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South Lebanon: Thousands displaced and urgent healthcare needs

“I won’t forget the sound of the air raid that woke us up that night, and I will wait for the day when I can go back to my old room.” Says Zahra 11 years old, from Aita Al Shaab displaced in Tayr Felsay, south of Lebanon.

The Israel-Gaza conflict has spilled over into neighbouring Lebanon, particularly along its southern borders, where clashes between Israeli forces and Hezbollah have persisted since October 8, 2023. In recent months the conflict have seen an escalation, with heavy Israeli bombardments displacing more than 94 thousand of Lebanese residents and exacerbating the region’s humanitarian crisis.

“At the beginning of the latest conflict in South Lebanon, we thought it would be as usual, for a few days, maybe weeks, and then it would stop. But when the air strikes intensified, we had to leave our house and farm and move immediately to my relatives in Tayr Falsay.” Says Abu Mohammed, 68 years old from Aitaroun displaced in Tayr Felsay, south of Lebanon. “I’m a farmer and I rely on my farm as a source of income. Being a displaced person isn’t new to me. In the 6 decades of my life, I’ve experienced displacement 4 times, in the 80s, 90s, 2006 and now.”

“I’ve always heard my parents’ stories of displacement over the years, and the stories of the previous wars that they witnessed, and I never thought that I would experience them myself. I miss my old room, my house, my friends.” Says Zahra.

To address the urgent healthcare needs of the displaced population, MSF has dispatched mobile medical teams to support primary healthcare centres in 4 locations in south of Lebanon: Al-Merouaniye, Ghassaniyeh, Qaaqaaiyet El Jisr, and Tayr Felsay.

MSF medical mobile teams provided 1333 medical consultations, in addition to medications, and psychosocial support for the displaced people.

“I came to this center after they told us that MSF would be visiting and providing free medical care, so I came here with my wife to follow up on the diabetes and hypertension with the medical doctor and get our medications. Since we arrived here, we haven’t found or received any humanitarian assistance from any organisation, except for the weekly visits of MSF medical teams to this health centre.” Explains Abu Mohammad.

Abu Mohammad adds, “If it weren’t for the solidarity of the people here with us, providing shelter, houses and food, I don’t know where we would end up.”

Al Nasser hospital, sole option for maternity and pediatric care in south of Gaza

When Hanin first sought care for her malnourished daughter in Khan Younis in southern Gaza, the clock began ticking on her chances of survival. “[My] child was in a critical condition. They referred me to the hospital but there was no means of transportation,” explains Hanin. Finally, they reached the Médecins Sans Frontières (MSF) inpatient therapeutic feeding centre on a cart. “My child was tired. She was resting her head towards me and not moving. She was close to death before we reached the hospital.”

After nine months of relentless war, people’s access to healthcare in Gaza continues to worsen, particularly for those most vulnerable when healthcare is unavailable, such as pregnant women and children. Their vulnerability has been exacerbated by repeated displacement, inadequate living conditions, insecurity, and poor nutritional conditions. As a result, MSF teams are seeing an increase in pre-term deliveries and malnutrition in children in the south of Gaza.

“The main health risks for pregnant women are blood-pressure related complications such as eclampsia, haemorrhage and sepsis – which can become deadly if not treated in time,” says MSF emergency unit health advisor Mercè Rocaspana. “In contexts like Gaza, late access to care is posing a health risk to pregnant women and their children, where the health system has been decimated and collapsed, posing severe risk to the health of pregnant women and their children are tragic – even lethal.”

Sole option for maternity and pediatric care in south of Gaza

Al Nasser Hospital is the last tertiary hospital providing maternal and paediatric care in Khan Younis. In February, after several weeks of intense fighting with Palestinian armed groups in Khan Younis, Israeli forces stormed the facility, which had been under siege. MSF teams were forced to flee the hospital and in May 2024, MSF teams returned to the hospital, and in June, together with the Ministry of Health and other actors reopened the maternity and paediatric wards, including an inpatient therapeutic centre, and started providing support to the paediatric intensive care and neonatal intensive care units.

The needs of women and children are skyrocketing, yet MSF teams at Al Nasser hospital are witnessing a shortage of vital supplies, jeopardising the provision and quality of care. Due to the lack of other functioning healthcare centres, Al Nasser is facing an overwhelming increase in patients every day. Between 29 June and 5 July, the paediatric emergency department alone recorded more than 2,600 consultations, meaning staff attended to more than 300 children each day. As more and more children are admitted for inpatient care they are being forced to share beds, pushing the paediatric services beyond their capacity.

“We are seeing malnourished children, an issue never seen in Gaza before,” says MSF project medical referent Joanne Perry, a member of the MSF team working in Al Nasser hospital. “People are living in tents with minimal access to clean water and abysmal sanitation. Bombing has devastated the sewage and water systems, resulting in diarrhea, dehydration, and hepatitis A and skin infections among children.”

Access to lifesaving maternal care

As the last hospital providing maternity care in Khan Younis, Al Nasser hospital and its medical team is handling from 25 to 30 deliveries a day. In addition to functioning hospitals being destroyed or closed, the decimation of infrastructure has also created severe obstacles for pregnant women to reach medical facilities. Pregnant women are often forced to navigate unsafe routes amidst the fighting and without safe transportation – often delaying access to health care and putting them at higher risk of complications.

“I rode on a donkey-pulled cart to Al Nasser Hospital alone, as my husband couldn’t afford to join due to financial constraints,” says Najwa, an expectant mother in Gaza.

At the same time, once women have given birth, they must quickly return to unsanitary conditions, often in tents, where lack of food and constant stress put them and their newborns at further health risk.

“Some women are delivering prematurely, often with postpartum complications exacerbated by their living conditions,” says MSF nursing team supervisor Mohamad working in the MSF neonatal intensive care unit of Al Nasser hospital.

In addition to maternity services, MSF is supporting the neonatal intensive care unit, which is equipped with 29 beds and incubators for high-risk newborns.

“There’s no […] diapers, or suitable clothing for my baby. Living in a tent exposes them to extreme conditions without even a proper bed,” says Khadra, who gave birth in Al Nasser hospital maternity ward.

As the sole functional maternity in the south of Gaza, Al Nasser hospital will continue to face challenges with capacity. Reopening the maternity and paediatric wards is one step forward to providing care, but an immediate and sustained ceasefire in Gaza, alongside unhindered humanitarian aid is the only solution to alleviate the suffering of people trapped in the Gaza Strip, including pregnant women and children.

Al Nasser hospital, Khan Younis: Living conditions and lack of care threatening the lives of pregnant women and newborns

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‘A war on people’ – MSF report reveals catastrophic toll of violence in Sudan

Amsterdam, 22 July 2024 – The war in Sudan has led to a collapse in the protection of civilians with communities facing indiscriminate violence, killings, torture and sexual violence amid persistent attacks on health workers and medical facilities according to a report released by Médecins Sans Frontières / Doctors Without Borders (MSF) today.

The report, ‘A war on people – The human cost of conflict and violence in Sudan’ describes how both the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) and their supporters are inflicting horrendous violence on people across the country. The war has wrought a catastrophic toll since fighting began in April 2023 with hospitals attacked, markets bombed, and houses razed to the ground.

Estimates for the total number of people injured or killed during the war vary but MSF, which works in eight states across Sudan, revealed that in just one of the hospitals it supports, Al Nao hospital in Omdurman, Khartoum state, 6,776 patients were treated for injuries caused by violence between 15 August 2023 and 30 April 2024, an average of 26 people per day. MSF has treated thousands of patients for conflict related injuries across the country, most for injuries caused by explosions, gunshots and stabbings.

A healthcare worker in Al Nao hospital describes the aftermath of shelling in a residential area of the city.

“About 20 people arrived and died straight after, some arrived already dead. Most of them came with already hanging hands or legs, already amputated. Some only with a small part of skin keeping two limbs together. One patient came with an amputated leg, their caregiver followed behind, carrying their missing limb in their hand.”

The report contains shocking reports of sexual and gender-based violence, especially in Darfur. An MSF survey of 135 survivors of sexual violence treated by MSF teams between July and December 2023 in refugee camps in Chad close to the Sudanese border found 90% were abused by an armed perpetrator, 50% were abused in their own homes and 40% were raped by multiple attackers.

These findings are consistent with testimonies from survivors still in Sudan, demonstrating how sexual violence is being perpetrated against women in their homes and along displacement routes, a characteristic feature of the conflict.

An MSF patient, describes events in Gedaref in March 2024. “Two young girls from Sariba, our neighborhood disappeared. Later when my brother was abducted and when he came back home, he said that the two girls were in the same house where he was detained and that the girls had been there for two months. He said that he was hearing bad things done to them, the kind of bad things they do to girls.”

The report contains testimonies detailing targeted ethnic violence against people in Darfur. In Nyala, South Darfur, people described how, in summer 2023, RSF and aligned militia went house to house, looting, beating, and killing people, targeting Masalit and other people of non-Arab ethnicities.

A patient in Nyala, South Darfur, told MSF “The men were armed with guns and dressed in RSF camouflage… I was stabbed many times and fell to the ground. As they exited my house they looked at me laying on the ground, I was barely conscious. I could hear them say ‘he will die, don’t waste your bullets’ as one of them pressed his foot on me.”

Throughout the war hospitals have been routinely looted and attacked. In June the World Health Organization said that in hard to reach areas only 20 to 30 per cent of health facilities remain functional, and even then at minimal levels. MSF has itself documented at least 60 incidents of violence and attacks on MSF staff, assets and infrastructure. The MSF supported Al Nao hospital in Omdurman has been shelled on three separate occasions, while a blast caused by an airstrike in May killed two children after the ICU roof collapsed at the MSF supported Baker Nahar Paediatric hospital in El Fasher. The hospital was forced to close.

Despite the health system struggling to adequately meet the population’s needs, humanitarian and medical organisations have frequently been blocked from providing support. Although authorities have begun issuing visas for humanitarian staff more readily, attempts to provide essential medical care are still regularly impeded through bureaucratic blockages such as refusals to issue travel permits to allow the passage of people and essential supplies.

Vickie Hawkins, MSF General Director, said: “The violence of the warring parties is compounded by obstructions: by blocking, interfering and choking services when people need them most, stamps and signatures can be just as deadly as bullets and bombs in Sudan.”

“We call on all warring parties to facilitate the scale up of humanitarian aid and, above all, to stop this senseless war on people by immediately ceasing attacks on civilians, civilian infrastructure and residential areas.”

MSF suspends delivery of care in Khartoum’s Turkish hospital

Nairobi – After over a year of violent incidents both inside and outside the Médecins Sans Frontières (MSF)-supported Turkish Hospital in Khartoum, Sudan – including threats made against the lives of MSF staff – MSF has taken the decision to evacuate our team from the hospital. This decision has not been taken lightly.

Amidst the ongoing war in Sudan, MSF had managed to provide continuous, hands-on, lifesaving treatment in the facility for almost 14 months, despite many, often deliberate, obstructions from the warring parties. However, as a result of recent events, this hands-on support is now no longer possible.

Hospitals and health facilities should be protected and respected by the warring parties as sanctuaries for the sick and wounded where health workers can safely deliver medical care.

Claire Nicolet, Head of MSF’s Emergency Response in Sudan

“The situation in the Turkish hospital, located in a Rapid Support Forces-controlled area, has become untenable,” says Claire Nicolet, head of MSF’s emergency response in Sudan. “Multiple violent incidents have taken place inside and outside the premises over the past 12 months, and the lives of our staff have been repeatedly threatened.”

“Most-recently, on the nights of 17 and 18 June, dozens of wounded combatants were brought to the Turkish hospital, and our team was aggressively woken up as Kalashnikovs were fired into their bedrooms,” says Nicolet. “This type of violence against our staff is unacceptable.”

“Hospitals and health facilities should be protected and respected by the warring parties as sanctuaries for the sick and wounded where health workers can safely deliver medical care,” continues Nicolet. “They cannot have their lives put at-risk as they try to save the lives of other people.”

Over the past year, MSF staff working at the Turkish hospital have been frequently harassed both inside the facility and on the street going to and from work. Many have been threatened with arrest. At the start of June, one MSF employee was arrested inside the hospital by two armed men, taken to an unknown location, and severely beaten.

The situation in the Turkish hospital, located in a Rapid Support Forces-controlled area, has become untenable.

Claire Nicolet, Head of MSF’s Emergency Response in Sudan

“The team are physically and mentally exhausted. Due to the blockade that has been imposed by the Sudanese authorities since September – forbidding the transportation of medical supplies and humanitarian personnel into Rapid Support Forces-controlled areas – the team in the Turkish hospital have been working without a break for the past 10 months,” Nicolet explains. “The blockade means it has not been possible for us to bring in a new team to replace them, and they have been working tirelessly to keep the hospital open under intense pressure.”

The Turkish hospital remains open thanks to the presence of the Ministry of Health staff. However, surgery will no longer be possible without the presence of the MSF staff who have been evacuated, and the future of the hospital is uncertain.

Since the start of the war, the Turkish hospital has been a crucial part of the health system, serving patients not only from Khartoum, but also from as far away as Wad Madani in Al-Jazirah state. MSF was also forced to suspend operations there in May 2024, due to repeated security incidents and obstructions to bring in staff and supplies, similar to those impacting Khartoum.

Before MSF established an emergency room and expanded the capacity of the operating theatre in the Turkish hospital in mid-May 2023, it was a specialist women’s and children’s hospital. Almost 80 per cent of all surgical procedures in the hospital over the past year were lifesaving caesarean sections for women experiencing complications during pregnancy and childbirth. As a result of these repeated security incidents, all surgery in the hospital has now stopped.

Our team was aggressively woken up as Kalashnikovs were fired into their bedrooms... This type of violence against our staff is unacceptable.

Claire Nicolet, Head of MSF’s Emergency Response in Sudan

MSF also provided ante-natal care, post-natal care, family planning, ran the paediatric intensive care unit, the inpatient therapeutic feeding centre for children with severe acute malnutrition, and the neonatal unit – the only neonatal unit in the whole of Khartoum. MSF’s hands-on support to these activities has also now been suspended.

Bashair Teaching hospital in Khartoum, also supported by MSF, has faced multiple armed incursions over the past few months as well, and between October 2023 and January 2024, MSF was forced to suspend surgery in the hospital. MSF continues to work in this hospital in spite of these incidents. The security situation across the board has deteriorated significantly, and in Khartoum especially.

MSF urges the warring parties to protect civilians and civilian infrastructure – including hospitals and other health structures. For facilities that are able to remain operational, it is vital that medical supplies and humanitarian workers are provided with the necessary permits to be able to move across frontlines. Due to the ongoing blockade imposed on humanitarian organisations by the Sudanese authorities, many facilities are struggling to remain open and the lives and health of millions of people in Khartoum and other parts of the country are at risk.

No end in sight: The repeated trauma of displacement for people in Gaza

Since the horrifying war on Gaza, Palestine, began, at least 38,000 Palestinians – more than half of them women and children – have been killed, and 87,000 others have been injured. For those who have managed to survive the relentless onslaught of bomb blasts, shelling and gunfire, staying alive has meant moving continually from place to place with whatever basic items they can manage to carry. However, testimonies from Médecins Sans Frontières (MSF) staff and patients, collected over the past nine months, clearly show that nowhere is safe in Gaza.

Teams from MSF working across the Gaza Strip, endeavouring to provide essential and lifesaving care to those who have been injured by relentless Israeli attacks, have also been forced to flee for their lives.

Kamil*, MSF emergency nurse, and Haider*, MSF watchman, were part of our team treating severely injured patients at Al-Shifa hospital in Gaza City during the bombardments between October and November 2023. Between them, they have been displaced 18 times up until today.

“When the war started, we carried on living at home for four days,” says Kamil. “My kids at that time were waking up and waiting for me to come and I would hold them and start calming them down and distracting them, telling them that it was fireworks, not bombing. It was very, very difficult.”

I was forcibly displaced eight times during this war. The difficulty of daily life, lack of sleep and extreme fear… I have lost a large number of my family members, approximately 25 people. I've lost approximately 400 people from my extended family, and five of my friends.

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Published on July 10, 2024

On the fifth day of the war, the top floor of Kamil’s building was hit by a drone rocket. He and his children moved into the MSF office, living alongside members of the MSF team, including Haider, whose wife and children stayed at their home, in a safer neighbourhood in north Gaza.

Kamil, Haider and the other MSF staff continued working daily at MSF’s burns clinic and Al-Shifa hospital, which was overwhelmed with patients with severe burns and shrapnel wounds.

“The patients I have seen during this war are different from previous wars,” says Kamil. “Most have deep burns, with shrapnel. Many have lost limbs or have infected wounds. I will never forget the smell of infection – it smells like bad oil.”

“We were receiving 30 to 40 patients every day at the clinic, while also working and treating dozens more at Al-Shifa hospital,” says Haider. “We kept doing this for 40 days, until things got too dangerous. The Israeli army started moving towards Al-Shifa hospital, towards us.”

By early November, at least 75 people – MSF staff and their families – were sheltering in the MSF clinic and guesthouse while fighting raged outside.

“The situation was really bad, and we were all scared,” says Haider. “If we opened the door, there was fire and gunshots. They were shooting people in the street.”

Over the next few weeks, the team’s living conditions deteriorated rapidly.

“In those weeks, we didn’t have enough water to clean ourselves or to drink,” says Haider. “We did not have enough to eat. Two weeks later, we were completely out of water.”

By mid-November, the situation had become untenable for our team in Gaza City, with fighting and bombing surrounding Al-Shifa hospital and the MSF clinic, office and guesthouse, and the decision was made to evacuate.

On 18 November, an MSF convoy set out for the south of Gaza, arranged with the approval of Israeli authorities. However, after being blocked from passing through the Israeli checkpoint on the road south, the MSF convoy was forced to turn back.

In one of the cars was Kamil and MSF nurse Alaa Al-Shawaa, with both of their families. On their way back, approximately 500 metres from the MSF clinic, they saw two Israeli tanks outside Al Shifa hospital as well as snipers on top of the surrounding buildings.

In November 2023, intense and unabated shelling in #Gaza City prevented thousands of Palestinians from safely leaving the area around Al-Shifa Hospital. At that time, Médecins Sans Frontières tried to evacuate over 100 staff and their families trapped inside MSF premises near the hospital, which were repeatedly attacked by the Israeli military.

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Published on July 10, 2024

At that point, Israeli forces opened fire on the car, with Alaa sustaining a gunshot wound to the head. “The bullets came close to my forehead, and one bullet pierced Alaa’s head,” says Kamil.

“He was bent over, and his head was leaning towards the steering wheel, close to my arms, so it was difficult for me to continue driving,” says Kamil. “There was blood everywhere in the car. I was trying hard to turn right towards the MSF office and follow the first three cars, who managed to turn before they started shooting.”

Kamil and the rest of the convoy managed to escape the gunfire and reach the relative safety of the MSF clinic. After parking, they carried Alaa from the passenger seat of the car into the clinic, but they were unable to revive him.

“When I saw he was dead, I went into shock,” says Haider. “I couldn’t control myself, I couldn’t think and I collapsed on the side of the road.”

Over the following days, the MSF team and their families stayed holed up at the clinic and guesthouse. While they were there, Israeli forces arrived outside the clinic with a bulldozer, pushing the MSF convoy of cars together and burning them.

After a few more hellish days of gunfire surrounding the MSF clinic and guesthouse, a temporary ceasefire between Israel and Hamas in the Gaza Strip took effect on 24 November. Israeli forces retreated from the area and a coordinated convoy was once again organised with Israeli authorities to allow the MSF team and their families to move south. This time they made it.

When the MSF team arrived in south Gaza, they stayed at MSF’s Lotus shelter in the city of Khan Younis and continued working. Kamil travelled daily to the European Gaza hospital, providing trauma care to the flow of wounded patients. Haider continued to drive the medical teams to the Indonesian hospital and take care of their security.

One week later, Haider received some devastating news.

“At that time, another type of suffering began,” says Haider. “I got the news that my sister and her children were killed in Gaza City. I went into a depression. Then one of my nieces and her children were killed.”

“Then, in the south, my nephew, his wife and his children were all killed after a bulldozer drove into their house. Twenty people from my family were killed that week,” says Haider. “My grandmother was so sad that, soon after, she died, too. When all this happened, I was in a really dark place, but I was trying to keep working.”

On 8 January, around two months after Kamil and Haider arrived in south Gaza, an Israeli tank shell struck the Lotus shelter, killing the five-year-old daughter of an MSF staff member and wounding three other people. Following the attack, more than 125 MSF staff and their families were relocated to ACAS University in Rafah, one kilometre from the Egyptian border. They stayed there for the next two months.

“We were constantly in fear, but we had no other options,” says Haider. “There were bombings and shootings. Once they bombed a building next to us and the shrapnel hit the university. We lived like this for a while, until they announced the invasion of Rafah.”

Since the invasion of Rafah, Kamil and Haider, like thousands of other Palestinians, have essentially not stopped moving due to the incessant bombings and attacks across the South and Middle Area of Gaza.

Haider has been moving from place to place across the Al-Mawasi area, living in a tent.

“I’ve been forcibly displaced eight times, an average of once a month,” he says. “Two days ago, there was another displacement. I didn’t sleep for 24 hours as we were moving from one place to another due to the explosions. I am always thinking about my wife and children in northern Gaza, and I am suffering every day.”

Living conditions are desperate for Haider and the thousands of other people on the move.

Since being forced to leave Rafah, Kamil and his children have moved multiple times in and around Al-Mawasi and Al-Bureij camp, in the Middle Area. Currently they are in Al-Bureij, but he stresses that nowhere is safe from the bombardments.

“Nowhere is safe and the conditions are terrible,” says Kamil. “We don’t have enough food, water, medicine or clothes. There are no shoes. There’s nothing. It’s very difficult to see my children like this.”

Kamil can only guess at the mental trauma suffered by his children as the result of their experiences.

“It’s traumatic,” says Kamil. “Even yesterday, the kids were playing with my nephews and I heard them telling the story of Alaa, they keep telling the story of Alaa. They’re still traumatised until now.”

According to the UN, 90 per cent of Gazans have been displaced at least once since the war between Israel and Hamas began, the majority of whom are forced to live in appalling conditions. For Haider, his only wish is to be reunited with his family in Gaza City and for the bloodshed to stop.

Enough is enough. Enough killing, enough bombing, enough shooting. You can rebuild your house; you can rebuild anything. But what you can’t do is bring back people who have left us. They can never come back.

Haider*, MSF watchman

*Names changed to protect identity.

South Gaza’s last comprehensive hospital at breaking point

JERUSALEM, 5th July 2024- As the European Gaza Hospital has shut down due to new evacuation orders, Nasser Hospital, the last comprehensive hospital in south Gaza, risks being overwhelmed with mass casualties and wounded patients, warns Médecins Sans Frontières (MSF). Meanwhile, MSF teams working in the hospital are seeing acute shortages of medical supplies, leaving patients at risk of losing vital healthcare.

Nasser Hospital is receiving an increase in patients every day, putting all departments in the hospital above bed capacity, while our teams are running on emergency medical stocks. The pediatric department has a capacity of 56 beds, but on 3 July MSF teams received some 100 patients. In the past few days, our teams in the orthopedic department have seen a doubling of the number of patients.

“We have children lying on the floor. There are no more mattresses and no more beds, so patients are in the corridors lying on blankets and sitting on stairs,” says MSF nurse activity manager Cristina Roldán. “The team has put nails on the wall so we can hang the IV fluids and medication we need to give patients, but it’s a very difficult situation, and the team is exhausted.”

On 1 July 2024, following evacuation orders by Israeli forces for the areas east and south of Khan Younis, the Ministry of Health decided to precautionarily evacuate the European Gaza Hospital. Patients were transported in ambulances from the European Gaza Hospital to Nasser Hospital, but many were forced to leave and walk some 10 km to get there. Approximately 250,000 people are at risk of displacement in Khan Younis, due to the evacuation order.

We have heard that patients have travelled on their own, either arriving to Nasser Hospital in beds or being walked by their families.

Javid Abdelmonei, MSF Medical Team Leader

While dealing with an influx of new patients, Nasser hospital is also grappling with limited fuel. Patients at the hospital and those in surrounding field hospitals are at risk of losing lifesaving care. Nasser hospital is the main site for field hospitals to sterilise their equipment. If it loses electricity due to a lack of fuel, sterilisation becomes difficult, and the care provided at several field hospitals will come to a stop.

“Overall, it’s a comprehensive issue – from shortages of beds and supplies to the lack of surgeons,” says Dr Abdelmoneim. “With yet another hospital closed, patients’ lives are even more at risk.”

While hospitals in Gaza continue to grapple with acute shortages of supplies, trucks carrying MSF medical supplies were denied entry into the Strip by the Israeli authorities on 3 July due to ongoing fighting in the south. MSF has been unable to bring any medical supplies into Gaza since the end of April.

The Israeli authorities must urgently open more crossing points to massively speed up the amount of aid getting through to Gaza. MSF also calls on all parties to ensure safe routes to move humanitarian assistance inside the Gaza Strip. This is the only way to avoid more preventable deaths.

Trapped in Fear: Syrian Refugees Face Unbearable Choices in Lebanon

** Names in this article have been changed to protect anonymity.

“I wish for death,” says Umm Khattab, a Syrian refugee who has called a flimsy tent along the northeast border of Lebanon home for years. “We live in constant anxiety and terror. Death has become more merciful than living here.”

Her words capture the stark reality faced by tens of thousands of refugees in Hermel, Qaa, and Arsal, Lebanon, where makeshift camps of tarps and scraps dot the arid landscape. These frail shelters offer little protection against the harsh elements and even less against the rising tide of anti-refugee sentiment in Lebanon. Refugees, crammed into inadequate spaces with dirt floors and no heating, grapple daily with the fear of security checkpoints and local tensions.

“Fear keeps my family of 10 crammed together in the tent all day,” says Wael, a 36-year-old father with hypertension and diabetes. “We never leave the tent after 6 p.m., as that is when the curfew on Syrians is imposed. The children never go out, and they face bullying from the local children.”

Wael has been a patient at the MSF clinic in Hermel for a few years now, receiving vital medication for his chronic condition, but recent measures have made access to life-saving care increasingly difficult.

Since April, Lebanon has intensified raids and security measures to address the issue of unregistered individuals. As a result, Syrian patients seeking healthcare at MSF clinics in the Baalbek-Hermel governorate face growing impediments due to fears and restrictions on their freedom of movement. For many refugees in the governorate, the decision to seek medical help is now fraught with fear. One such example is Wael, who must cross a checkpoint to get to the MSF clinic in Hermel.

“I always feel anxious when I have an appointment at the MSF clinic,” confides Wael. “I fear the security checkpoints. My appointment was on May 20^th, but I was afraid to go out because of a security campaign in the area, so I decided not to go. The fear causes my blood sugar to rise, and I worry I won’t have the means to lower it.” During these security campaigns, Syrian nationals with expired papers are often captured at checkpoints and forcibly deported back to Syria, usually without the chance to contact their families in Lebanon.

Other patients with chronic disease have resorted to rationing or abandoning medication altogether out of fear of leaving their tent to get them. A few miles away in neighboring Qaa, Amer, another 36-year-old living with hypertension, had completely run out of his medication in April.

“I ran out of medicine and don’t have the means or courage to go for a refill,” Amer says. “I have nightmares of being chased by the authorities. I do not dare cross the checkpoint and be taken away from my family perhaps forever.”

“I suffer from high blood pressure,” says 60-year-old Talal from the floor of his battered tent in Arsal. “I started taking medication two months ago because of rapid heartbeat, and my blood pressure regularly spikes above the normal range.”

The only way Talal was able to traverse the mountainous landscape of Arsal to get his medication was through a beatdown motorbike that recently got confiscated. A recent countrywide crackdown on unregistered vehicles in Lebanon has caused many Syrians to lose their motorcycles—which often serve as their only means for transportation after the economic crisis. “It was our only means to take care of our needs,” he laments. “If I want to go buy food for my family or get my medical consultation and medication from your clinic, I will need to rent a motorbike or a “tuk-tuk” cart, which is cheaper than a car but still too expensive for us.”

MSF has been present in the Baalbek-Hermel governorate, in the northeast of the country, since 2010. For over a decade, MSF has been providing high-quality and free-of-charge medical services including pediatrics, sexual and reproductive healthcare, treatment for non-communicable diseases, vaccinations against preventable diseases, and mental health support for refugees and the local community alike. Currently, MSF teams run a clinic in Arsal and another in Hermel, as well as supporting access to secondary healthcare through partner hospitals. Yet, even amidst this beacon of assistance, missed medical appointments soar as fear tightens its grip on the refugee community.

Two tents down from Amer’s shelter lives Umm Omar, who underwent a home delivery less than a month ago. Umm Omar’s memory of the night her water broke unexpectedly is hazy, but she recalls clearly how the community’s fear of crossing army checkpoints kept her confined to the tent’s dirt floor, battling the pains of labor without anesthesia.

“I was screaming in the dead of night, and no one could take me to a clinic,” says Umm Omar as she swaddles her newborn. “They called for a fellow refugee here whose mother was a midwife. She thankfully delivered my baby by memory of the practice. But I still can’t leave the camp to get him a birth certificate.”

Reflecting on their past, refugees often recount the perilous journey into Lebanon in similar words, fleeing devastation with little but the clothes on their backs and finding hope for survival in the hills of Lebanon.

Initially welcomed by the warmth of the host community, their sanctuary has since soured amidst Lebanon’s economic meltdown. “At first, the municipality helped us when we came to Arsal,” says Maya, who has spent more of her life in Lebanon than in Syria. “They gave us some items to sit on and use. Then they enrolled me in school, and I started going to school. The community initially welcomed us and did not make us feel like strangers.”

However, as Lebanon strains under its fifth year of severe economic crisis, Syrian refugees face more intolerance in the country now. The economic hardship, compounded by fear of movement, has forced refugees into an impossible choice between their safety and their health. Even lower on the list of priorities for refugees at the moment is their mental health.

“We live in constant anxiety and terror. I can’t even sleep due to these security campaigns and my fear for my children,” says Umm Khattab, who has been suffering breakdowns since her son was deported in late 2023. “Our children’s hearts race with fear and anxiety during these campaigns, and we only hear the phrase, ‘Here they come!’ I try to comfort my children, but inside I am more afraid than they are.”

After several years of displacement, some Syrian refugees have developed further psychological symptoms. Their daily lives have been impacted and changed; nothing is like before. People are tired. They feel insecure, depressed, and down. They are stuck in a 'dead middle,' a state of perpetual limbo, that affects the entire family."

Amani Al Mashaqba, MSF’s mental health activity manager in Baalbek-Herme

“Everyone is on edge,” Umm Khattab says, inadvertently describing the symptoms of post-traumatic episodes. “When we hear someone speaking loudly or a loud noise, we think a security raid has begun, and we panic.” Similar testimonies are shared by refugees in Arsal and Hermel.

The physical and mental toll on the refugee population is profound. “Our main hope is to live in safety and not be approached by the security forces. Fear is our primary suffering here,” says another refugee. This pervasive fear is not just a barrier to healthcare but a constant companion in their daily lives.

“Believe me, if our place in Syria was safe, I wouldn’t stay here for a minute. What will we do in Syria? We have nothing left there. Now we wish for death because death has become more merciful than living here,” says Umm Khattab.

The Syrian war, which began in 2011, led to widespread destruction and violence, displacing millions of people to the neighboring countries of Lebanon, Turkey, Jordan, Iraq and abroad. The ongoing instability has left Syria unsafe for many, making it challenging for many to return to their homeland. Syrian refugees seeking healthcare in northeastern Lebanon face increasing obstacles due to fears and restrictions on their movement. Vulnerable communities’ access to healthcare should not be hindered by fear or intimidation. Patients should not have to choose between their safety and seeking medical help.

“All I ask is for safety” —a plea that echoes the deep yearning for stability that defines the refugee experience for many in Lebanon today.

States supporting Israel’s military operations are complicit in the massacre of civilians

On 26 May, Israeli forces killed at least 49 Palestinians in airstrikes on a displaced persons camp in Tal Al-Sultan in Rafah, Gaza. More than 180 injured people were taken to a nearby stabilisation point supported by Médecins Sans Frontières/Doctors Without Borders (MSF). Two days later, Israel bombed a camp for displaced people in Al-Mawasi, west of Rafah, killing at least 21 Palestinians and leaving 64 wounded. These massacres are taking place just after the International Court of Justice (ICJ) ordered Israel on May 24 to “immediately” halt its military offensive in Rafah, in application of the Convention on the Prevention and Punishment of the Crime of Genocide.

Caroline Seguin, MSF’s head of emergency programmes in Gaza, describes the ongoing apocalyptic situation there.

What happened following the Israeli airstrikes on the camp for displaced people in Tal Al-Sultan on 26 May?

MSF was supporting a stabilisation point operating round the clock right next to where the Israeli airstrikes took place. Our teams treated more than 180 people with complex injuries, including shrapnel wounds, fractures and extensive burns. We also received 28 people who were already dead on arrival at the stabilisation point or died of their injuries soon after. The teams worked throughout the night to stabilise the patients and transfer them to health facilities located further west near Al-Mawasi. They were forced to flee the following night as fighting intensified in the area, once again putting an end to vital medical activities for Gazans.

Women and children were among the victims. There are entire families, often consisting of several dozen people, sleeping in tents and living in extremely difficult conditions. These are civilians who, once again, are being injured and killed by Israel’s bombing of densely populated areas.

This strike illustrates once again the total disregard for Palestinian lives by Israeli forces. The area where the airstrikes took place is a camp for displaced people and the civilians there had not received any order to evacuate. There is no safe place in Gaza for civilians.

Long spared from ground fighting, more than 1.3 million Palestinians had been sheltering in Rafah, the vast majority of whom have been forcibly displaced multiple times in a war without respite for the civilian population. What conditions have displaced people been living in since the beginning of the Israeli offensive on Rafah on 6 May?

More than 900,000 people have fled Rafah since the beginning of the Israeli offensive on the city and its surroundings. They have been forcibly displaced for the umpteenth time, this time to Al-Mawasi, a stretch of sand along the Mediterranean coast, Deir al-Balah and Khan Younis.

The Israeli military continues to push Gazans inexorably into areas that it declares safe but which are in reality exposed to bombing and fighting. On 16 May, 78 per cent of the Gaza Strip was ordered by Israeli forces to evacuate. Palestinians in Gaza are now caught up in the fighting and crammed into a tiny, unlivable area, trying to survive in impossible conditions with no guarantee of safety.

Massive and indiscriminate Israeli bombings continue to devastate northern and central Gaza including repeated airstrikes on the Palestinian refugee camp of Nuseirat and in the south with the current offensive on Rafah. Since the beginning of the war, more than 35,000 Palestinians have been killed and at least twice that number have been injured and are in need of treatment, including complex surgical operations. MSF teams have been forced to evacuate 12 health facilities over the last seven months, including nine that were attacked. It is worth repeating that our colleagues have suffered 23 violent incidents — direct attacks, sometimes being rounded up, arrested and tortured by Israeli forces.

This is a massacre that has been going on for almost eight months, in which women and children are the main victims. Today in Gaza, the whole population is within range of bombs, gunfire and tank shelling, and anyone can be killed, including humanitarian workers in a clearly marked convoy, as was the case for MSF in November 2023 and World Central Kitchen in April 2024.

No MSF trucks have entered the Gaza Strip since 6 May. On 26 May, around 130 vehicles carrying humanitarian aid were allowed through the Kerem Shalom crossing, controlled by the Israeli military. The supply operation was interrupted by fighting, forcing around 70 trucks to turn back. What are the consequences for Palestinians in Gaza and how are MSF teams continuing to work?

Since the total closure of the Rafah crossing on 7 May, we have been witnessing a further strangulation of the Gaza Strip, a new collective punishment for Palestinians. We have had to reorganise the hospitals in which we work, closing facilities and transferring patients from the Indonesian and Emirati hospitals in Rafah to Nasser Hospital in Khan Younis, where we treat trauma and burns and provide follow-up care.

Water supply is critical throughout Gaza. Due to a lack of fuel, desalination plants are operating at reduced level. This week we were only able to distribute 50,000 litres of water due to the lack of fuel, compared to 400,000 litres the week before. There is more imported food available in some markets, where it gets through in private company trucks, but it is unaffordable for most Gazans.

Israel is continuing its policy of obstructing humanitarian aid; we are seeing this obstruction of aid combined with a charade designed to make people believe that aid can enter the Gaza Strip via the floating pier built by the United States or through the Kerem Shalom crossing. In reality, nearly eight months on, we are still seeing blockade, obstruction, and appalling delays in the transport of equipment patients need for treatment, such as generators, water pumps, scanners, X-ray equipment, oxygen, sterilisation equipment, and more. Aid, when it is not completely blocked, comes in dribs and drabs, and can in no way adequately meet the immense needs of Palestinians in Gaza.

MSF could save more lives if the Israeli government stopped intentionally blocking humanitarian assistance. In addition to the bombings, people are dying every day because of Israeli obstruction of aid.

The only way to get aid into Gaza today is to increase the number of road entry points into areas where the lives of humanitarian workers are not in danger — areas that are not on the front lines, as is currently the case for Kerem Shalom, which is not a viable solution. Humanitarian aid must enter Gaza in sufficient quantities to meet the immense needs of a devastated population. We must have the means to distribute the aid and we must be able to do so unhindered and in safety. It should also be remembered that more than 220 humanitarian workers have been killed in Gaza since the beginning of the war.

The International Court of Justice (ICJ) has ordered Israel to “immediately halt its military offensive, and any other action in the Rafah Governorate” which could bring about “the physical destruction” of the Palestinians. What does this ruling change in concrete terms on the ground?

For Palestinians who are being bombed and are trapped in the fighting, the ICJ’s ruling does not radically change their daily lives. The measures ordered by the Court are legally binding, but it has no means of enforcing them. On 26 January, the ICJ issued provisional measures ordering Israel to prevent and punish acts of genocide and ensure that basic services and aid reach people in the Gaza Strip. The Court’s rulings, both in terms of the pressure they exert on Israel and the media coverage they generate, highlight the systematic and manifest nature of the destruction of civilian infrastructure in Gaza, including attacks on hospitals — which we have documented in recent months — as well as schools, mosques, universities, roads, farmland, and more. These are being deliberately and methodically destroyed. The entire social fabric of Gaza is being annihilated.

Hospitals in the north of Gaza continue to be targeted in attacks and have undergone massive destruction, as is the case for Al Awda and Kamal Adwan hospitals. There is no longer a fully operational hospital in Rafah since the Kuwaiti Hospital was taken out of service following an airstrike that killed two of its staff. Since the beginning of the war, the health system — hospitals, ambulances, medical personnel and patients — has been the target of deliberate and systematic attacks by the Israeli military. Currently, Israel refuses to take in patients, particularly children, who cannot be treated in Gaza, and medical evacuation to Egypt has not been possible since Israel took control of the border.

There is vital and urgent need to force Israel to immediately cease its policy of destruction of all sources of life in Gaza. The United States, which systematically opposes UN Security Council resolutions calling for a ceasefire, is complicit in this policy of destruction and fueling it, as do the United Kingdom and European states allied with Israel. These countries must stop supporting Israel’s military operations in order to protect civilian lives and prevent the genocide of the Palestinian people.

Gaza: Israel must end its campaign of death and destruction

Jerusalem, Paris, Brussels, Barcelona, 28 May 2024 – As the United Nations Security Council meets today after Israel struck tent camps sheltering displaced people in designated “humanitarian zones” in southern Gaza, Médecins Sans Frontières/Doctors Without Borders (MSF) calls for an immediate end to the Rafah offensive and the ongoing atrocities across the Gaza Strip. Israel’s military strategy of repeatedly launching attacks in densely populated areas inevitably leads to the mass killing of civilians.

Civilians are being massacred. They are being pushed into areas they were told would be safe only to be subjected to relentless airstrikes and heavy fighting. Entire families, made up of dozens of people, are crowded into tents and living in extremely difficult conditions. Over 900,000 people were forcibly displaced again as Israeli forces intensified their offensive on Rafah in early May.

Chris Lockyear, MSF Secretary Genera

Today, 21 Palestinians were killed and 64 injured, according to local health authorities, after Israeli forces bombed another tent camp for displaced people in Al-Mawasi, west of Rafah in southern Gaza.

Medical staff and patients at an MSF-supported trauma stabilisation point in Tal Al-Sultan in Rafah were also forced to flee on the night of 27 May, as hostilities in the area intensified, effectively stopping all medical activities in the facility. This forced evacuation of yet another healthcare facility comes 24 hours after Israeli forces carried out an air strike on what they had designated as a “safe zone”, killing at least 49 people and wounding over 250 others. Staff at the stabilisation point recorded a mass casualty influx of 180 wounded people and 31 dead, with patients suffering from severe burns, shrapnel wounds, fractures, and other traumatic injuries. These patients were stabilised and referred to field hospitals located towards Al-Mawasi, further west, as there are no remaining functional trauma hospitals able to cope with such a mass casualty event.

“All of last night we heard clashes, bombings and rockets being fired. Nobody knows what exactly is happening,” says Dr Safa Jaber, an MSF gynaecologist who is living in the Tal Al-Sultan tent camp with her family. “We are scared for our children, scared for ourselves. We were not expecting this to happen suddenly. Where shall we go? We are struggling to find the basics that every human being needs to stay alive.”

Just last week, the International Court of Justice (ICJ) ordered Israel to “immediately” halt its military offensive in Rafah and to let in desperately needed humanitarian aid, and ensure it reaches those who need it. But Israel’s offensive in southern Gaza has since escalated, no amount of meaningful aid has entered the enclave since 6 May, and the pattern of systematic attacks on healthcare has continued. All countries supporting Israel’s military operations in these circumstances are morally and politically complicit. We call on countries, particularly the United States, United Kingdom, and allied European Union Member States, to do whatever in their power to influence Israel to stop the ongoing siege and continued attacks on civilians and civilian infrastructure in Gaza.

Nearly eight months into this war, there is no longer a single healthcare facility in Gaza that has the capacity to handle a mass casualty event such as the one on 27 May. The closure of the MSF-supported trauma point in Tal Al-Sultan follows an air strike on the same day on Kuwaiti hospital in Rafah, which killed two staff and put the hospital out of service. Nearly all hospitals in Rafah have been forcibly evacuated, and are either out of service or barely functioning, leaving no possibility for the provision of or access to medical care.

Hundreds of thousands of civilians are being subjected to a brutal and relentless demonstration of collective punishment. Along with the bombings, the severe blockages of aid are making it impossible for us to help in a meaningful way. People are also dying because humanitarian workers are being prevented from doing their jobs.

Karin Huster, MSF Project Medical Referent in Gaza

Israeli bombardments and heavy fighting also continue to devastate the north of the enclave, which is almost inaccessible for humanitarian workers. Hospitals in the north are under fire and have been subject to extensive destruction, including Al-Awda and Kamal Adwan hospitals, the latter of which was bombed by Israeli forces just today. Other hospitals such as Al-Aqsa hospital in Deir al Balah and Nasser hospital in Khan Younis have reported fuel shortages and may soon no longer be able to function.

We call for all warring parties to respect and protect medical facilities, their staff, and patients.

We call for Israel to immediately halt its offensive on Rafah and to open the Rafah crossing point to let in humanitarian and medical aid at scale.

We call for an immediate and sustained ceasefire throughout the Strip.

Yet another hospital in Gaza forced to close amid the intensified Israeli offensive in Rafah

The intensification of the onslaught by the Israeli forces in Rafah, Gaza, has forced Médecins Sans Frontières/Doctors Without Borders (MSF) to stop providing lifesaving care at Rafah Indonesian Field hospital on 12 May. The 22 patients who remained in the hospital have been referred to other facilities, as we can no longer guarantee their safety. MSF has seen a pattern of systematic attacks against medical facilities and civilian infrastructure since the beginning of the war. In light of this, as well as the advancing offensive, we have made the decision to leave Rafah Indonesian Field hospital.

“We have had to leave 12 different health structures and have endured 26 violent incidents, which include airstrikes damaging hospitals, tanks being fired at agreed deconflicted shelters, ground offensives into medical centres, and convoys fired upon,” says Michel-Olivier Lacharité, MSF Head of Emergency operations.

The health system is being dismantled resulting in devastating consequences for people trapped in Gaza. According to OCHA, 24 out of the 36 hospitals in Gaza are now out of service. MSF is trying to establish field hospitals elsewhere in the Gaza Strip, but these few structures will not be able to cope with a massive influx of wounded civilians, on top of overwhelming medical needs. They can in no way replace a functional health system.

Prior to evacuating the hospital, MSF had been offering post-operative care for war-wounded patients since mid-December 2023. Our teams worked on providing care to people in the 60-bed hospital, where surgeons undertook approximately 35 procedures per week in the operating theatre. Inpatient and outpatient care ran six days a week, with about 130 consultations a day, with teams providing dressing changes, physiotherapy, and counselling. The Ministry of Health has also been forced to move its activities from Rafah Indonesian Field hospital, resulting in the closure of the entire hospital.

Alongside this closure, prolonged blockages of aid are further crippling the humanitarian response and endangering the lives of people trapped in Gaza. Supplies of fuel, needed to run everything from hospitals to bakeries, and other necessities, are running dangerously low while people cannot leave or enter the enclave.

MSF has reopened our activities at Nasser hospital in Khan Younis with outpatient and inpatient departments focusing on orthopaedic surgery, care for burns, and occupational therapy services; maternity services will open in the coming days. MSF staff were forced to flee Nasser hospital in mid-February and leave patients behind after a shell struck the orthopaedic department and Israeli forces ordered the evacuation of the facility before raiding it.

As the people in Gaza again face another onslaught of bombing, missiles, shooting and violence, we again call for an immediate stop to this offensive, which is displacing hundreds of thousands of people and depriving them of essential aid. At least 360,000 Palestinians have fled Rafah, according to the United Nations, since Israeli forces have expanded their offensive and evacuation orders, which make it impossible to provide lifesaving humanitarian and medical assistance amid this campaign of indiscriminate death and destruction.

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No end in sight: The repeated trauma of displacement for people in Gaza

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South Gaza’s last comprehensive hospital at breaking point

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Trapped in Fear: Syrian Refugees Face Unbearable Choices in Lebanon

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States supporting Israel’s military operations are complicit in the massacre of civilians

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Gaza: Israel must end its campaign of death and destruction

Yet another hospital in Gaza forced to close amid the intensified Israeli offensive in Rafah

Yet another hospital in Gaza forced to close amid the intensified Israeli offensive in Rafah

Also Available in Choose Language العربية

South Lebanon: Thousands displaced and urgent healthcare needs

Al Nasser hospital, sole option for maternity and pediatric care in south of Gaza

‘A war on people’ – MSF report reveals catastrophic toll of violence in Sudan

MSF suspends delivery of care in Khartoum’s Turkish hospital

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South Gaza’s last comprehensive hospital at breaking point

Trapped in Fear: Syrian Refugees Face Unbearable Choices in Lebanon

States supporting Israel’s military operations are complicit in the massacre of civilians

Gaza: Israel must end its campaign of death and destruction

Yet another hospital in Gaza forced to close amid the intensified Israeli offensive in Rafah

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