Despite working for Médecins Sans Frontières (MSF) for over 22 years, Palestinian doctor Mohammed Abu Mughaisib has never experienced anything like the devastation that Gaza has endured for the past almost 800 days. He tells The BMJ: “With all my experience being in Gaza and working during different military escalations, I cannot describe what I saw.
“ We have to stop saying that the health system has ‘collapsed’ over the past two years. There is no more health system. It has been targeted at the primary, secondary, and tertiary level. Everything has been targeted.”
Mughaisib—MSF’s deputy medical coordinator in Palestine—is speaking from Ireland, where he was evacuated in September. This year’s BMJ appeal supports MSF’s work in Gaza and more than 75 other countries (box 1). “ Donating will save children; it will save patients. It will make a child cry less from his pain. It will save a woman who is pregnant and has medical problems. It will help an injured patient who needs long term care. All the donations will really help to save the lives of patients in Gaza.”
BMJ appeal 2025-26
The BMJ’s annual appeal is supporting the work of Médecins Sans Frontières (MSF). Around the world, MSF teams are providing maternity care, containing outbreaks, and performing vital surgeries. In areas overwhelmed by conflicts and natural disasters more lives can be saved when we are in the right place at the right time.
Donate today at https://msf.org.uk/bmj-annual-appeal-2025
RETURN TO TEXTHe says that MSF’s work also ensures that Palestinian doctors get paid fairly, as many doctors in Gaza have been working without pay or are being paid so little that they cannot afford to support their families as the prices of basic and essential supplies rise. “In Gaza, [the prices are] like being in London, Paris, and Tokyo all put together,” Mughaisib says.
MSF currently runs two field hospitals and several clinics in Gaza, while also supporting some of the main hospitals. The charity provides everything from primary healthcare and vaccinations to specialised care and surgical services. Mughaisib says that, although international doctors do come to support their teams, nearly all the staff that MSF employ in Gaza are Palestinian.
Hospitals overwhelmed
Mughaisib says that the hospitals that had been able to stay even partially open were constantly overwhelmed by mass casualty events and more closely resembled “public markets” than emergency departments. “You couldn’t stand because of the crowdedness, the huge number of people who were critically injured. Injured patients were on the floor because there was no space. And doctors and paramedics were running from one side to another trying to save whoever they could.
“Medical staff running to the emergency department were afraid that they would see members of their family. It was a horrible situation inside the hospitals.”
More than 70 000 Palestinians, including over 18 400 children, have been killed in Gaza in the past two years. A further 170 000 have been injured.1 At least 1722 healthcare workers have been killed in Gaza—an average of two every day for the past two years.2
Healthcare attacks in Gaza in 2024. Interactive version and downloadable data at https://public.flourish.studio/visualisation/26510590/.10
Despite a US brokered ceasefire between Israel and Hamas being officially declared on 10 October, Mughaisib says that the Israeli attacks never stopped. Israel has violated the ceasefire at least 497 times in 44 days, the Gaza Government Media Office reports. More than 340 people—mainly women, children, and elderly people—have been killed in these attacks.3
“Just yesterday there were 28 killed, 77 injured. So I mean to speak about a ceasefire, there is no ceasefire,” Mughaisib says, referring to Israeli attacks on 19 November.4 “Since the declaration of a ceasefire, there have always been airstrikes and bombing—it didn’t stop. A lot of people have been killed and injured. The majority of them were children and women. So there is no excuse about targeting military or Palestinian fighters or whatever. No, children were the main target.”
“The smell of infected wounds and blood”
Mughaisib describes the carnage he saw in the days leading up to his evacuation. “I went to say goodbye to the team at Nasser Hospital. When I entered the MSF unit, patients were on the floor. There was no space. It was at more than 200% occupancy. Patients were shouting, crying from pain, and the smell of infected wounds and blood . . . I couldn’t really stand it for more than five minutes,” Mughaisib says.
“With all [MSF’s] capacity, with all our means, we are still overwhelmed by the number of injured patients.”
To him, the doctors and healthcare workers in Gaza are heroes for continuing to work and put their patients first despite the horrific circumstances—and in the face of detention, torture, and death. “They’re really heroes. They’re part of the population, so they are suffering the same as everyone else,” he says. “And they’re at risk leaving the hospital and leaving their family behind.
“They are stressed because they know that, at any moment, they could have members of their family in the emergency room. It has happened. Our colleagues were working in the operating room, and they received their children dead and injured.”
Mughaisib says that doctors have been forced to provide healthcare without the right equipment and medication—including operating without painkillers or anaesthesia for patients or without enough surgical tools. “They could operate on two to three patients in the operating room or operate on patients on the floor.”
On top of this, many have felt the gnawing starvation caused by aid being blocked and restricted for months.5 “The medical staff were starved and completely exhausted. There was no food to buy, so they had no energy, but still they were coming to work, and even with the warnings from the Israeli army to evacuate the hospital they were refusing,” he says.
Despite some doctors who were detained by Israeli forces being released, many are still being held. One such doctor is MSF orthopaedic surgeon Mohammed Obeid, who is still being held in an Israeli prison after being detained during an Israeli raid on Kamal Adwan Hospital in October 2024.
“You cannot leave your patients—including babies in incubators—and just obey the orders and leave. [These doctors] had the ethical duty to stay, and the consequences were being arrested and tortured, and some of them have been killed because of this,” Mughaisib says. “[Obeid] didn’t want to leave the hospital, because you cannot ask a doctor, an orthopaedic surgeon in a war zone, to leave his patients and leave the hospital. That’s the only ‘crime’ that doctors like Mohammed Obeid have committed.”
More than 300 health workers have been detained in the past two years by Israeli forces, with widespread reports of prisoners being beaten, tortured, and subjected to sexual violence.6 Orthopaedic surgeon Adnan Al-Bursh died in Israeli detention in April last year, and the Israeli human rights organisation HaMoked reported that it had evidence that Al-Bursh had been beaten and assaulted before his death.7
Winter and flooding
Mughaisib is worried about the rise of infectious diseases this winter. Heavy rain and storms have caused flooding in Gaza in recent days, only worsening the conditions for the population that is trying to survive under flimsy tents and plastic tarps.8
“ There will be an increase in infectious disease, upper respiratory and lower respiratory tract infections, and mainly in children and vulnerable adults. This will really overcrowd clinics and emergency departments,” Mughaisib warns. “The polluted water and lack of a sewage system will also mean gastrointestinal infections and skin infection.”
And although the flow of aid into Gaza has improved since the ceasefire was declared, many items are still being blocked by Israel, and the number of trucks being allowed in is far below the number required to meet the desperate needs of two million people.9
“People are still in tents—they can’t go back to their homes because there are no homes anymore. Gaza has been destroyed,” Mughaisib explains. “Plus now they are all living in a very tiny region.” Despite Israel agreeing to slowly withdraw its forces to certain areas as part of the ceasefire agreement, much of the population is still squeezed into a small part of the Gaza Strip.
And with Gaza’s water desalination plants and sewage system destroyed, access to clean water is a major issue. “ Water is a huge problem in Gaza, drinkable water. MSF is providing drinkable water through distribution points, but still the needs are huge.”