In the summer of this year IDEALS was alerted by Dr Judith Darmandy and Sally Fitzharris to the plight of three young Gaza amputees. Although they had undergone some rehabilitation treatment in Israel they were now back in Gaza and their follow up treatment is now very uncertain.

IDEALS initial request was to equip these unfortunate youngsters with wheelchairs but very soon it became apparent that the situation in Gaza had resulted in a large number of disabled individuals who had to manage without proper rehabilitation or equipment. We were put in contact with Professor Colin Green from Northwick Park University Hospital who has much experience of establishing training and research programmes in Gaza and as a result we were introduced to the organisation Medical Aid for Palestine (MAP). Two meetings have now taken place and our future programme for Gaza will involve establishing Primary Trauma Care in the area for medical and nursing personnel and paramedics in outlying parts of Gaza that are often "cut off" form immediate specialist surgical care at times of major conflict. In addition we will be investigating the facilities for rehabilitation of severely injured patients to see if IDEALS can develop assistance in this field.

A review visit, completely financed by IDEALS, will take place in January 2008 and involve Project Co-ordinator Dr Andy Ferguson and the Trustees Sir Terence English, Dr Eamon McCoy and John Beavis. In the mean time we stand by our original promise to assist with wheel chairs and other equipment for the injured boys first shown to us and will work in collaboration with MAP in this matter

In August 2009 IDEALS Trustees Sir Terence English and John Beavis visited Gaza on behalf of PTC UK and supported by Medical Aid for Palestine MAP. The purpose was to meet with members of the medical profession and assess whether PTC was suitable for the area. We were greeted with enthusiasm and as well as deciding that a system of PTC would be of great value we also decided that there was much else that IDEALS could do to support these highly professional people. The memories of the Sarajevo siege were revived as it became obvious that the severe plight of the Gazans was matched by their determination to "carry on regardless".

In November Dr Andy Ferguson and John Beavis returned as an advanced party to prepare for a full PTC course and were joined five days later by a team consisting of three surgeons "including Sir Terence" and two anaesthetists to undertake two main courses and one Instructors course. From this a total of more than fourty doctors and nurses were trained and sixteen were appointed as Instructors to lead the development of PTC in Gaza.

IDEALS Technical advisor Andy Ferguson conducted a survey of the medical facilities in Gaza and concluded that the siege was responsible for delay and in some cases inadequate care of chronically sick patients. To assist with this would require massive funds but, as was discovered by IDEALS in Bosnia, solving such problems is an imperative part of reconstructing Gazan society. Greater effort must be made to try and develop local facilities and so IDEALS will try to establish Surgical Fellowships in limb reconstruction at a London Teaching hospital. The purpose of this is to train young surgeons in the management of patients with mutilating limb injuries from all trauma but especially those caused by war. In addition we hope to develop video conferencing for Gazan doctors to allow discussion and examination of patients with colleagues around the world.

The picture heading this article was painted by Mark a severely disabled 52 year old man. Despite being in a wheel chair and unable to speak he portrays his vibrant personality with the dynamic painting. He contributes much to the lives of those who know him --especially his family. Mark is fortunate to live in a country which expresses its civilisation by caring for him as well as possible. Unfortunately chronically disabled individuals or those with continuing disease are the hidden victims of war. The world responds to acute problems but the exacerbation of the plight of those who need constant care is often forgotten. Sometimes this is shown in the lack of drugs for illnesses such as diabetes while at other times it is the failure of the war torn country to provide equipment or therapy to those, like Mark. IDEALS believes that it is entirely appropriate and according to its foundation mission statement, to look beyond the care of the acutely injured and to consider the long term problems of war by assisting with patients suffering from conditions like cerebral palsy and other neurological problems. Dr Andrew Ferguson visited Gaza along with John Beavis in early 2011 and have identified specific projects for which we hope to raise funds and will be described in separate articles on this website.

IDEALS was approached by a third year medical student enquiring about the possibility of visiting Gaza on one of our routine visits. The student has an eclectic interest in medicine and was not simply interested in seeing the effects of war. He was able to accompany Dr Andy Ferguson and John Beavis in July 2011 and was present as arrangements were made for the charity's involvement in care for the chronically disabled. In addition, he was able to meet a large number of medical personnel and take part in clinical activities involving the burns unit and the operating theatres' work. He was present during a major ward round in the rehabilitation unit at Al Wafa Hospital which had suffered massive damage during Operation Cast Lead in December 2009. Thankfully the hospital has been largely rebuilt but for many months the staff have had no or very little payment for their extraordinary activity. The work and clinical content of this experience was very valuable. Most importantly he met the ordinary Gazan people and witnessed the privations of a seige and the continued hope for peace and return to a normal life. He was present at one of the major graduation ceremonies of the Islamic University having been invited there by Professor Mofeed, Director of Surgery and Dean of the Medical School. His visit was combined with a one month tour of The West Bank and Israel and has written a commentary on his visit to Gaza.

In Rafah, Southern Gaza on the Egyptian border a project of community Occupational Therapy was concluded with many good results.

The appointed OT was working with a major local charity, Al Asdiqaa Association, and ultimately overseen by IDEALS. Due to the blockade the number of OTs has diminished and so a major part of the project was to train families in their homes.

In addition it was essential to train Community Based Rehabilitation workers, (CBR) and Physiotherapists to consider and manage the problems of daily living in severely disabled people in order to enhance their lives and allow them to enjoy their place in the community. In addition the appointed OT carried out treatment in the patients’ homes.

During a good year over 600 patients were seen and treated in their own homes; A total of 824 home visits were conducted which cover all geographical location of the project in Rafah. Weekly training sessions held for their entire community based rehabilitation team, led by the OT and designed to enhance their OT skills; the OT is supervising adaptations to 100 homes for PWD in Rafah (work funded by the government's Charitable Works Agencies).

The OT reported on the results of training for OT assistants and workers:-

A total of 48 training workshop were held for 18 CBR workers and OT assistants.

Outcome of the training:

There was a shift in the mentality of the trainees from thinks as medical practitioner to creatively thinking as an occupational therapy.

The trainees could be engaged in designing simple devices that fit the needs of people with disability particularly children who are in need for social, mental and physical stimulation. (eg. interactive toys to stimulate sensations and fine motor abilities)

The trainees were able to create activities that engage people with disability particularly children in social stimulation activities, which include but not limited to, activities that promote ADL, productive, and leisure time activities.

The trainees were able to successfully conduct group therapy sessions, which promote socialization among group members, as well as exchange of experience which positively reflect on improving the group's performance in daily life.

The IDEALS team was the clinical arm of a combined project supported financially by HM Government Department and logistically managed by the charity Medical Aid for Palestinians. The IDEALS’ representatives consisted of Orthopaedic & Trauma Surgeons, Graeme Groom, Sarah Phillips and John Beavis. Accompanying them were other King’s College Hospital Consultants Dr Simon Calvert, a Director of the Accident and Emergency Department, and Mr Naveen Cavale, Consultant Plastic and Reconstructive Surgeon.

The Organisational Director in the field of this mission, with considerable expert in Public Health was, as usual, Dr Andrew Ferguson who is the Technical Advisor to IDEALS. Although the Peace Agreement had been in existence for two weeks there were still deficiencies. Andrew Ferguson’s assessment, which will be published separately, showed major problems with equipment and widespread domestic and social inadequacies as a result of the prolonged hostilities. He linked up with other organisations such as the Limb Fitting Centre run by ICRC and visiting members of Handicap International. It became obvious that the planned Limb Reconstruction work would have to link up strongly with the ICRC Unit while Handicap International demonstrated there were a significant number of patients living outside the hospitals with major limb injuries.

Surgical work was undertaken but assessment revealed that many of the evacuated patients had been returned without any treatment. Mr Naveen Cavale advised on complex plastic surgical problems and was involved in the reconstructive surgery while Sarah Phillips and Graeme Groom undertook specific limb reconstruction work. All were of the opinion he stated that the main focus was to develop equipment that is required and to organise the repeated visits of the combined team. Dr Simon Calvert, accompanied by John Beavis, made a detailed assessment of the Accident and Emergency Department and the extensive care given at Shiva Hospital and the Burns Unit. The full report will be posted on this website but it is clear that a long term training and advisory programme must be set in motion to try to establish a modern Emergency Department system. Dr Calvert’s training work will be based at King’s College Hospital.

The IDEALS team, which will include Dr Eamon McCoy (Consultant Anaesthetist and IDEALS Trustee) will return to Gaza on 18th October 2014 and they will actively pursue these challenging tasks.

The surgeons belong to the charity Ideals, and were sent to Gaza by Medical Aid for Palestinians to visit the main hospitals there to carry out assessments and to perform post-traumatic, reconstructive surgeries. View the full article on the BBC

We have been awarded a second grant by the Tropical Health Education Trust (THET) to continue the work to help develop a specialist limb reconstruction service in Gaza. Following the success of the training fellowships at King's College Hospital (KCH), London, for three orthopaedic surgeons from Gaza, this second grant will support further training fellowships for other key members of the limb reconstruction team (two plastic surgeons, a specialist nurse and physiotherapist), and a series of visits by senior KCH consultants to Gaza over the next two years to provide in-service training: educational workshops and joint outpatient clinics/theatre sessions.

Excellent news!

Our main objective in the current emergency was to get surgical teams and life-saving equipment/supplies into Gaza as soon as possible.

Our first team worked at the European Gaza hospital, Khan Younis, for two weeks from 27th December 2023, our second team returned from the same hospital a fortnight ago, and our third team travel out on Sunday 25th February.

We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries.

So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.

Update to Current Crisis

The conflict in Gaza began on 7th October 2023. As of the 8th April 2024:

• 33,207 Palestinians in Gaza have been killed and 75,933 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments across Gaza from air, land and sea are ongoing, with intense ground operations and fighting between Israeli forces and Palestinian armed groups.
• Only 10 of 36 hospitals across Gaza are partially functional and able to admit patients. Most of those, particularly in the north, are only able to provide limited services because of critical shortages of supplies and staff. In Khan Younis, patients and staff have largely been evacuated from Nasser hospital, and the European Gaza hospital (EGH) is at risk of closure due to the issuance of evacuation orders in adjacent areas and the ongoing conduct of hostilities nearby.
• Over 80% of primary health care clinics have shut down because of damage or a lack of fuel and/or staff. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• There are an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions; most without access to midwives, doctors or health care facilities. A threefold increase in the miscarriage rate has been reported since the war began, due primarily to displacement, shock and malnutrition.
• 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
• A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly. There has also been a concerning increase in the number of cases of mumps and meningitis, with potentially devastating outbreaks of typhoid, cholera and measles anticipated.
• On 6th April, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Martin Griffiths, described the passing six months of war in Gaza as a “betrayal of humanity,” warning that “we face the unconscionable prospect of further escalation in Gaza, where no one is safe and there is nowhere safe to go. An already fragile aid operation continues to be undermined by bombardments, insecurity and denials of access.”
• Critical food shortages have created famine conditions across Gaza, especially in the north. On 15th March the United Nations Children’s Fund (UNICEF) reported a staggering and rapid rise in malnutrition levels among children, warning that "there is a high risk that malnutrition rates will continue to increase across the Gaza Strip in the absence of more humanitarian assistance and the restoration of essential services". Tragically over 20 young children in northern Gaza have already died as a result of acute malnutrition.
• Mains electricity has been unavailable since 11th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
• Erez crossing remains closed by the Israeli authorities. Rafah and Kerem Shalom crossings are now open more consistently, allowing a small number of internationals and critically injured patients to leave and the delivery/distribution of aid into Gaza, but still only a fraction of the fuel, food, water and medical supplies needed are getting in.

Our Immediate Objective:

• To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible.
• Our first team worked at the European Gaza hospital, Khan Younis, for two weeks from 27th December 2023, and we have deployed teams to the same hospital for two weeks every month since then. We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.

Medium/Longer-Term Objectives:

• To continue regular missions and vital equipment procurement over the next year, with the focus changing post ceasefire from emergency care to longer-term reconstruction and rehabilitation.

• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.

To support our life-saving work please donate through the link above. Thank you.

Update to Current Crisis

The conflict in Gaza began on 7th October 2023. As of the 27 th March 2024:

• 32,490 Palestinians in Gaza have been killed and 74,889 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments across Gaza from air, land and sea are ongoing, with intense ground operations and fighting between Israeli forces and Palestinian armed groups, especially in and around Shifa hospital in Gaza city and in central Khan Younis.
• Only 12 of 36 hospitals across Gaza are partially functional and able to admit patients. Most of those, particularly in the north, are only able to provide limited services because of critical shortages of supplies and staff. In Khan Younis, patients and staff have largely been evacuated from Nasser hospital, and the European Gaza hospital (EGH) is at risk of closure due to the issuance of evacuation orders in adjacent areas and the ongoing conduct of hostilities nearby.
• Over 80% of primary health care clinics have shut down because of damage or a lack of fuel and/or staff. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• Only four of 22 United Nations Relief Works Agency (UNRWA) health centres are still operational in southern areas of Gaza. Midwives are providing care for post-natal and high-risk pregnant women at these centres, with an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions.
• 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.  A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly. There has also been a concerning increase in the number of cases of mumps and meningitis, with potentially devastating outbreaks of typhoid, cholera and measles anticipated.
• Critical food shortages have created famine conditions across Gaza, especially in the north. On 15th March the United Nations Children’s Fund (UNICEF) reported a staggering and rapid rise in malnutrition levels among children, warning that "there is a high risk that malnutrition rates will continue to increase across the Gaza Strip in the absence of more humanitarian assistance and the restoration of essential services". Tragically over 20 young children in northern Gaza have already died as a result of acute malnutrition.
• Mains electricity has been unavailable since 11th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
• Erez crossing remains closed by the Israeli authorities. Rafah and Kerem Shalom crossings are now open more consistently, allowing a small number of internationals and critically injured patients to leave and the delivery/distribution of aid into Gaza, but still only a fraction of the fuel, food, water and medical supplies needed are getting in.

Our Immediate Objective:

• To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible. Our first team worked at the European Gaza hospital, Khan Younis, for two weeks from 27th December 2023, and we have deployed teams to the same hospital for two weeks every month since then. We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.

Medium/Longer-Term Objectives:

• To continue regular missions and vital equipment procurement over the next year, with the focus changing post ceasefire from emergency care to longer-term reconstruction and rehabilitation.
• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.

To support our life-saving work please donate through the link below. Thank you.

Update to Current Crisis

The conflict in Gaza began on 7th October 2023. As of the evening of 28th January 2024:

• 26,422 Palestinians in Gaza have been killed and 65,087 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments across Gaza from air, land and sea are ongoing, with intense ground operations and fighting between Israeli forces and Palestinian armed groups, especially in Deir al Balah and Khan Younis.
• Only 14 of 36 hospitals across Gaza are partially functional and able to admit patients. In Deir al Balah and Khan Younis, three hospitals – Al Aqsa, Nasser and European Gaza hospitals – are at risk of closure due to the issuance of evacuation orders in adjacent areas and the ongoing conduct of hostilities nearby.
• Over 80% of primary health care clinics have shut down because of damage or a lack of fuel and/or staff. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• Only four of 22 United Nations Relief Works Agency (UNRWA) health centres are still operational in southern areas of Gaza. Midwives are providing care for post-natal and high-risk pregnant women at these centres, with an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions.
• Nearly 1.9 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
• A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly. There has also been a concerning increase in the number of cases of mumps and meningitis.
• Essential food stocks are severely depleted throughout Gaza and completely exhausted in the north. On 16th January, in a joint statement, a number of UN Special Rapporteurs said that “currently every single person in Gaza is hungry, a quarter of the population are starving and struggling to find food and drinkable water, and famine is imminent.”
• On 28th January, the UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Martin Griffiths stated that “the people of Gaza have been enduring unthinkable horrors and deprivation for months. Their needs have never been higher – and our humanitarian capacity to assist them has never been under such threat. We need to be at full stretch to give the people of Gaza a moment of hope.”
• Mains electricity has been unavailable since 11th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
• Erez crossing remains closed by the Israeli authorities. Rafah and Kerem Shalom crossings are now open more consistently, allowing a small number of internationals and critically injured patients to leave and the delivery/distribution of aid into Gaza, but still only a fraction of the fuel, food, water and medical supplies needed are getting in.

Our immediate objectives:

• To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible. Our first team worked at the European Gaza hospital, Khan Younis, for two weeks from 27th December 2023, and our second team entered Gaza on 23rd January 2024 and are also working at the European Gaza hospital. We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation. To simultaneously complete a thorough assessment of health care needs in Gaza to guide our subsequent work.

Medium-term objectives:

• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.
• To bring standards of major trauma care at the five principal hospitals up to modern international standards.

To support our life-saving work please donate through the link above. Thank you.

Update to Current Crisis

The conflict in Gaza began on 7th October 2023. As of the 29th April 2024:

• 34,488 Palestinians in Gaza have been killed and 77,643 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments across Gaza from air, land and sea are ongoing, with intense ground operations and fighting between Israeli forces and Palestinian armed groups.
• Only 10 of 36 hospitals across Gaza are partially functional and able to admit patients. Most of those, particularly in the north, are only able to provide limited services because of critical shortages of supplies and staff. In Khan Younis, patients and staff have largely been evacuated from Nasser hospital, and the European Gaza hospital (EGH) is at risk of closure due to the issuance of evacuation orders in adjacent areas and the ongoing conduct of hostilities nearby.
• Over 80% of primary health care clinics have shut down because of damage or a lack of fuel and/or staff. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• There are an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions; most without access to midwives, doctors or health care facilities. A threefold increase in the miscarriage rate has been reported since the war began, due primarily to displacement, shock and malnutrition.
• 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
• A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly. There has also been a concerning increase in the number of cases of mumps and meningitis, with potentially devastating outbreaks of typhoid, cholera and measles anticipated.
• On 6th April, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Martin Griffiths, described the passing six months of war in Gaza as a “betrayal of humanity,” warning that “we face the unconscionable prospect of further escalation in Gaza, where no one is safe and there is nowhere safe to go. An already fragile aid operation continues to be undermined by bombardments, insecurity and denials of access.”
• Critical food shortages have created famine conditions across Gaza, especially in the north. On 15th March the United Nations Children’s Fund (UNICEF) reported a staggering and rapid rise in malnutrition levels among children, warning that "there is a high risk that malnutrition rates will continue to increase across the Gaza Strip in the absence of more humanitarian assistance and the restoration of essential services". Tragically over 20 young children in northern Gaza have already died as a result of acute malnutrition.
• Mains electricity has been unavailable since 11th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
• Erez crossing remains closed by the Israeli authorities. Rafah and Kerem Shalom crossings are now open more consistently, allowing a small number of internationals and critically injured patients to leave and the delivery/distribution of aid into Gaza, but still only a fraction of the fuel, food, water and medical supplies needed are getting in.

Our Immediate Objective:

• To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible.
• Our first team worked at the European Gaza hospital, Khan Younis, for two weeks from 27th December 2023, and we have deployed teams to the same hospital for two weeks every month since then. We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.

Medium/Longer-Term Objectives:

• To continue regular missions and vital equipment procurement over the next year, with the focus changing post ceasefire from emergency care to longer-term reconstruction and rehabilitation.

• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.

To support our life-saving work please donate through the link above. Thank you.

Current Crisis

The conflict in Gaza began on 7 th  October 2023. As of the 25 th May 2024:

• 35,800 Palestinians in Gaza have been killed and 80,200 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments across Gaza from air, land and sea are ongoing, with intense ground operations and fighting between Israeli forces and Palestinian armed groups, especially in Jabalya and eastern/central Rafah.
• Only 15 of 36 hospitals across Gaza are partially functional, and only eight of these can currently admit patients. No hospitals are currently accessible in the north of Gaza, and all health facilities are facing critical shortages of staff, fuel and medical supplies. Eight field hospitals are operational, providing some support to a fragmented and overwhelmed health care system.
• Over 80% of primary health care clinics have shut down because of damage or a lack of fuel and/or staff. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• There are an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions; most without access to midwives, doctors or health care facilities. A threefold increase in the miscarriage rate has been reported since the war began, due primarily to displacement, shock and malnutrition.
• 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
• A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly. There has also been a concerning increase in the number of cases of mumps and meningitis, with potentially devastating outbreaks of typhoid, cholera and measles anticipated.
• Critical food shortages have created famine conditions across Gaza, especially in the north. The United Nations Children’s Fund (UNICEF) has reported a staggering and rapid rise in acute malnutrition levels among children, warning that "there is a high risk that malnutrition rates and deaths from starvation will continue to increase across the Gaza Strip in the absence of more humanitarian assistance and the restoration of essential services".
• Mains electricity has been unavailable since 11 th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
• Since the start of the military operation in Rafah on the 7 th May 2024 the already inadequate delivery/distribution of aid into Gaza has plummeted still further, with only a tiny fraction of the fuel, food, water and medical supplies needed getting in.

Our Immediate Objective:

• To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible. Our first team worked at the European Gaza hospital, Khan Younis, for two weeks from 27th December 2023, and we have deployed teams to the same hospital for two weeks every month since then. We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.

A Summary of Our Clinical Activity to Date:

Medium/Longer-Term Objectives:

• To continue regular missions and vital equipment procurement over the next year, with the focus changing post ceasefire from emergency care to longer-term reconstruction and rehabilitation.
• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.

To support our life-saving work please donate through the link above. Thank you.

Current Crisis

The conflict in Gaza began on 7th October 2023. As of the 24th June 2024:

• 37,626 Palestinians in Gaza have been killed and 86,098 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments continue across Gaza from air, land and sea, as well as ground incursions and intense fighting between Israeli forces and Palestinian armed groups, resulting in further civilian casualties and displacement, and destruction of houses and other civilian infrastructure.
• Only 17 of 36 hospitals across Gaza are partially functional, and only eight of these can currently admit patients. All health facilities are facing critical shortages of staff, fuel and medical supplies. Eight field hospitals are operational, providing some support to a fragmented and overwhelmed health care system.
• Over 80% of primary health care clinics have shut down because of damage or a lack of fuel and/or staff. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• There are an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions; most without access to midwives, doctors or health care facilities. A threefold increase in the miscarriage rate has been reported since the war began, due primarily to displacement, shock and malnutrition.
• 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
• A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly. There has also been a concerning increase in the number of cases of mumps and meningitis, with potentially devastating outbreaks of typhoid, cholera and measles anticipated.
• Critical food shortages have created famine conditions across Gaza, especially in the north. The United Nations Children’s Fund (UNICEF) has reported a staggering and rapid rise in acute malnutrition levels among children, warning that "there is a high risk that malnutrition rates and deaths from starvation will continue to increase across the Gaza Strip in the absence of more humanitarian assistance and the restoration of essential services".
• Mains electricity has been unavailable since 11th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
• Since the start of the military operation in Rafah on the 7th May 2024 and the closure of Rafah crossing, the already inadequate delivery/distribution of aid into Gaza has plummeted still further, with only a tiny fraction of the fuel, food, water and medical supplies needed getting in.

Our Immediate Objective:

• To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible. Our first team worked at the European Gaza hospital, Khan Younis, for two weeks from 27th December 2023, and we deployed teams to the same hospital for two weeks every month from then until May 2024. We were able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients had lost family members and had devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation. Sadly we have had to cancel our last two missions because of the extremely limited access to Gaza since the closure of Rafah crossing, but we hope to send our next team in for the whole of August and resume regular missions after that.

A Summary of Our Clinical Activity to Date:

Medium/Longer-Term Objectives:

• To continue regular missions and vital equipment procurement over the next year, with the focus changing post ceasefire from emergency care to longer-term reconstruction and rehabilitation.
• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.

To support our life-saving work please donate through the link above. Thank you.

Current Crisis

• The conflict in Gaza began on 7th October 2023. As of the 29th July 2024:
• 39,363 Palestinians in Gaza have been killed and 90,923 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments continue across Gaza from air, land and sea, as well as ground incursions and intense fighting between Israeli forces and Palestinian armed groups, resulting in further civilian casualties and displacement, and destruction of houses and other civilian infrastructure.
• Only 16 of 36 hospitals across Gaza are partially functional, and only eight of these can currently admit patients. Not a single hospital is fully functional and all health facilities are facing critical shortages of staff, fuel and medical supplies. Eight field hospitals are operational, providing some support to a fragmented and overwhelmed health care system.
• Over 80% of primary health care clinics have shut down because of damage or a lack of fuel and/or staff. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• There are an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions; most without access to midwives, doctors or health care facilities. A threefold increase in the miscarriage rate has been reported since the war began, due primarily to displacement, shock and malnutrition.
• 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
• A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly. There has also been a concerning increase in the number of cases of mumps and meningitis, with potentially devastating outbreaks of typhoid, cholera and measles anticipated.
• Efforts continue to avert the spread of polio after six circulating variant poliovirus strains were detected in environmental samples from Deir al Balah and Khan Younis in late June 2024. Gaza had a vaccination coverage of 99% prior to the war, a rate that has now dropped to 86% due to the “decimation of the health system, lack of security, destruction of infrastructure, mass displacement and shortage of medical supplies,” explained the WHO Director-General, Tedros Adhanom Ghebreyesus. “While no cases of polio have been recorded yet, without immediate action it is just a matter of time before it reaches the thousands of young children who have been left unvaccinated and unprotected,” he added.  
• Critical food shortages have created famine conditions across Gaza, especially in the north. The United Nations Children’s Fund (UNICEF) has reported a staggering and rapid rise in acute malnutrition levels among children, warning that "there is a high risk that malnutrition rates and deaths from starvation will continue to increase across the Gaza Strip in the absence of more humanitarian assistance and the restoration of essential services".
• Mains electricity has been unavailable since 11th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
• Since the start of the military operation in Rafah on the 7th May 2024 and the closure of Rafah crossing, the already inadequate delivery/distribution of aid into Gaza has plummeted still further, with only a tiny fraction of the fuel, food, water and medical supplies needed getting in.

Our Immediate Objective:

• To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible. Our first team worked at the European Gaza hospital, Khan Younis, for two weeks from 27th December 2023, and we deployed teams to the same hospital for two weeks every month from then until May 2024. We were able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients had lost family members and had devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation. Sadly we have had to cancel our last two missions because of the extremely limited access to Gaza since the closure of Rafah crossing, but we hope to send our next team in for the whole of August 2024 and resume regular missions after that.

A Summary of Our Clinical Activity to Date:

Medium/Longer-Term Objectives:

• To continue regular missions and vital equipment procurement over the next year, with the focus changing post ceasefire from emergency care to longer-term reconstruction and rehabilitation.
• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.

To support our life-saving work please donate through the link above. Thank you.

Current Crisis

The conflict in Gaza began on 7th October 2023. As of the 23rd September 2024:

• 41,431 Palestinians in Gaza have been killed and 95,818 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments across Gaza from air, land and sea are ongoing, with intense ground operations and fighting between Israeli forces and Palestinian armed groups.
• Only 17 of 36 hospitals across Gaza are partially functional, and only eight of these can currently admit patients. Not a single hospital is fully functional and all health facilities are facing critical shortages of staff, fuel and medical supplies. Eight field hospitals are operational, providing some support to a fragmented and overwhelmed health care system.
• Only 57 of 132 primary health care clinics are even partially functional, because of damage or a lack of fuel and/or staff and/or drugs/supplies. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• There are an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions; most without access to midwives, doctors or health care facilities. A threefold increase in the miscarriage rate has been reported since the war began, due primarily to displacement, shock and malnutrition.
• A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly, and the first case of polio in Gaza in 25 years now confirmed. There has also been a concerning increase in the number of cases of mumps and meningitis, with potentially devastating outbreaks of typhoid, cholera and measles anticipated.
• 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
• Critical food shortages have created famine conditions across Gaza, especially in the north. The United Nations Children’s Fund (UNICEF) has reported a staggering and rapid rise in acute malnutrition levels among children, warning that "there is a high risk that malnutrition rates and deaths from starvation will continue to increase across the Gaza Strip in the absence of more humanitarian assistance and the restoration of essential services".
• Mains electricity has been unavailable since 11th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
• Since the start of the military operation in Rafah on the 7th May 2024 and the closure of Rafah crossing, the already inadequate delivery/distribution of aid into Gaza has plummeted still further, with only a tiny fraction of the fuel, food, water and medical supplies needed getting in.

Our Immediate Objective:

• To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible. Our first team worked at the European hospital for two weeks from 27th December 2023, and we have deployed another five teams since then to the European and Nasser hospitals, both in Khan Younis. We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.

A Summary of Our Clinical Activity to Date:

Medium/Longer-Term Objectives:

• To continue regular missions and vital equipment procurement over the next year, with the focus changing post ceasefire from emergency care to longer-term reconstruction and rehabilitation.
• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.

To support our life-saving work please donate through the link above. Thank you.

The conflict in Gaza began on 7 th  October 2023. As of the 10 th December 2024:

• 44,786 Palestinians in Gaza have been killed and 106,188 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments across Gaza from air, land and sea are ongoing, with intense ground operations and fighting between Israeli forces and Palestinian armed groups.
• Only 17 of 36 hospitals across Gaza are partially functional, and only eight of these can currently admit patients. Not a single hospital is fully functional and all health facilities are facing critical shortages of staff, fuel and medical supplies. Eight field hospitals are operational, providing some support to a fragmented and overwhelmed health care system.
• Only 57 of 132 primary health care clinics are even partially functional, because of damage or a lack of fuel and/or staff and/or drugs/supplies. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• There are an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions; most without access to midwives, doctors or health care facilities. Maternal deaths, miscarriages and preterm births continue to rise, with conditions being particularly critical in besieged areas of the North Gaza governorate, where an estimated 1,720 pregnant women have remained largely cut off from essential aid for over two months.
• Fewer than 400 patients have been evacuated to receive life-saving medical treatment outside of Gaza over the past seven months; mainly children with cancer. About 14,000 patients with life-threatening conditions await approval to exit.
• A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly, and the first case of polio in Gaza in 25 years now confirmed. There has also been a concerning increase in the number of cases of mumps and meningitis, with potentially devastating outbreaks of typhoid, cholera and measles anticipated.
• 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
• Critical food shortages have created famine conditions across Gaza, especially in the north. The United Nations Children’s Fund (UNICEF) has reported a staggering and rapid rise in acute malnutrition levels among children, warning that "there is a high risk that malnutrition rates and deaths from starvation will continue to increase across the Gaza Strip in the absence of more humanitarian assistance and the restoration of essential services".
• Mains electricity has been unavailable since 11 th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.
• Since the start of the military operation in Rafah on the 7 th May 2024 and the closure of Rafah crossing, the already inadequate delivery/distribution of aid into Gaza has plummeted still further, with only a tiny fraction of the fuel, food, water and medical supplies needed getting in.

Our Immediate Objective:

• To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible. Our first team worked at the European hospital for two weeks from 27th December 2023, and we have deployed another six teams since then to the European and Nasser hospitals, both in Khan Younis. We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.

A Summary of Our Clinical Activity to Date:

Medium/Longer-Term Objectives:

• To continue regular missions and vital equipment procurement over the next year, with the focus changing post ceasefire from emergency care to longer-term reconstruction and rehabilitation.
• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.

To support our life-saving work please donate through the link above. Thank you.

A ceasefire came into effect in Gaza on 19th January 2025. A surge of supplies has entered Gaza since the beginning of the ceasefire, enabling an increase in the humanitarian response to critical needs.

Debris management, retrieval of bodies and addressing explosive ordnance contamination across Gaza are some of the immediate priorities, together with the further scaling up of humanitarian aid and reinstatement of essential services.

IDEALS has a senior orthopaedic surgeon at the European hospital, Khan Younis, for four weeks from 21st January, and he will be joined by a team of four additional orthopaedic and plastic reconstructive surgeons on 13th February. We hope that team will be able to carry in some vital surgical supplies if the ceasefire holds and the improved access continues. However, even if the ceasefire holds and leads to a more permanent peace, we are only at the beginning of a recovery process that will take decades. Within that recovery there are an estimated 20,000 patients requiring complex limb reconstruction; to save their lives and limbs and preserve/improve function and overall quality of life.

This is an overwhelming level of need and we hope you will continue to support our efforts to make a positive difference.

To support our life-saving work please donate through the link above. Thank you.

Prior to the ceasefire:

• At least 47,161 Palestinians in Gaza have been killed and 111,166 injured. Women and children, tragically, make up 70% of all those killed to date.
• Many people remain missing, presumably buried under the rubble, waiting for rescue or recovery.
• Heavy bombardments across Gaza from air, land and sea are ongoing, with intense ground operations and fighting between Israeli forces and Palestinian armed groups.
• Only 17 of 36 hospitals across Gaza are partially functional, and only eight of these can currently admit patients. Not a single hospital is fully functional and all health facilities are facing critical shortages of staff, fuel and medical supplies. Eight field hospitals are operational, providing some support to a fragmented and overwhelmed health care system.
• Only 57 of 132 primary health care clinics are even partially functional, because of damage or a lack of fuel and/or staff and/or drugs/supplies. This severely compromises access to health care for everyone, but particularly young children, pregnant and breastfeeding women, older persons, persons with disabilities and patients with non-communicable diseases (NCDs).
• There are an estimated 50,000 pregnant women in Gaza and more than 180 giving birth every day in the most appalling conditions; most without access to midwives, doctors or health care facilities. Maternal deaths, miscarriages and preterm births continue to rise, with conditions being particularly critical in besieged areas of the North Gaza governorate.
• Fewer than 500 patients have been evacuated to receive life-saving medical treatment outside of Gaza over the past eight months; mainly children with cancer. About 14,000 patients with life-threatening conditions await approval to exit.
• A severe water shortage, consumption of contaminated water, massive overcrowding in shelters and breakdown of the vaccination programme have already resulted in a surge in communicable disease reports, with cases of diarrhoea, respiratory tract infections and hepatitis A rising rapidly, and the first case of polio in Gaza in 25 years now confirmed. There has also been a concerning increase in the number of cases of mumps and meningitis, with potentially devastating outbreaks of typhoid, cholera and measles anticipated.
• 1.8 million Palestinians have been displaced from their homes, fleeing to emergency shelters or the homes of family/friends, with many now displaced multiple times.
• Critical food shortages have created famine conditions across Gaza, especially in the north. The United Nations Children’s Fund (UNICEF) has reported a staggering and rapid rise in acute malnutrition levels among children.
• Mains electricity has been unavailable since 11th October 2023, with completely inadequate fuel supplies for emergency generators, even at hospitals.

Our Immediate Objective:

To help respond to the current emergency, getting surgical teams and life-saving equipment/supplies into Gaza as soon as possible. Our first team worked at the European hospital for two weeks from 27th December 2023, and we have deployed another six teams since then to the European and Nasser hospitals, both in Khan Younis. We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.

A Summary of Our Clinical Activity to Date:

Medium/Longer-Term Objectives:

• To continue regular missions and vital equipment procurement over the next year, with the focus changing post-ceasefire from emergency care to longer-term reconstruction and rehabilitation.
• To continue support for the established adult/paediatric trauma and limb reconstruction services, to ensure resilience and robust succession planning.

After 6 months of war in Gaza, medical services there have all but collapsed

The European Gaza Hospital in the city of Khan Younis is one of the last functioning medical facilities.

A British plastic surgeon, Dr Victoria Rose, has been recording conditions while working there, treating people with bullet wounds, burns and blast injuries. Many of them are young children.

Her video diary reveals the appalling conditions faced by patients and the medical staff treating them.

Jane Hill presents a BBC News at Ten special report by Dr Victoria Rose.

Dr Andy Ferguson spent two weeks working as a doctor in Gaza, at the European Hospital in Khan Younis, helping treat people with severe trauma wounds from bombing, shrapnel and gunfire.

As Israel's forces pushed further south into Gaza over Christmas and New Year, supplies of medicine, anaesthetic and crucial equipment began to run low - and eventually run out entirely in some places.

This is what Dr Ferguson saw.

A ceasefire came into effect in Gaza on 19th January 2025. A surge of supplies entered Gaza post ceasefire, enabling an increase in the humanitarian response to critical needs, but the entry of all aid was stopped by the Israeli authorities three weeks ago and the ceasefire tragically ended on 18th March 2025. In the past week nearly 800 Palestinians have been killed and over 1,600 injured.

Debris management, retrieval of bodies and addressing explosive ordnance contamination across Gaza are some of the current priorities, together with the immediate resumption of the ceasefire and humanitarian aid, and reinstatement of essential services.

Since the war began in October 2023 we have deployed eight teams of between one and four specialist surgeons and anaesthetists to the European and Nasser hospitals, both in Khan Younis. In total 23 specialists have been deployed to date, with a highly experienced orthopaedic surgeon at the European hospital right now.

We have been able to support local colleagues, exhausted and fearful for their families, with the emergency surgical management of survivors of major trauma (predominantly blast and crush injuries), and the subsequent management of patients with complex limb injuries. So many of these patients have lost family members and have devastating, disabling wounds, requiring multiple operations and lifelong rehabilitation.

Our latest team entered Gaza on 6th May and are already hard at work at the European hospital, Khan Younis. The need for our specialist trauma and limb reconstruction expertise has never been greater, with a large number of patients with complex injuries already on the wards and new patients with horrific blast and crush injuries arriving every day. We hope that a second team will join them next week, but access remains extremely difficult and unpredictable.

Over nine weeks into the full aid blockade imposed on people in Gaza and with a major escalation in the Israeli bombardment from air, land and sea, Gaza's health system is at breaking point - overwhelmed by traumatic injuries, damaged infrastructure and severe shortages of staff, equipment and supplies