Hospitals and clinics destroyed. Millions of tons of debris contaminated with toxic substances, unexploded ordnance and human remains. Tens of thousands of people with injuries that will require a lifetime of care.
As Gaza鈥檚 residents return to what is left of their homes, they face new risks on top of monumental health challenges. Fifteen months of war has killed more than 47,000 people, according to local health officials, displaced 90% of Gazans and reduced many areas to rubble. Clean water is in short supply and sewers, so important for protecting public health, are badly damaged spurring worries about the spread of infectious disease.
Aid groups are rushing to provide food and supplies amid a fragile ceasefire between Israel and Hamas as they plan the best way forward.
鈥淵ou have a population with just every health need imaginable 鈥� (who have) been unable to get access to care 鈥� for more than a year,鈥� said Yara Asi, an expert in global health management and visiting scholar at the FXB Center of Health and Human Rights at Harvard. 鈥淲hat is that going to look like in the near future and the long term ?鈥�
Here鈥檚 a look at some of the urgent health issues.
Healthcare in shambles
Most of Gaza鈥檚 36 hospitals were damaged or partly destroyed by Israeli bombs, with only half still partially operational, according to the World Health Organization. Almost two-thirds of health clinics aren鈥檛 open. That makes it impossible to treat everyone who needs urgent and long-term care 鈥� including an estimated 30,000 people who need ongoing rehabilitation for 鈥渓ife-changing injuries,鈥� such as amputations.
The WHO said that when it鈥檚 safe, it鈥檒l team up with other organizations to prioritize critical services such as trauma and emergency care, primary health care and mental health support.
That includes increasing hospital-bed capacity in northern and southern Gaza, and bringing in prefabricated containers to help treat patients at damaged hospitals and clinics, the WHO said.
International workers also are needed to ease staffing shortages, the organization said.
Asi and other experts said most hospital equipment has been destroyed, and is expensive and difficult to import.
鈥淗ow are Palestinians going to import the advanced, expensive medical equipment that actually makes the hospital more than a building?鈥� Asi said. 鈥淭hat鈥檚 going to take years.鈥�
Israel says Hamas is responsible for damage to the health system because the group often used hospitals to hide or gather its men. Under the current six-week ceasefire, Israel has allowed sharp increases of humanitarian supplies. But the sides have not agreed on a permanent end to the war, and Israel has not publicly laid out a postwar vision that would include plans for reconstruction and cleanup of the territory.
Life-changing injuries
The WHO said one-fourth of the estimated 110,000 people injured in the fighting suffered 鈥渓ife-changing鈥� injuries, including over 12,000 who need to be evacuated as soon as possible for specialized care.
Among the injured are thousands of children who lost limbs and will need prosthetics and long-term care, said Marc Sinclair, a pediatric orthopedic surgeon from Dubai who has volunteered in Gaza for over a decade.
He said the charity he helped start, Little Wings Foundation, will partner with the Palestinian Children鈥檚 Relief Fund and a German prosthetics company that will supply containers that can be turned into workshops.
They hope to begin training doctors and manufacturing prosthetics in the West Bank and move the operation to Gaza when they are able.
鈥淭he volume of injured is so huge that it鈥檚 going to be an enormous task to fulfill the needs,鈥� Sinclair said. 鈥淲e鈥檙e talking about children that have not just single amputations, but 鈥� multiple amputations.鈥�
Asi, from Harvard, said thousands of people also suffered traumatic injuries, including brain damage, that will require lifelong care. 鈥淎nd then you have those people that have regular health ailments,鈥� she said. 鈥淭hey鈥檝e been unable to get access to care or medications in some cases for more than a year.鈥�
Threat of infectious disease
A shortage of clean water, destroyed sanitation systems, overcrowding and missed childhood vaccinations have created ideal circumstances for spread of infectious disease, said Asi, also co-director of the Palestine Program for Health and Human Rights.
She said children 鈥� many of whom experienced malnutrition and mental trauma 鈥� are a special concern.
Gaza experienced a polio outbreak for the first time in decades, so it is clear that both children and adults are at risk of other infectious diseases, Asi said.
She said people have described crowded living conditions, a lack of hygiene supplies and garbage and sewage in the streets.
鈥淚t鈥檚 really a health catastrophe from every potential facet,鈥� she said, adding that there have been outbreaks of respiratory infections in tent camps and shelters, and many people are living with undiagnosed skin rashes and infections.
Dangerous debris
Experts say Palestinians returning to their homes in Gaza will be at risk from breathing dust or touching debris contaminated with toxic chemicals, asbestos and human remains, as well as munitions that never exploded. On Monday, tens of thousands of people began returning to northern Gaza as part of the ceasefire, finding piles of rubble where their homes once stood.
It鈥檚 critical to move quickly to identify and contain environmental hazards to 鈥減revent returning residents from inadvertently coming into contact with harmful pollutants鈥� and to keep it from spreading, a United Nations Environment Programme spokesperson said.
The agency plans to begin an on-the-ground assessment within two to three months, as security allows.
The first priority should be for specialized teams to search for and clear unexploded ordnance, then to test air, water and soil for toxic substances, said Paul Walker, chair of the Chemical Weapons Convention Coalition and a former staff member of the House Armed Services Committee.
鈥淧eople are anxious, I know, to rebuild,鈥� he said, but returning home right now 鈥渃ould be very dangerous 鈥� I think we鈥檝e got to expect as people work through the rubble there will inevitably be injuries and deaths.鈥�
But it might be difficult to convince residents to delay their return, said Asi. She said she鈥檚 seen videos showing caravans of people walking 鈥渋n some cases knowing that there鈥檚 nothing waiting for them but just wanting to go back to the land to recover the bodies of loved ones or to see if their house survived or what survives from their home.鈥�
