Gaza Herald _Public health researchers say their work is helping build an evidence base for accountability over Israel’s actions in Gaza, documenting what they describe as a systematic assault on the territory’s healthcare system since October 2023.
Rather than treating Gaza’s devastation as a generic “humanitarian crisis,” researchers have examined how Israeli military operations, bombardment, siege measures and the destruction of civilian infrastructure combined to undermine the health system and the population’s ability to survive.
Their findings could contribute to future investigations into alleged war crimes and other international crimes, including proceedings before the International Court of Justice in the case brought by South Africa accusing Israel of genocide.
Tracking the collapse
Public health research offers a different form of evidence from eyewitness accounts and conventional reporting. By combining mortality records, satellite imagery, hospital data and health-system monitoring with statistical and geographic analysis, researchers have been able to identify patterns in civilian deaths and infrastructure destruction.
One of the earliest indicators was the unusually high proportion of women and children among those killed.
During Israel’s major assaults on Gaza in 2008–09, 2012, 2014 and 2021, women and children accounted for roughly 30% to 41% of those killed. In the first weeks following October 7, 2023, however, they represented approximately 67% of recorded deaths.
Researchers said the demographic pattern was consistent with exceptionally high levels of civilian harm and raised concerns about the conduct of Israel’s bombing campaign.
The mass casualties also rapidly overwhelmed hospitals that were already operating under years of blockade and severely constrained resources.
Satellite and geospatial analysis provided further evidence of the scale of destruction. During the first six weeks of the assault, researchers found damage at more than 60% of health facilities, more than two-thirds of educational facilities and over 40% of water infrastructure sites.
The destruction, they said, was not randomly distributed. Statistical analysis identified significant concentrations of damage around critical civilian infrastructure, raising concerns that essential facilities were being systematically targeted.
Researchers also identified damaging patterns in areas that Israel had designated as “safe zones” and along evacuation routes where civilians had been instructed to seek safety.
Hospitals under attack
Hospitals were among the facilities subjected to intense military pressure, including bombardment and sieges.
International humanitarian law provides hospitals and medical units with special protection. That protection can be lost only under narrowly defined circumstances involving acts harmful to an opposing party outside the facility’s humanitarian function. Even then, the loss of protection does not automatically make an attack lawful.
Israel has repeatedly justified attacks and raids on hospitals by alleging that they were being used for military purposes, including as Hamas command centers. Researchers note that substantial evidence supporting some of these claims has not been publicly demonstrated.
Using publicly available crater data and hospital locations, researchers examined the proximity of major explosions to medical facilities across Gaza.
Their analysis found that roughly one-quarter of Gaza’s hospitals had at least one crater from a US-supplied 2,000-pound bomb within an estimated lethal blast radius during the first six weeks of the war. More than 80% were within distances associated with significant infrastructure damage and injuries.
The researchers argue that these findings demonstrate the extraordinary exposure of hospitals, patients, medical workers and surrounding civilian communities to some of the most destructive weapons used during the campaign.
By the end of October 2023, they found, no hospital in Gaza remained fully functional.
A health system pushed toward collapse
The destruction went beyond individual hospitals.
Researchers working with the World Health Organization examined hospital functionality throughout the first year of the war, taking into account the effects of bombardment, evacuation orders, shortages and the breakdown of essential services.
The analysis found that Gaza’s health-system functionality dropped below 40% within months. At certain points, nearly three-quarters of hospitals were classified as nonfunctional and unable to provide even basic medical services.
For researchers, the pattern points to the degradation of an entire health system rather than a series of isolated incidents.
The collapse was driven through several interconnected mechanisms: mass civilian casualties, destruction of hospitals and medical infrastructure, damage to water systems and other essential civilian services, restrictions associated with the siege, displacement and the continuing military campaign.
Evidence for accountability
Researchers argue that documenting these patterns has implications well beyond public health.
The data can help investigators assess whether military conduct complied with international humanitarian law, examine alleged war crimes and evaluate evidence relevant to genocide and other mass atrocity crimes.
The research also challenges narratives portraying attacks on healthcare infrastructure as isolated or unintended consequences of military operations.
By examining the geographic distribution of destruction, mortality patterns and the progressive loss of healthcare capacity, public health researchers say they can establish a more rigorous record of how Gaza’s medical system deteriorated.
Their work helps connect military and political decisions to measurable consequences for the population, and preserves evidence that could become important in future efforts to establish responsibility, seek justice and provide restitution for the destruction of Gaza’s health system.
