Dr Husni Zainal, MSF Hong Kong president 

The world is aghast at unrelenting weeks of siege warfare and intense indiscriminate Israeli bombing that killed thousands of people and hit hospitals and medical facilities in Gaza. Our Médecins Sans Frontières/Doctors Without Borders (MSF) colleagues who keep working in several hospitals in northern and southern Gaza and their families bear witness to the fact that there is no safe place today to survive the horrors of this conflict. 

Since 1989, MSF has been providing specialised medical care in the Gaza Strip with 300 staff in various locations. During the current conflict MSF staff have supported the Indonesian Hospital, Al Awda hospital, Nasser hospital and run a standalone clinic in Gaza, while also reopening the Al-Shifa operating theatre to receive burn and trauma patients in October. 

Last week, at the Nasser Hospital in Khan Younis where MSF teams work in southern Gaza, surgeons were doing around 10 burn surgeries a day after a 22 November Israeli airstrike, but the hospital is already overflowing with hundreds of patients with burns who must wait to be operated. The medical needs are huge, and we are ready to scale up activities, but we need basic guarantees of safety and unrestricted access of medical and humanitarian supplies into Gaza – neither of which appears possible without a lasting and unconditional ceasefire.  

The recently agreed temporary ceasefire for hostage and prisoner exchanges offers minimal respite after more than 50 days of intense fighting, it is simply not enough to avert a total humanitarian catastrophe as people will be forced straight back into a total conflict zone unless it is extended. 

The crisis following the attacks by Hamas in early October and the massive Israeli counter-strikes is an entirely man-made humanitarian catastrophe unfolding in full view of world’s leaders. Southeast and East Asian leaders from the governments of China, Indonesia, Malaysia and Brunei have played constructive roles to push for a lasting unconditional ceasefire that can prevent more unnecessary deaths and suffering while also allowing the restoration and scale-up of humanitarian aid on which the survival of the population of Gaza depends.

We continue to call for an immediate end of the mass killing in Gaza, an end to the pushing siege of people of Gaza, their forced displacement and for unimpeded and increased flow of impartial aid into Gaza to avert a human catastrophe. Last week China, as President of the UN Security Council, chaired a high-level meeting on the Palestine-Israel conflict and we hope for positive developments as leaders meet in New York.

The conflict in Gaza has seen violations of International Humanitarian Law on several occasions with attacks on healthcare facilities combined with the Israeli government-imposed siege withholding food, water, fuel and electricity.

Our colleague Dr Mohammed Obeid working at Al Shifa hospital on 11 November, described the reality of what he witnessed: “There's a sniper who attacked four patients inside the hospital. One of them has a gunshot wound directly in his neck, and he is a quadriplegic [patient], and the other one [was shot] in the abdomen. In Al-Shifa hospital there is no electricity, actually there is no water, there is no food. Our team is exhausted. We have two neonate patients who died, because the incubator is not working, because there is no electricity. We have an adult patient in the ICU, he died because the ventilator shut down, because there is no electricity.” 

MSF has highlighted the deliberate or indiscriminate strikes on civilians and medical facilities, medical personnel and transports. We are encouraged to see the Chinese government recognise and condemn the blatant disregard of the protection owed to civilians and medical workers, including our own colleagues. We are shocked at the failure of many global powers since these failures dramatically erode protection of civilians and healthcare workers. We desperately need an alternative way forward.

In Gaza, medical care as the last lifeline or survival space for people itself is under fire. In this situation it is impossible for hospitals to function properly given the sheer volume of patients, dwindling medical supplies, lack of clean water and fuel - let alone to be safe havens. Hospitals have turned into morgues. Hospitals have consistently been subjected to Israeli Defence Force orders to evacuate patients and medical staff within a matter of hours. The attacks around and inside hospitals were acute and deadly: by 20 November the World Health Organisation had recorded over 335 attacks on healthcare in the occupied Palestinian territory since 7 October - 164 attacks in the Gaza Strip and 171 attacks in the West Bank. (33 assaults on healthcare in Israel occurred during Hamas’s 7 October attacks).

MSF-supported medical facilities and staff were subjected to three attacks in less than one week.

On November 21, two MSF doctors, Dr Mahmoud Abu Nujaila and Dr Ahmad Al Sahar, and a third doctor, Dr Ziad Al-Tatari, were killed when the 3rd and 4th floors of the Al Awda hospital building, where an MSF Limb Reconstruction Unit is located, were hit by a strike. Several patients and other staff inside the hospital were also injured. The Al Awda hospital was one of the last remaining functioning hospitals in northern Gaza, where some MSF staff still work to provide medical care to people who could not flee south.

On 20 November, MSF colleagues reported our clinic had been damaged by the fighting: a wall had been torn down and part of the building was on fire. This happened as an MSF staff member with 20 members of their family were sheltering in the clinic.  Five MSF cars stationed in front of the clinic were all destroyed. 

On 18 November 2023, two people died after an attack on an MSF evacuation convoy carrying 137 people - MSF Palestinian staff and their families who, had been trapped by unrelenting fighting inside MSF premises, near Al-Shifa hospital.  

As more people across the world unite in a demand on the Israeli government and its backers to ensure a cessation of hostilities there is a clear message that grows louder: Nothing can justify indiscriminate or deliberate strikes on civilians, hospitals, medical staff and patients. Nothing.  

And as we look the future, we’ve prepared supplies and staff in Egypt in support but our concern grows deeper for what lies ahead in the coming weeks and months for more than 1 million displaced Gazans and the health risks they will face and their needs grow ever more acute.

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