.[17] Institutions that mobilized swiftly against Russia’s invasion of Ukraine have met Gaza with near silence, reflecting what Roberto De Vogli and colleagues call “selective empathy.”[18] Susan Sontag warned that repeated exposure to images of atrocity produces not solidarity but moral fatigue, as suffering becomes spectacle and then background noise.[19] Gaza has reached that stage.
None of this is to say that nothing has moved. An open letter has gathered more than 15,000 signatures, and several public health associations have since recognized the situation in Gaza as genocide—meaningful acts of institutional courage that remain the exception, not the norm.[20]
Reconstruction requires an enforceable ceasefire; the unimpeded entry of medicines, fuel, and equipment; accountability for attacks on health workers and facilities; and genuine Palestinian-led governance of the health sector. It also requires what anthropology and ethics have long insisted on: recognition that health is a social achievement and that restoring it means repairing the conditions of dignity and trust that sustain a population. We called for our profession to move from bearing witness to what we term “healthogenesis,” the active work of reestablishing the conditions under which care and a livable social world can become possible again. Until the bombing, blockade, and silence end, the work of healthogenesis cannot begin, and the promise made on October 10, 2025, risks becoming the latest entry in a long history of promises Gaza has learned not to believe.
Isabella Frigerio, MD, PhD, is a consultant pancreatic surgeon in the HPB Surgical Unit, Pederzoli Hospital, Peschiera del Garda, Italy, and co-founder of Women in Surgery Italia.
Mohammad Abu Hilal, MD, is a professor of surgery at the School of Medicine, University of Jordan, Amman, Jordan, and a consultant HPB surgeon in the Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Andrew A. Gumbs, MD, PhD, is the director of artificial intelligence surgery in the Service de Chirurgie Digestive Minimale Invasive, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, France, and a professor of surgery in the Department of General, Visceral, Vascular and Transplant Surgery, Otto von Guericke University, Magdeburg, Germany.
Umberto Cillo, MD, is a professor of surgery and director of the Hepato-Pancreato-Biliary and Liver Transplant Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Italy.
Gaya Spolverato, MD, is a surgical oncologist, professor of surgery, and director of General Surgery Unit 3, Padua University Hospital, Italy, and co-founder of Women in Surgery Italia.
Alessandro Vitale, MD, PhD, is a professor of surgery and consultant HPB and transplant surgeon in the Hepato-Pancreato-Biliary and Liver Transplant Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Italy.
Please address correspondence toAndrew A. Gumbs. Email: aagumbs@gmail.com.
Competing interests: None declared.
Copyright © 2026 Frigerio, Abu Hilal, Gumbs, Cillo, Spolverato, and Vitale. This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited.
References
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[2] F. Shalltoot, “Medical Aid for Palestinians: Gaza Facing a Health-Care Catastrophe,” Lancet 407/10548 (2026).
[3] Insecurity Insight, for the Safeguarding Health in Conflict Coalition, Attacks on Health Care in the Occupied Palestinian Territory, 21 January–03 February 2026, https://www.insecurityinsight.org/wp-content/uploads/2026/02/74.-21-January-03-February-2026-Attacks-on-Health-Care-in-the-oPt.pdf.
[4] Physicians for Human Rights–Israel, “Release the 14 Gaza Doctors” (May 10, 2026), https://www.phr.org.il/en/release-the-14-gaza-doctors/.
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[12] P. Farmer, Pathologies of Power: Health, Human Rights, and the New War on the Poor (University of California Press, 2003).
[13] World Health Organization, Eastern Mediterranean Regional Office, “Risk of Disease Spread Soars in Gaza as Health Facilities, Water and Sanitation Systems Disrupted” (November 8, 2023), https://www.emro.who.int/media/news/risk-of-disease-spread-soars-in-gaza-as-health-facilities-water-and-sanitation-systems-disrupted.html; C. I. Yavuz and S. B. Unal, “War and Environmental Health in Gaza,” Eastern Mediterranean Health Journal 31/2 (2025); United Nations Office for the Coordination of Humanitarian Affairs, “Humanitarian Situation Report: 26 June 2026” (June 26, 2026), https://www.ochaopt.org/content/humanitarian-situation-report-26-june-2026.
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