“We Could Have Saved So Many More”: Anguish and Death Caused by Israel’s Restrictions on Medical Supplies in Gaza​

"I was in the pre-op area when she was wheeled in, a tiny, 7-year old girl, screaming at the top of her lungs. That’s when I saw that she only had half her leg. She was grabbing in desperation at the physician who was standing next to her, and asking over and over again for anesthesia drugs. We rushed her into the operating room, despite knowing that the anesthesiologist does not have anesthesia drugs to give her, and he does not have sedation medicines to get her sedated or control her pain. As this little girl screams and writhes on the stretcher, the anesthesiologist just starts singing softly to her, like a lullaby. He knows that’s all the comfort he can offer her." 

– Dr. Mike Mallah, deployed to Gaza in March 2024. Watch his story.

Published July 9, 2025

Following the October 7, 2023 attack in Israel committed by Hamas and allied groups, the Israeli government launched a military campaign that has resulted in a humanitarian catastrophe for the 2.1 million Palestinians living in the Gaza Strip.^[1] As injury and death tolls surged, health care professionals from across the world traveled to Gaza to address the dire medical needs and support local Palestinian health care workers, who had already been working under extraordinarily difficult conditions, facing constant threats, targeting, detention, and harassment, risking their lives to care for the wounded and sick.^[2]

As these health care professionals returned from Gaza, Physicians for Human Rights (PHR) partnered with the Global Human Rights Clinic (GHRC) at the University of Chicago Law School and the Section of Trauma and Acute Care at the University of Chicago to analyze 47 interviews documenting what they saw while entering and providing care in Gaza.^[3] At every point in their effort to provide care, volunteer health care professionals face systematic practices and policies that directly impact their ability to prevent suffering and loss in Gaza; specifically restrictions that prohibit them from bringing in basic supplies critical to providing lifesaving care. From morphine to scalpel handles, health care providers narrate how sweeping and unpredictable restrictions, imposed by Israeli authorities under the guise of “dual use” item limitations, resulted in foreseeable, severe, and often preventable pain and anguish to the women, men, and children who came to them seeking care. ^[4]

At every point in their effort to provide care, volunteer health care professionals face systematic practices and policies that directly impact their ability to prevent suffering and loss in Gaza; specifically restrictions that prohibit them from bringing in basic supplies critical to providing lifesaving care.

While the focus of this report is primarily on the period before Israel’s total blockade on aid to Gaza, which was imposed in early March 2025, it is important to highlight that the escalation of restrictions has only deepened the humanitarian crisis. These ongoing developments underscore the urgency of not only lifting the blockade but also ensuring independent monitoring to prevent the continuation of arbitrary restrictions on the delivery of lifesaving supplies.

Dr. Mike’s Story

Context

The Israeli military offensive in Gaza since October 7, 2023 has included attacks on civilian infrastructure,^[5] including against medical facilities, transportation, and personnel.^[6] As of July 2, 2025, the UN reports that military operations led by the Israeli Defense Forces (IDF) have resulted in 57,012 deaths and 134,592 injuries among Palestinians in Gaza.^[7]

None of Gaza’s major hospitals have been spared, with the World Health Organization (WHO) finding that over 94 percent of all hospitals in the Gaza Strip have been damaged or destroyed.^[8] According to WHO, 735 attacks on health care were reported in Gaza between October 7, 2023 and June 11, 2025,^[9] resulting in the deaths of more than 1,057 health care providers,^[10] and damage or destruction of 159 medical facilities.^[11] The denial of health care has also occurred through the deprivation of access to medical supplies.^[12] This violence and restrictions have occurred against a backdrop of mounting and acute medical needs arising from the armed conflict itself and the drastic deterioration of health outcomes across the entire population.^[13]

The occupation and continued effective control have led to socioeconomic decline, restrictions on the entry of supplies,^[16] and isolation that had strained the health system long before October 7, 2023.^[17]  

Since October 7, 2023, restrictions on medical supplies in Gaza have taken multiple forms, including the outright prohibition of certain items, delays caused by protracted approval processes, denial of movement permits to aid convoys, and direct attacks on aid convoys, warehouses, and humanitarian personnel.^[18] Several humanitarian and UN agencies we spoke to have described restrictions since October 2023 on virtually all supplies and equipment that have resulted in a near-total collapse of health services.

Since 2008, the Israeli government has had a list of “dual use” items that govern which supplies, including medical items, can enter Gaza.^[19] Items on this list require special approval from Israeli authorities before being allowed to enter Gaza. The Israeli authorities claim that these restrictions are necessary because of these items’ perceived potential for diversion toward military use and argue that Hamas has been taking these supplies from their intended civilian use.^[20] The claim that Hamas is diverting humanitarian aid from reaching Palestinians living in Gaza is widely refuted, including by the UN and the United States Envoy to Israel.^[21] The list of restricted items is not transparently published or clearly communicated but appears broad in practice and regularly shifting.^[22] Israel released updated lists in January 2023 and November 2024 identifying medical items that no longer require special approval, thus implicitly acknowledging their prior classification as “dual use.” ^[23]

The criteria for what items are restricted remain unclear. In addition to restrictions on “dual use” items, further limitations on medical supplies entering Gaza have been implemented since October 2023, even though the specific policy or policies, list of restricted items, and justification for these restrictions remain unclear and unpublicized.^[24] Humanitarian organizations regularly submit requests to secure approval for bringing supplies into Gaza. However, even when clearance is granted by the Coordinator of Government Activities in the Territories (COGAT), items may still be blocked or denied entry at the border.

Further, while many medically necessary items are not explicitly designated as “dual use” by Israel, they have been restricted in practice, particularly since October 2023. These include items such as cold chain equipment, oxygen generators, insulin pens, and water purification tablets, which have been repeatedly delayed or denied entry into Gaza.^[25]

In addition to supply restrictions, access to humanitarian services has also been severely hampered. Since the beginning of the armed conflict in Gaza on October 7, 2023, the routes of entry for medical aid and missions have been significantly limited and changed depending on the intensity of war, security situation, and access permissions.^[26] These changes altered the inspection protocols and approval procedures for humanitarian convoys, including the movement of medical missions and the flow of medical supplies. The key events that impeded access are:^[27]

Findings: Israel’s Medical Supply Restrictions Lead to Preventable Suffering and Death in Gaza

Before being deployed to Gaza, volunteer health care professionals were aware not only of the shortage of medical supplies but also of the overwhelming number of war-related trauma injuries affecting Palestinians living in Gaza. To manage the unprecedented scale and severity of injuries and alleviate enormous pressure on a collapsing and war-ravaged health system, health care providers participating in short-term medical missions sought to bring with them the essential medical supplies they anticipated would be needed for patient care for the duration of their mission. However, the majority of health care professionals traveling to Gaza who were interviewed shared that they were unable to bring in the supplies necessary to carry out even basic lifesaving medical procedures. In many cases, this was due to restrictions imposed by Israeli authorities, whose control over Gaza’s border crossings ultimately determines what humanitarian items are permitted entry. These limitations directly and negatively impacted their ability to provide care safely, effectively, and in accordance with professional standards to the patients they served in the weeks ahead in Gaza.

Blocked from Saving Lives: Restrictions on Medical Supplies

Within Gaza’s battered health system, Israel’s restrictions on medical equipment, supplies, and medications have posed a significant challenge for health care providers that prevented them from maintaining a minimum level of medical care for civilians. Our analysis shows that these restrictions were deliberate, excessive, unclear, unpredictable, and unjustified.

Opaque restrictions: “I felt that this was unnecessary withholding of things just to withhold it and to cause more destruction.”^[37]

The health care providers we interviewed consistently described limitations on items they could bring to Gaza as extreme, inconsistent, and deliberately opaque. None of the interviewed health care professionals, nor any of the humanitarian organizations to which we spoke, were able to obtain a definitive list of banned items. The only publicly accessible list found by PHR and GHRC researchers was the “dual-use items” list from 2008, subsequently updated in 2015 and again in November 2024.^[38] Critically, this list does not include most of the items reported by interviewed health care providers and humanitarian organizations as being restricted when they prepared to travel to Gaza or went through military checkpoints.

According to Israeli authorities, all restricted items have the potential for military use.^[39] However, the prohibited supplies, such as medications including pain medication, wound care supplies, and surgical equipment, have no legitimate military purpose. All interviewed health care professionals reported that they did not witness any signs of militarization by Hamas or other armed groups within the medical facilities where they were working.

December 2023 to May 2024 – Limited instructions and frequent denials: “It’s hard to understand a pattern and to be able to prepare for that. It’s not consistent at all.”^[40]

During the early phase of the war, from December 2023 to May 2024, health care providers were given limited instructions about what they could bring with them. At that time, medical missions were entering Gaza from the Rafah border. Israeli forces were not physically present at the border crossing and health care providers were able to bring as much luggage as they could manage into Gaza. Regardless, health care providers shared that despite being informed they could bring in supplies, they were required to submit a list of all items to Israeli authorities via the WHO and obtain approval before transferring them into Gaza. In many cases, items essential for performing basic medical procedures were denied entry on the basis of “dual use” restrictions. Humanitarian organizations have reported a consistent pattern of Israeli control over aid entering Gaza through the Rafah crossing, requiring all humanitarian shipments to undergo a lengthy scanning and approval process by Israeli authorities.^[41]

After May 2024 – More extreme and less workable: “We were told that we are not allowed more than one suitcase.”^[44]

After Israeli forces seized control over the Rafah border crossing in May 2024, all medical missions were routed through Kerem Shalom/Kerem Abu Salem and restrictions on what health care providers could bring into Gaza became more extreme. Volunteer health care providers were only allowed to bring in one checked bag, a carry-on bag, and one backpack. After a period, this was reduced to simply one checked bag and one backpack.  Health care providers shared that only personal-use items were permitted in their bags; any items seen as going beyond what was needed for personal use could be confiscated. Health care workers reported that confiscation practices were arbitrary and varied depending on the Israeli officer at the border, making the rules highly subjective.

Health care workers reported the following items as being restricted from entering Gaza: anesthesia, strong pain killers, sanitation materials, scalpels, scalpel handles, insulin, orthopedic tools (drills, screws, metal plates), suture materials, dressings and gauze, point of care testing, water purification materials, chest tubes, hormone medications for reproductive health, dialysis supplies, batteries, oxygen cylinders, airway and intubation supplies, tourniquets, clamps, skin staplers, and pulse oximeters. Notably, some of these items are included on the January 2023 and November 2024 Israeli lists of medical equipment that no longer requires special approval.

Restrictions on medical supplies and the entry of volunteer health care providers intensified significantly in 2025. Health care workers seeking to enter Gaza faced steadily increasing restrictions, including limits on the amount of medical equipment, electronics, and cash they could carry, as well as new caps on the number of providers allowed entry and the duration of their missions. While the Rafah crossing briefly reopened in February 2025 to allow health care workers entering Gaza and Palestinian patients seeking medical treatment to pass through, it was closed again by Israeli authorities in March 2025. Since then, restrictions have tightened even further, extending to the quantity of food volunteers are permitted to bring in, compounding the already severe operational challenges faced by medical missions and humanitarian actors on the ground.

Extreme restrictions equal extreme consequences: “We did have a surgeon who was capable of fixing that [the injury], but we didn’t have any tools to fix it.”^[47]

Among the restricted items that health care providers highlighted were anesthetics and strong pain-relieving medications such as morphine and ketamine, which are essential in a wide range of medical procedures to reduce pain and ensure surgeries are performed without suffering. While some of these items may be permitted through formal humanitarian channels under specific conditions, health care professionals described a lack of access to any reliable, timely, and transparent supply chain. As a result, individuals and medical teams sought to carry in essential items themselves to ensure they could deliver care upon arrival. However, these efforts were frequently blocked by Israeli authorities. These individual restrictions, combined with systemic delays and denials in the official humanitarian aid process, contributed to severe shortages of lifesaving equipment and medicines on the ground.

Health care providers also reported restrictions on tools and instruments needed to manage orthopedic injuries and perform surgeries. Screws, plates, drills, and scalpel handles were also prohibited with foreseeable and severe health consequences.

Batteries needed to run essential medical devices, such as portable ultrasounds and blood testing devices used to assess and evaluate patients, were not allowed to be brought in.

Health care providers also reported a significant shortage of basic medical supplies, including antiseptics, antibiotics, gloves, gauze, intubation supplies, and basic medications.

Broad shortages and arbitrary restrictions highlighted above have crippled the health system’s ability to respond to the scale of injuries and illnesses in Gaza, and as will be outlined below, has led to preventable, severe pain and suffering, and loss of lives.

Agony and Amputations: Supply Restrictions Led to Deviations from Basic Standards of Care

Health care workers consistently highlighted that the available medical supplies in Gaza were far from sufficient to meet the health care needs due to the scale of war and nature of injuries. These shortages were attributed to the limited and delayed flow of humanitarian aid permitted by Israeli authorities. But health care workers also consistently noted that they were not able to bring in the medical supplies needed to supplement what they knew to be limited stocks. Their personal accounts offer insight into how severely restricted the larger humanitarian supply chains have been, with everything from items in individuals’ suitcases to aid convoys being prohibited.

In its war in Gaza, the IDF is using a vast and complex array of weaponry that severely impacts civilians and devastates Gaza’s infrastructure.^[52] These weapons cause large-scale damage and would place immense strain on any health system, let alone one that has been deliberately attacked.^[53] The targeting of homes, schools, medical facilities, and camps for displaced people has resulted in an overwhelming number and variety of injuries. According to the Rehabilitation Task Force report, as of May 2025, around 30,000 Palestinians living in Gaza are in need of long-term rehabilitation services since October 2023.^[54]

Health care providers working in Gaza described receiving patients of all ages with all types of war-related trauma injuries, including severe burns, complex fractures, vascular injuries, amputations, internal bleeding, and crush injuries caused by airstrikes and collapsing buildings.

Many patients required effective pain management, surgical interventions, intensive care, and long-term rehabilitation, which have remained largely unavailable due to the lack of resources and supplies. These medical challenges unfolded in what was repeatedly described by humanitarian organizations and individual health care providers as the most dangerous and complex crisis they had ever encountered.

All these factors overwhelmed the health system, transforming treatable injuries into death sentences and rendering even basic care extraordinarily difficult, if not impossible.

Health care professionals described numerous cases where patients, including children, arrived at health facilities with injuries that under normal circumstances would have been survivable but proved excruciating or fatal due to delays in care or lack of essential resources such as anesthesia, blood products, or sterile surgical equipment. The result was a cruel paradox; doctors and nurses ready to save lives but unable to do so for lack of most basic supplies. This was not just a logistical problem, but a profound ethical burden experienced daily by health care providers, compounded by the harsh conditions under which they worked. 

Mike Mallah, MD, who worked in Gaza in March 2024, recounted how he was prohibited from bringing in anesthesia, IV fluids, antibiotics, and other essential medications. What he witnessed inside Gaza was even more devastating. He spoke of the unbearable helplessness among health care providers and the desperation of their patients. Dr. Mallah and other health care providers recounted treating major trauma injuries without appropriate pain management, leading to painful procedures and deaths.  

Health care providers performed limb amputations instead of standard vascular and orthopedic surgeries due to restrictions on surgical tools, screws, and plates, and shortages in essential supplies such as wide-spectrum antibiotics, sterilization equipment, and wound care materials. These choices represent a significant departure from internationally accepted standards of care, where surgeries to save limbs would typically be performed if the minimum necessary resources were available. Health care providers also described mass casualty events in which more challenging triage decisions had to be made under extreme pressure driven by limited resources, even beyond what they are accustomed to in other humanitarian settings.

The war in Gaza has also exacerbated a public health crisis that was already straining the health system long before October 2023. Chronic, non-communicable diseases, such as diabetes, hypertension, and renal failure, were highly prevalent in Gaza before the war.^[58] With the health care system’s shift toward treating war-related trauma injuries, fewer resources were allocated to manage patients with chronic cases, and health care providers reported not seeing these patients as frequently as is required. Even when patients sought care, there were not enough supplies for health professionals to provide the needed care, including insulin for diabetic patients and hemodialysis, which requires purified water, for renal failure patients, resulting in preventable deterioration and more deaths among civilians.

Malnutrition is also a critical and compounding health crisis in Gaza, severely impacting patients with both war-related trauma injuries and chronic illnesses.^[60] For individuals with traumatic injuries, malnutrition hinders the body’s ability to heal, weakens immune response, and increases the risk of infection and complications, often turning survivable injuries into life-threatening conditions. Health care providers reported a higher mortality rate in intensive care units due to infections and malnutrition.

In patients with chronic illnesses, health care providers saw that the lack of adequate nutrition undermined disease management, exacerbated existing conditions, and contributed to rapid clinical deterioration.

The severe shortage and restrictions on medical supplies have profoundly compromised the quality of care in Gaza, forcing health care providers to make life-or-death decisions under conditions that fall far below acceptable medical standards and contribute to unnecessary pain, suffering, complications, and loss of lives.

Conclusion

Since the beginning of the war in Gaza in October 2023, Israeli authorities have imposed strict, opaque, and arbitrary restrictions on medical supplies and created barriers to access for those seeking to manage acute trauma, war-related injuries, and chronic illnesses. These restrictions have included prohibiting essential medical items from getting into Gaza, delaying approval processes, and outright denying the entry of critical aid needed to sustain life.^[62] As the war has progressed, these obstacles have compounded the collapse of Gaza’s health system, which is already immensely strained from the overwhelming scale of trauma injuries, the exacerbation of chronic conditions, and the profound deterioration of living conditions.

Health professionals are forced to operate in extremely challenging conditions while deprived of access to basic resources, making it impossible to deliver safe or effective care. Surgeries are performed without anesthesia, infections go untreated, and patients with survivable injuries or chronic illnesses die. The accounts presented here from 47 health workers who were in Gaza reveal a harrowing picture of human suffering marked by unnecessary pain, lasting disability, and preventable deaths. And these are merely a small snapshot.

These accounts are based on the experiences of health care providers who worked in Gaza on short-term medical missions. However, they demonstrate the scale of the health crisis and underscore the broader harm caused by Israel’s policies and practices obstructing medical care. These violations have only worsened between March and May 2025, with Israel’s complete blockade of humanitarian aid, including food, fuel, and medical supplies.^[63]

Israel is bound by international humanitarian laws, otherwise known as the laws of war, in its conduct of hostilities in Gaza. This includes the Geneva Conventions of 1949, particularly Common Article 3 and the law of occupation, as well as customary international humanitarian law. Israel is also bound to ensure the rights of Palestinians in Gaza under international human rights law as it has effective control in the Occupied Palestinian Territories.

Under international humanitarian law, all parties to an armed conflict are obligated to ensure the protection and facilitation of medical care for the wounded and sick, without discrimination. Israel’s deliberate obstruction of aid and the denial of access to essential medical supplies and personnel represent a grave breach of these obligations.^[64]

Under international humanitarian law, all parties to an armed conflict are obligated to ensure the protection and facilitation of medical care for the wounded and sick, without discrimination. Israel’s deliberate obstruction of aid and the denial of access to essential medical supplies and personnel represent a grave breach of these obligations.

The consequences of Israel’s obstruction of medical supplies and attacks on health will reverberate for years. The long-term impact on Gaza’s population, physically, psychologically, and socially, will not only be measured by lives lost, but also by lives permanently altered in the absence of timely medical care and adequate medical supplies. Where such policies and practices led to death and foreseeable and severe pain and suffering, they raise serious questions of violations of Palestinians’ rights to life, health, and freedom from torture and cruel, inhuman, and degrading treatment.

Amid unimaginable devastation and relentless violence, health care providers working in Gaza have demonstrated extraordinary courage and unwavering commitment to saving lives. Physicians for Human Rights and the Global Human Rights Clinic reiterate our appreciation, admiration, and respect for the lifesaving and health-preserving efforts of Palestinian and international medical professionals providing care in Gaza, who work with limited supplies, under threat of bombardment, and in overwhelmed facilities. Risking their own safety, they perform emergency surgeries, treat severely wounded civilians, and provide care to malnourished children and trauma victims. Their presence offers not only medical aid but also a lifeline of hope to a population enduring extreme hardship. Despite logistical hurdles, restricted access, and constant danger, these health care workers persist, driven by an unshakable sense of duty to protect human life and dignity in one of the world’s most challenging and dangerous humanitarian environments.

Recommendations

• To All Parties to the Conflict:
  • Immediately cease all forms of violence against medical services, health care facilities, medical transport, health care workers, and humanitarian personnel in Gaza in compliance with international law, including international humanitarian law, international criminal law, and international human rights law.
  • Support all possible efforts to facilitate the work and access of humanitarian and medical agencies, including through UN coordination and local partnerships, in line with humanitarian principles.
• To the Government of Israel
  • Respect and implement the orders of the International Court of Justice (ICJ) requiring that Palestinians in Gaza have access to lifesaving aid and essential services. This must include the evacuation of the sick and injured who cannot currently access care.
  • Immediately cease all unlawful attacks on health care, including the detention of health care workers, in compliance with international law, including international humanitarian law, international criminal law, and international human rights law.
  • Ensure medical and health care supplies can enter Gaza without delay, restrictions, or obstruction. Immediately lift the blockade on Gaza, establish safe humanitarian corridors, and allow the unrestricted and sustained flow of humanitarian aid, food, fuel, and medical supplies through all available means and delivered in line with humanitarian principles.
  • Ensure that items with medical end uses are not unduly restricted or delayed through inclusion in “dual use” lists or other policies or practices that prohibit their delivery into Gaza in line with internationally recognized standards and international law.  
  • Grant full and safe access to independent international investigative bodies to Gaza to assess the humanitarian situation, investigate allegations of Hamas’s misuse of humanitarian assistance, evaluate the impact of current Israeli policies and practices on basic human rights of civilians in Gaza.

• To Hamas and Other Palestinian Armed Groups
  • Protect and facilitate access to and delivery of humanitarian aid at all times.
  • Ensure that humanitarian aid, including medical supplies, is not diverted from civilian use.
  • Cease using civilian areas or infrastructure for military purposes.
  • Respect and implement all applicable rules of international humanitarian law, particularly those aimed at the protection of the civilian population, including the principles of distinction, proportionality, and precautions in attack, and the obligation to take all feasible precautions against the effects of attacks, and the special protections guaranteed for health care facilities, transports, and health care workers.
  • Safely and unconditionally release all hostages held by armed groups in Gaza. Until they are released, ensure they are treated humanely.

• To the Palestinian Authority
  • Support the opening of an independent international investigation to assess violations of international law, including international humanitarian law, international criminal law, and international human rights law in the armed conflict in Gaza.

• To United Nations Member States
  • Urge all parties to the conflict to abide with international humanitarian law and Security Council Resolutions 2720, 2721, and 2728 on humanitarian aid and access, including by:
    • Ending indiscriminate and disproportionate attacks on civilians.
    • Ensuring the unconditional release of all hostages.
    • Supporting the safe delivery of humanitarian aid without delay or obstruction.
    • Working in close coordination with the United Nations and the Government of Egypt to facilitate the entry of the humanitarian convoy and to guarantee the immediate, safe, and unimpeded passage of humanitarian aid, medical personnel, and relief workers.
  • Apply diplomatic pressure to end the siege and facilitate unimpeded humanitarian access.
  • Establish clear guidance prohibiting the classification of essential medical supplies as “dual use” items, to prevent their restriction in humanitarian contexts.

• To International Accountability Mechanisms, including the International Court of Justice, International Criminal Court, and United Nations Treaty Bodies
  • Investigate, pursue accountability, and secure reparations for attacks on health care in violation of international law, including the systematic denial and restriction of humanitarian access and medical supplies.

Visuals created by 22 Degrees – Design and Innovation

---

^[1] UNDP, “War in Gaza,” UNDP, May 28, 2025, https://www.undp.org/war-gaza; The Independent International Commission of Inquiry on the Occupied Palestinian Territory, “Report of the Independent International Commission of Inquiry on the Occupied Palestinian Territory, Including East Jerusalem, and Israel – Advance Unedited Version (A/HRC/56/26),” Question of Palestine, June 2, 2025, https://www.un.org/unispal/document/coi-report-a-hrc-56-26-27may24/.

^[2] “oPt Emergency Situation Update: Issue 60 | 7 October 2023 – 17 June 2025” (World Health Organization, June 17, 2025), https://www.emro.who.int/images/stories/Sitrep_60_GS2.pdf?ua=1.

^[3] Researchers at GHRC and the Section of Trauma & Acute Care Surgery at the University of Chicago have conducted 55 interviews to date and continue to collect data at the time of publication.

^[4] The research team analyzed interviews with health care providers deployed to Gaza between December 2023 and December 2024. This analysis was supplemented by information gathered from conversations with humanitarian partners, insights shared by GHRC from additional interviews with providers deployed in 2025, and a comprehensive desk review of relevant materials.

^[5] World Bank, European Union, United Nations, “Gaza Strip Interim Damage Assessment (Summary Note),” March 29, 2024, https://thedocs.worldbank.org/en/doc/14e309cd34e04e40b90eb19afa7b5d15-0280012024/original/Gaza-Interim-Damage-Assessment-032924-Final.pdf.

^[6] The Independent International Commission of Inquiry on the Occupied Palestinian Territory, “Report of the Independent International Commission of Inquiry on the Occupied Palestinian Territory, Including East Jerusalem, and Israel – Advance Unedited Version (A/HRC/56/26)”; UN OHCHR, “Thematic Report: Attacks on Hospitals during the Escalation of Hostilities in Gaza (7 October 2023 – 30 June 2024),” December 31, 2024, https://www.ohchr.org/sites/default/files/documents/countries/opt/20241231-attacks-hospitals-gaza-en.pdf.

^[7] UN OCHA, “Reported Impact Snapshot | Gaza Strip (25 June 2025),” United Nations Office for the Coordination of Humanitarian Affairs – Occupied Palestinian Territory, June 25, 2025, https://www.ochaopt.org/content/reported-impact-snapshot-gaza-strip-25-june-2025.

^[8] World Health Organization, “Health System at Breaking Point as Hostilities Further Intensify in Gaza, WHO Warns,” accessed June 26, 2025, https://www.who.int/news/item/22-05-2025-health-system-at-breaking-point-as-hostilities-further-intensify–who-warns.

^[9] “oPt Emergency Situation Update: Issue 60 | 7 October 2023 – 17 June 2025.”

^[10] UN OHCHR, “UN Experts Horrified at Blatant Disregard for Health Rights in Gaza Following Deadly Raid on Kamal Adwan Hospital,” accessed June 26, 2025, https://www.ohchr.org/en/press-releases/2025/01/un-experts-horrified-blatant-disregard-health-rights-gaza-following-deadly.

^[11] “oPt Emergency Situation Update: Issue 60 | 7 October 2023 – 17 June 2025.”

^[12] UN OHCHR, “Thematic Report: Attacks on Hospitals during the Escalation of Hostilities in Gaza (7 October 2023 – 30 June 2024).”

^[13] Ibid.

^[14] “Legal Consequences Arising from the Policies and Practices of Israel in the Occupied Palestinian Territory, Including East Jerusalem” (International Court of Justice, July 19, 2024), https://www.icj-cij.org/sites/default/files/case-related/186/186-20240719-adv-01-00-en.pdf.

^[15] Ibid.

^[16] UN News, “New Import Restrictions Risk Triggering ‘Dramatic Deterioration’ in Gaza, Says UN Humanitarian Coordinator | UN News,” United Nations News, July 17, 2018, https://news.un.org/en/story/2018/07/1014952.

^[17] United Nations Secretary General, “Report of the Independent International Commission of Inquiry on the Occupied Palestinian Territory, Including East Jerusalem, and Israel,” Pub. L. No. A/77/328 (2022), https://www.ohchr.org/sites/default/files/documents/hrbodies/hrcouncil/coiopt/2022-10-19/Report-COI-OPT-14Sept2022-EN.pdf.

^[18] MSF, “In Gaza, Staff Are Risking Their Lives to Provide Care,” Medicins Sans Frontieres, May 29, 2025, https://www.doctorswithoutborders.org/latest/gaza-staff-are-risking-their-lives-do-their-jobs; The International Committee of the Red Cross, “Israel and the Occupied Territories: After Two Months of Aid Blockage, Humanitarian Response in Gaza on Verge of Total Collapse | International Committee of the Red Cross,” May 1, 2025, https://www.icrc.org/en/news-release/israel-and-occupied-territories-after-two-months-aid-blockage-humanitarian-response-verge-collapse.

^[19] GISHA- Legal Center for Freedom of Movement, “Controlled Dual-Use Items – Unofficial Translation,” September 28, 2008, https://gisha.org/UserFiles/File/LegalDocuments/procedures/merchandise/170_2_EN.pdf.

^[20] UN, “Cautious Response to Israel’s New List of Permitted Gaza Imports – IRIN News Article,” IRIN News, July 7, 2010, https://www.un.org/unispal/document/auto-insert-195032/; Israel Ministry of Foreign Affairs, “Hamas-Israel Conflict 2023: Frequently Asked Questions,” accessed June 26, 2025, https://www.gov.il/en/pages/swords-of-iron-faq-6-dec-2023#2.

^[21] “UNRWA: Claims Versus Facts,” UNRWA, accessed June 6, 2025, https://www.unrwa.org/unrwa-claims-versus-facts-2025; -Samy Magdy, “U.S. Envoy Says Israel Has Not Shown Evidence That Hamas Is Diverting UN Aid in Gaza,” PBS News, February 17, 2024, https://www.pbs.org/newshour/world/u-s-envoy-says-israel-has-not-shown-evidence-that-hamas-is-diverting-un-aid-in-gaza.

^[22] UN OCHA, “Gaza Humanitarian Response Update | 2-15 February 2025,” February 19, 2025, https://www.un.org/unispal/wp-content/uploads/2025/02/OPT.pdf; Tamara Qiblawi et al., “Anesthetics, Crutches, Dates: The Aid Israel Is Arbitrarily Keeping from Gaza,” CNN, March 2, 2024, https://www.cnn.com/2024/03/01/middleeast/gaza-aid-israel-restrictions-investigation-intl-cmd.

^[23] GISHA- Legal Center for Freedom of Movement, “Medical Equipment No Longer on Dual Use: Unofficial Translation,” January 2, 2023, https://gisha.org/UserFiles/File/general/Medical_equipment_no_longer_on_dual_use.pdf.

^[24] Refugees International, “Siege and Starvation: How Israel Obstructs Aid to Gaza,” Refugees International, Refugees International, (May 29, 2025), https://www.refugeesinternational.org/reports-briefs/siege-and-starvation-how-israel-obstructs-aid-to-gaza/. “Israeli authorities have also refused to provide clear criteria for the delivery of goods to Egyptian, Jordanian, or UN authorities, despite repeated requests. As humanitarian officials told Refugees International, In the absence of clear criteria, humanitarian actors have had to resort to informally crowdsourcing their own lists of approved and rejected items, accumulated based on the collective experiences of individual organizations.”

^[25] Ibid.

^[26] UN OCHA, “Humanitarian Access Snapshot – Gaza Strip | October 2024,” United Nations Office for the Coordination of Humanitarian Affairs – Occupied Palestinian Territory, November 11, 2024, https://www.ochaopt.org/content/humanitarian-access-snapshot-gaza-strip-october-2024.

^[27] Aya Batrawy, “A Timeline of Events Leading up to Israel’s Rafah Offensive,” NPR, May 8, 2024, sec. Middle East crisis — explained, https://www.npr.org/2024/05/08/1249657561/rafah-timeline-gaza-israel-hamas-war.

^[28] BBC, “What Is the Rafah Crossing and Why Is It Gaza’s Lifeline?,” November 1, 2023, https://www.bbc.com/news/world-middle-east-67121372.

^[29] Tori Rodriguez, “Providing Care in Conflict Zones: A Neurosurgeon’s Mission to Gaza,” Neurology Advisor, May 29, 2025, https://www.neurologyadvisor.com/features/conflict-and-health/.

^[30] Mari Carmen Viñoles, “What It Takes to Get Lifesaving Supplies into Gaza,” MSF, May 29, 2025, https://www.doctorswithoutborders.org/latest/impossible-task-getting-lifesaving-supplies-gaza.

^[31] Nafisa Eltahir, “At Least 2,000 Medical Evacuations from Gaza Prevented by Rafah Crossing Closure, Says WHO | Reuters,” Reuters, May 29, 2025, online edition, https://www.reuters.com/world/middle-east/least-2000-medical-evacuations-gaza-prevented-by-rafah-crossing-closure-says-who-2024-06-25/.

^[32] Associated Press, “Aid Trucks Begin Entering Gaza under Agreement with Egypt to Bypass Rafah,” NPR, May 26, 2024, sec. Middle East, https://www.npr.org/2024/05/26/g-s1-1069/aid-trucks-begin-entering-gaza-under-agreement-with-egypt-to-bypass-rafah.

^[33] Reuters, “EU Ministers Agree to Revive Rafah Border Mission | Reuters,” Reuters, May 29, 2025, https://www.reuters.com/world/eu-ministers-agree-revive-rafah-border-mission-2025-01-27/.

^[34] António Guterres, “Secretary-General’s Press Encounter on the Humanitarian Situation in Gaza,” May 29, 2025, https://www.un.org/unispal/document/sg-press-encounter-23may25/.

^[35] “Emergency Medical Teams (EMTs) in the Gaza Strip | March – May 2025” (World Health Organization), accessed June 26, 2025, https://www.emro.who.int/images/stories/EMT_2025_-_Final.pdf.

^[36] “The Secretary-General – Remarks to the Press on Gaza,” UN News, (April 8, 2025), https://www.ochaopt.org/content/secretary-general-remarks-press-gaza; Foreign Ministers of 23 Countries and EU Representatives, “Joint Donor Statement on Humanitarian Aid to Gaza (Non-UN Document),” Question of Palestine, May 29, 2025, https://www.un.org/unispal/document/joint-donor-statement-on-humanitarian-aid-to-gaza-non-un-document/.

^[37] Interview UC_0027

^[38] GISHA- Legal Center for Freedom of Movement, “Approval for the Entry of Dual Use Equipment – November 2024: Unofficial Translation,” accessed June 26, 2025, https://docs.google.com/document/u/0/d/e/2PACX-1vTomNNf8ZKonZht6yfWLF8d9L8gi5Ag7AN8V7be9ox40Sh74r3jKWuOzirHwhZuKA/pub?pli=1; GISHA- Legal Center for Freedom of Movement, “COGAT Officers’ Authorities Regarding ‘Dual-Use’ Permits Have Been Officially Regulated by Law, Following Gisha’s Legal Advocacy,” June 30, 2017, https://gisha.org/en/cogat-officers-authorities-regarding-dual-use-permits-have-been-officially-regulated-by-law-following-gishas-legal-advocacy/.

^[39] Israel Ministry of Foreign Affairs, “Prime Minister’s Office Statement Following the Israeli Security Cabinet Meeting Ministry of Foreign Affairs,” June 20, 2010, https://www.gov.il/en/pages/prime_minister_office_statement_20-jun-2010; Israel Ministry of Foreign Affairs, “Hamas-Israel Conflict 2023.”

^[40] Interview UC_0046

^[41] Viñoles, “What It Takes to Get Lifesaving Supplies into Gaza.”

“On arrival at Egypt’s Al-Arish airport, humanitarian supplies are loaded onto trucks and taken to Egyptian Red Crescent warehouses, where they are inspected by Egyptian authorities. After inspection, they are reloaded onto trucks and driven to the Rafah border crossing. This first stage takes five to 10 days. 

At Rafah, all trucks are scanned, then driven to an Israeli checkpoint some 30 miles south at Nitzana, where the supplies are unpacked, loaded onto special pallets to fit into the scanner, and scanned again. The convoy then returns to Rafah, where supplies approved by Israeli authorities are unloaded from Egyptian trucks onto Palestinian trucks to enter Gaza. This stage can take weeks.”

^[42] Interview UC_0046

^[43] Interview UC_0046

^[44] Interview UC_0011

^[45] Interview UC_0001

^[46] Interview UC_0022

^[47] Interview UC_0008

^[48] Interview UC_0045

^[49] Interview UC_0008

^[50] Interview UC_0030

^[51] Interview UC_0021

^[52] UN OHCHR, “UN Report: Israeli Use of Heavy Bombs in Gaza Raises Serious Concerns under the Laws of War,” OHCHR, June 19, 2024, https://www.ohchr.org/en/press-releases/2024/06/un-report-israeli-use-heavy-bombs-gaza-raises-serious-concerns-under-laws.

^[53] UN OHCHR and Security Council, “Israel’s Attacks Have Devastating Impact on Gaza’s Hospitals, UN High Commissioner for Human Rights Tells Security Council – Statement,” Question of Palestine, May 29, 2025, https://www.un.org/unispal/document/israels-attacks-have-devastating-impact-on-gazas-hospitals-high-commissioner-for-hr-turk-tells-security-council-statement/; Amnesty International, “U.S.-Made Weapons Used by Government of Israel in Violation of International Law and U.S Law,” Amnesty International USA, April 29, 2024, https://www.amnestyusa.org/press-releases/u-s-made-weapons-used-by-government-of-israel-in-violation-of-international-law-and-u-s-law/; David Gritten, “Gaza War: Where Does Israel Get Its Weapons?,” BBC, April 5, 2024, https://www.bbc.com/news/world-middle-east-68737412.

^[54] Rehabilitation Task Force, “Rehabilitation SitRep Q2 2025,” June 11, 2025, https://reliefweb.int/attachments/0ac8eeb2-a453-4e4b-bc2f-2acf64228f4c/Final%20Rehabilitation%20SitRep%20Q2%202025.pdf.

^[55] Interview UC_0028

^[56] Interview UC_0028

^[57] Interview UC_0008

^[58] Francesco Checchi, Zeina Jamaluddine, and Oona MR Campbell, “War in the Gaza Strip: Public Health Situation Analysis” (London School of Hygiene & Tropical Medicine, November 6, 2023), https://www.lshtm.ac.uk/media/75901.

^[59] Interview UC_0045

^[60] According to WHO, the entire population of 2.1 million in Gaza is experiencing extended food shortages due to the Israeli government’s blockade, with half a million at serious risk of hunger, acute malnutrition, starvation, illness, and death. (World Health Organization, “People in Gaza Starving, Sick and Dying as Aid Blockade Continues,” WHO, May 12, 2025, https://www.who.int/news/item/12-05-2025-people-in-gaza-starving–sick-and-dying-as-aid-blockade-continues.)

^[61] Interview UC_0043

^[62] UN News, “Recurring Denials Hamper Aid Delivery to North Gaza | UN News,” United Nations News, January 11, 2024, https://news.un.org/en/story/2024/01/1145422.

^[63] David Gritten and Alice Cuddy, “Gaza Health System ‘Stretched beyond Breaking Point’, WHO Warns,” BBC, May 21, 2025, https://www.bbc.com/news/articles/cj933kj17n0o.

^[64] The International Committee of the Red Cross, “Convention (IV) Relative to the Protection of Civilian Persons in Time of War. Geneva, 12 August 1949.,” accessed June 26, 2025, https://ihl-databases.icrc.org/en/ihl-treaties/gciv-1949.