On Sunday, a mere nine days following the implementation of a truce in Gaza, medical teams from Doctors Without Borders (MSF) at Al Aqsa hospital treated 70 patients suffering from blast injuries sustained in Israeli airstrikes. Concurrently, MSF medical personnel at Nasser hospital attended to a patient shot by an Israeli quadcopter. Staff at one of MSF’s field hospitals in Deir al Balah admitted 18 individuals with blast injuries. The U.N. Department of Safety and Security, responsible for monitoring humanitarian security threats like those in Gaza, documented at least five distinct locations across the Strip that were hit by airstrikes.
These assaults, occurring less than two weeks after Israel and Hamas had agreed to cease hostilities and exchange Israeli hostages for Palestinian detainees, left MSF staff in Gaza deeply disturbed and fearful of a reversion to the devastating violence that has resulted in a significant number of fatalities and injuries over the past two years, according to Gaza’s health ministry.
During the ongoing attacks, a flurry of allegations, rebuttals, and shifts in access policies also unfolded. Within a 24-hour window, Israel initially imposed, then retracted its decision to shut down the Rafah border crossing between Gaza and Egypt. While the Kerem Shalom and Kissufim crossings have since been reopened, the Rafah crossing remains closed.
This situation presents the primary challenge for Gaza today. Although the ceasefire is crucial for preventing additional casualties and deaths, humanitarian aid for Gaza’s two million residents is essential to begin improving their living conditions. Currently, only a fraction of the necessary food supplies are entering Gaza daily, falling far short of the World Food Programme’s recommended minimum. Furthermore, making the delivery of aid conditional is not only unethical but also cynical, inhumane, and detrimental to our shared humanity.
The cost of these conditions is immense. The impact of the last two years is shocking. Tens of thousands have perished, with many more wounded or permanently disabled. Over 90% of Gaza’s homes are damaged or uninhabitable: families are displaced, seeking refuge inside schools, or residing in cramped, temporary structures due to the scarcity of other options. A U.N.-backed report from August indicated that mass starvation was emerging in Gaza City. Today, food availability remains highly inconsistent, as do food prices. Essential infrastructure is largely destroyed. Meaningful economic activity has become nearly impossible. Services, infrastructure, governance, stability—everything required for even a semblance of normal life is either gone or severely compromised.
This widespread collapse is most evident within Gaza’s health system. What remains functions less as a coordinated system and more as a fragmented network of last-resort facilities. Only a limited number of health clinics are operational, and not one is fully functioning. A handful of NGO field hospitals provide some critical capacity, mainly surgical, but are insufficient to replace what has been destroyed, let alone meet the comprehensive medical needs of a distressed, injured, and deprived population enduring horrific conditions. More than 1,700 healthcare workers have been killed, making Gaza the deadliest environment for aid workers, with 183 fatalities recorded last year. Fifteen of those killed since 2023 were MSF colleagues. The specialized knowledge and skills of health staff cannot be replaced quickly.
The health system is in ruins. This is because Israeli bombardments and blockades have rendered it impossible for hospitals and health clinics to operate effectively, for their staff to remain safe and housed nearby, and for patients to access necessary care. Currently, over 15,000 patients are registered for treatment abroad because the required care is unavailable locally. While Egypt has accommodated a few hundred patients, other nations have taken far fewer (the U.K. only 39 and France just 14, for instance). At least 740 patients from this list—including 137 children—are still awaiting permits to depart.
Despite some improvements in the commercial supply of goods since the ceasefire agreement, the distribution of humanitarian aid continues to be hampered by bureaucratic hurdles, delays, and blockages. So-called “dual-use goods”—a partial list including solar panels, surgical fixator sets, and spare parts for sewage pumps—have long necessitated special approvals, with each item requiring individual clearance for every importation. Various aid organizations, among others, argue that these overall restrictions are unwarranted and violate Israel’s international obligations. This approach to access, relying on constant negotiation, renegotiation, and repeated discussions over individual items, is neither sustainable nor capable of delivering aid at the required scale.
Any restrictions on aid, given Gaza’s immense needs, should be deemed unacceptable. Denying people the basic necessities for survival to extract compliance or achieve a political accord should be unacceptable. Humanitarian aid and civilian protection are clear obligations under international law: individuals are not required to earn or justify their rights to food, medicine, and shelter. We must not normalize the practice of conditioning relief on security guarantees or political compliance, which ultimately costs lives.