Palestinian walk carrying sacks of flour near Jabalia, in the northern Gaza StripCredit: AFP / Bashar Taleb

It was Friday night, October 20, 2023. The pain of October 7 burned in every part of my body, and running to the shelter with my baby and pregnant partner was still a daily occurrence. At Physicians for Human Rights Israel, the organization I head, we received an urgent phone call from Dr. Bashar Murad, director of Al-Quds Hospital in Gaza. He received an evacuation warning from the Israeli military ahead of an attack. The hospital served hundreds of thousands of residents and, at that the time, housed hundreds of patients and thousands of displaced people.

At 1:00 AM, we submitted an urgent petition to the High Court of Justice to prevent the attack. Medical facilities are granted special protection under international humanitarian law because harming them affects not only the uninvolved civilian in the hospital during the attack – caregivers and patients – but also the many thousands whose survival depends on the hospitals.

The Israeli military claimed it did not plan to attack imminently, but another threat came nine days later. We petitioned the court again, to no avail. The court refused to intervene and dismissed our petition. Three weeks after the initial warning, on November 12, the hospital collapsed under siege and bombardment and was forced to cease operations.

That night, after Dr. Murad’s call, I couldn’t get back to sleep. I held my head and said to myself: They want to kill them. As simple as that. A sick elderly person, a woman in labor, or a premature baby in an incubator. I said this to myself but couldn’t believe it.

Since then, for 21 months, Israel has systematically dismantled Gaza’s health system in a cascading sequence, each phase compounding the damage of the last one.

As hospitals in northern Gaza were bombed, besieged and denied access to fuel, patients and displaced families were forced to flee south to overwhelming fragile, already barely-functioning facilities in Deir al-Balah, Khan Younis and Rafah. The collapse of care in one area produced impossible burdens elsewhere: When al-Shifa collapsed, al-Nasser was flooded with patients; when al-Nasser was dismantled, the European Hospital began to break down. With each assault, more hospitals collapsed, staff were killed or detained and essential services could not be provided.

In every case where the army attacked hospitals – except for Al-Awda and Shuhada Al-Aqsa hospitals – Israel claimed that the hospitals were being used by Hamas and therefore lost their protected status. While there is evidence of Hamas presence in some medical facilities, Israel’s reports on the matter have been found unreliable, unverified by any independent external body and fail to substantiate their sweeping claims.

The pervasive damage to healthcare infrastructure led to a worsening systemic collapse: Displacement led to overcrowding, overcrowding accelerated disease and disease spread unchecked amid collapsing sanitation. Israel’s siege on Gaza deepened this collapse. Medical evacuations were halted, crossings were sealed and the little remaining humanitarian aid dried up. Malnourishment surged, especially among children, whose health deteriorated rapidly in the absence of food, water and medical care.

92 percent of children between the ages of six months and two years in Gaza do not receive the nutrition they need. At least 87 children have died of starvation since the war began.

Gaza’s collapsed health system is expected to care for at least 137,409 Palestinians reported wounded, along with the sick. At least 4,700 Palestinians in Gazan have had at least one limb amputated, almost 35 percent of whom are children.

This is in addition to the 59,587 Palestinians reported killed in direct military action as of June 15 – and this is a conservative estimate that includes only those fully identified, meaning their full names and identifying details were verified. This figure represents more than 2.8 percent of Gaza’s population, which averages out at around 90 killed per day, including 27 children and 14 women daily. In total, 17,921 children have been reported killed since October 2023.

Palestinians gather as they seek aid that entered Gaza through Israel, in Beit Lahia, northern Gaza StripCredit: Mahmoud Issa / Reuters

This is what genocide looks like.

This grave statement is made with a heavy heart. We, Physicians for Human Rights Israel, reached this conclusion after many months of documenting the reality and carefully studying the medical and legal aspects of Israel’s war, and in consultation with local and international experts.

We must be committed to the truth. That truth lies in the details and the bigger picture, the raw facts and the legal analysis.

That is why we published a report detailing Israel’s actions in Gaza and analyzing how these actions have led to the destruction of the living conditions necessary for the survival of Palestinians in Gaza.

The destruction of the healthcare system, the blocking of medical evacuations, starvation, blockade, the weaponization of humanitarian aid, displacement, destruction of homes and sanitation infrastructure, the spread of communicable diseases and more are all contributing factors.

A Palestinian carries a bag with aid supplies that entered Gaza through Israel, in Beit Lahia, northern Gaza Strip.Credit: Mahmoud Issa / Reuters

When examining all these together, we identify a clear pattern that indicates intent. The systematic nature is the smoking gun.

For nearly two years, we have witnessed the dedication of our colleagues in Gaza – true health professionals in every sense – who have acted heroically to save lives amid a murderous assault.

They do this while being under direct attack themselves. Israel has killed 1,580 health workers and detained another 302 – all while their families and communities are being killed, wounded and displaced.

What must we do? We must stand with our partners in Gaza’s health system, look the reality in the eye and do everything in our power to protect them. Their relentless struggle to save lives must serve as our compass, too remind us day and night that their lives matter. And that the “crime of crimes” – genocide – cannot go unchallenged and unaccounted for.

Guy Shalev