Health workers for a free Palestine

Anatomy of genocide

Targeting of health infrastructure is definite policy. Ian Spencer assesses the terrible human cost of the Israeli assault since October 7

In the month since the start of its war on Gaza, Israel has killed over 10,000 people, including 3,000 women and over 4,000 children - a child murdered every 10 minutes. Nearly 25,500 people have been wounded, many of them gravely, with life-changing injuries.

The targeting of health infrastructure is now such a feature of the Israeli genocide that there can be no doubt that it is a deliberate policy, as are the lies used to justify it. A convoy of five ambulances was struck by Israel on November 4, near the Al-Shifa hospital, the largest in Gaza, despite appeals for safety for patients. According to the Israel Defence Forces, the ambulances were targeted “because they were transporting Hamas fighters” and the hospital “housed an underground command centre for Hamas”.1 This remains unproven and, given the IDF’s track record on lying, unlikely.

The destruction of the ambulance convoy resulted in 15 deaths and 60 wounded. It was evacuating the hospital towards the Rafah border crossing but had to return, because the route was blocked by rubble. The population of the Gaza Strip, understandably, tries to shelter near hospitals to avoid the indiscriminate bombing. But the IDF understands this - which may explain why hospitals are being targeted! Then in a perverse, Orwellian, inversion of truth, it accuses Hamas of using the civilian population as a human shield.

Israel repeatedly questions mortality and casualty rates published by the Palestinian Authority ministry of health, which is the only reliable source of information on casualty rates. It has been assisted in this by Joe Biden, who said: “I have no notion that the Palestinians are telling the truth about how many have been killed. I’m sure innocents have been killed, and it’s the price of waging a war.”2 In response the ministry issued a 212-page list of names and ID numbers of casualties.


The BBC too likes to imply that the figures may be unreliable by routinely referring to “the Hamas-run health ministry”.3 Yet, the figures are based on reports directly from hospitals, which continue to document each casualty in a bed, or on the floor in a corridor. Each casualty and body in the morgue is reported by name and ID number to the ministry. Previous attacks by Israel were documented in the same way and, when investigated by the UN, were shown to be accurate.4 What we cannot know so easily is the numbers of those still missing, under the rubble and whose decomposed remains are unlikely to be recovered until after the war (if at all). However, this figure is currently estimated at around 2,500.5

The World Health Organisation has condemned the attacks on the Al-Shifa Hospital, Al-Quds Hospital and the Indonesian Hospital in Gaza City. WHO has pointed out that women, children and newborns are disproportionately bearing the burden of the slaughter and represent 67% of all casualties. The bombardments, displacement of population, destruction of health infrastructure, collapsing water supplies and restriction of food and medicines have severely disrupted maternal, infant and child health services. There are an estimated 50,000 pregnant women in Gaza, with around 180 giving birth every day (on November 1 the Al-Hilo maternity hospital was shelled). In the absence of health facilities, women are giving birth in such housing as remains undamaged or even amongst the rubble. Consequently, medical complications of infection, stress-induced miscarriage and stillbirth are increasing.6

The indiscriminate nature of the killing has included 88 staff of the United Nations Relief and Works Agency (UNRWA) - the highest death toll for the organisation ever recorded in a single conflict. A measure of the impotence of the UN - or what amounts to the same thing, its domination by the US - is that Craig Mokhiber, the director of the New York office of the UN high commissioner for human rights, resigned because he said the UN was failing in its duty to prevent the genocide of Palestinians. He is quoted as saying that the UN had also failed to prevent previous genocides against “the Tutsis in Rwanda, Muslims in Bosnia, the Yazidi in Iraqi Kurdistan and the Rohingya in Myanmar”.

It is not as if nothing has ever been done. Nato went to war with Serbia and inflicted widespread bombing on its civilian population on the pretext of Serbia’s “ethnic cleansing” of Muslims and Croats. However, the more extensive, prolonged killing and ethnic cleansing of Palestinians is passed over in silence, while the US, UK and much of the European Union not only fail to meet their treaty obligations under the Geneva Conventions, but are arming Israel and providing political and diplomatic cover for it.7

Over half of Gaza is now homeless and dependant on facilities provided by UNRWA, which estimates that 4,600 displaced pregnant women and 380 infants require medical attention. There are 22,500 cases of acute respiratory infection and 12,000 cases of diarrhoea that have been reported - both a major cause of mortality in the newborn. There is widespread malnutrition and dehydration. Even if refugees reach a relatively safe haven, such as a UN school, the water ration is just three litres per person per day for all needs.


Wars produce particular types of injuries. Crush injuries, for example, cause hypovolaemic shock, which can be fatal, due to the loss of plasma, which in the context of a Gaza starved of medical supplies cannot be replaced by intravenous infusion. Crushed limbs can lead to irreversible muscle cell death and require amputation. Even if someone is pulled from the wreckage, they may subsequently die because of severe electrolyte imbalance due to the release of intracellular electrolytes, which cause cardiac arrest, as well as kidney and multiple organ failure.

Blast injuries cause complex tissue damage, including traumatic lung and brain injury. Primary blast injuries result from high pressures created by the explosion. In addition to the lung barotrauma, there is also ear drum rupture. There can be abdominal haemorrhage and perforation, as well as eye rupture. Secondary blast injuries typically involve penetrating ballistic damage from fragments, from the bomb itself, as a feature of its design, as well as that of debris. Tertiary blast injuries typically include bone fractures, traumatic amputations, as well as the same kind of injuries associated with crushing. Quaternary blast injuries include burns, which is particularly significant in Gaza owing to the Israeli use of white prosperous bombs. Other lung trauma can occur from the inhalation of toxic gases, dust, smoke and fumes.8

Gunshot wounds are more complex than simple penetration injuries. They are likely to involve vital organs. A bullet revolves at high speed due to the rifling of the gun’s barrel. Invariably, clothing fibres and associated dirt and infective agents are carried deep into the wound. Penetration of the chest leads to pneumothorax and those hit are at high risk of dying without specialist dressing to allow the reflation of the lung and subsequent chest drainage. Abdominal wounds invariably ensure gut trauma and probable death from peritonitis, if not properly treated.

The pressure wave associated with high-velocity projectiles lead to widespread tissue cavitation and permanent destruction, seemingly out of proportion to the size of the bullet. Naturally, the exit wound is considerably larger than the entry wound. People who watch puerile action-adventure films are inclined to think that a larger bullet is more lethal. But the small size of the rounds carried by Nato soldiers, as well as the IDF, mean that the bullet is more accurate, flies faster and further than a larger round, such as those used by Hamas. The smaller round is more destructive by virtue of its velocity as well as muzzle energy. The fact that the Nato round is longer means that there is a greater charge behind the smaller projectile and consequently higher kinetic energy. Smaller rounds mean that soldiers can carry more of them. Each Nato rifle carries between 20 and 30 rounds in each magazine and therefore, with the flick of a change lever, every rifle is the equivalent of a sub-machine gun.

The point of this is to illustrate how the injuries of war frequently require highly specialised surgical treatment. But the hospitals of Gaza now have little water, antiseptic, analgesia or anaesthesia. The unavailability of intravenous fluids, antibiotics and even a clinically clean environment means that such surgical interventions are carried out under conditions that are worse than in a World War II field hospital. Injuries that would have been survivable in a well-equipped modern hospital are now more likely to lead to a prolonged, painful death or permanent disability.


The lack of hygiene and antibiotics greatly increases the likelihood of death from infection. Dr Marwan Abdusa, head of surgery at Al‑Shifa Hospital, reports that “on a normal day we have a capacity for 210 beds”, but “we now have more than 800 that need to be admitted”. Moreover, “We have a health disaster. We have a type of worm, called white flies, covering the wounds after surgery. They appear after one day.”9

While it is natural to highlight the destruction of health facilities - in part because it is in clear violation of the Geneva conventions and a war crime - the true threat to the health of the majority of Gazans is the increased likelihood of epidemic and water-born disease. This is added to by the fact that, apart from the pitifully small amounts being delivered by aid agencies, the water desalination plant that Gazans were dependent on is no longer working for the want of fuel.

Much of the destruction of war and the killing of civilians is, as we saw in the crass remark by Joe Biden, regarded as being ‘collateral damage’ - the near-accidental and regrettable consequences of military action that cannot be avoided. However, no-one can make that claim of Israel’s actions, which clearly fall within the definitions contained in the Convention on the Prevention of the Crime of Genocide. The backing of the US world hegemon makes justice unlikely.

  1. The Daily Telegraph November 6.↩︎

  2. The Guardian October 27.↩︎

  3. www.bbc.co.uk/news/world-middle-east-67332684.↩︎

  4. Arab News November 8.↩︎

  5. www.map.org.uk/landing-pages/gaza-emergency-situation-2023.↩︎

  6. World Health Organisation statement November 3.↩︎

  7. The Guardian October 31.↩︎

  8. blastinjuryresearch.health.mil/index.cfm/blast_injury_101.↩︎

  9. The Daily Telegraph November 6.↩︎