Rebuilding Gaza's Health System: Challenges and Priorities

Urgent Public Health Priorities

• 🛡️ Safety and access are paramount, requiring ceasefire compliance, guaranteed access for aid, and deconfliction with Israeli forces.
• ⚠️ Removal of unexploded ordinances is critical for safe passage in essential corridors for health, water, and shelter.
• 💧 Life-saving services include ensuring sufficient quantity and quality of water, sanitation, adequate shelter, food, power, and fuel.
• 🏥 Stabilizing trauma care and emergency care is crucial, alongside primary care for women and children, and addressing non-communicable diseases for older populations.

Scale of Destruction and Debris

• 💥 Gaza's health system has experienced unprecedented destruction, with very few hospitals partially functioning and none fully operational.
• 🏗️ Over 62 million tons of rubble need removal, a complex and lengthy process that complicates relief efforts and poses health risks like asbestos exposure.
• ⏳ Dealing with rubble and unexploded ordinances could take years, if not decades, requiring prioritization of areas for debris removal and clearance.

Rebuilding the Health System

• ⛺ Immediate needs include hospital tents and self-contained emergency medical teams to supplement damaged infrastructure.
• 🏥 Rebuilding should focus on area-based care, prioritizing primary healthcare and key hospitals in concentrated population areas.
• 🛠️ A long-term vision involves rebuilding with intention, focusing on trauma rehabilitation, preventive, and primary care, rather than immediately reconstructing all hospitals.
• 🌐 Rebuilding must be at a systems level, addressing the health workforce, supply chains, and infrastructure systematically.

Unique Challenges in Gaza

• 🌍 Gaza's small, densely populated area and constant displacement of people, with no option to leave the conflict zone, make it unique.
• 💥 Relentless bombardment and false assurances of safe places have created an acute and rare conflict setting.
• 🗳️ Political factors influence aid distribution, with funding often based on donor political desires rather than needs.
• 🎯 Deliberate attacks on humanitarian workers and infrastructure (hospitals, water systems) are increasingly common globally, making response difficult.

Long-Term Health Crisis and Recovery

• 📉 The health crisis is expected to last for generations, with significant intergenerational effects.
• 🧠 Stunting (physical and mental) due to prolonged malnutrition will impact child development.
• 😥 Mental health and psychosocial issues will linger for decades, affecting populations on both sides.
• 📚 Lack of educational continuity may lead to learning disabilities.
• 🚶‍♂️ Extensive rehabilitation needs for those with lost limbs and severe injuries will be a generational challenge.

Current State and Future Outlook

• ⏳ Rebuilding Gaza's health system, which was once sophisticated, will likely take a decade or more.
• 📈 Progress since the ceasefire is limited due to ongoing access restrictions and the sheer scale of destruction.
• 🤝 Gazan healthcare workers must lead the planning and rebuilding efforts, with unlimited access for international support.
• ✈️ Medical evacuation numbers are shamefully low compared to the vast need, requiring greater international commitment.

Prevalent Medical Conditions and Hospital Conditions

• 🤕 Trauma victims continue to require surgery and reconstruction, even with a ceasefire.
• 💊 Chronic diseases (cancer, heart, lung, kidney) and infectious diseases are undertreated due to resource limitations.
• 🌾 Profound malnutrition underpins many conditions, impacting recovery and treatment capabilities.
• 🏥 Hospitals operate with severely limited resources, marginally better since the ceasefire but far from normal functioning.
• 💔 Health workers are heroic but broken, mentally and physically exhausted, despite saving lives daily.
• 💉 Preventing infectious diseases like polio and measles requires early focus on water and sanitation, and rapid vaccine distribution.
• 💧 Oral cholera vaccines are a consideration but face high global demand and insufficient quantity.
• 🚁 Inspiring examples of healthcare workers' resilience include working through starvation, operating after fainting, and returning to work after injury or arrest.