Babies in Gaza at Risk of Disease and Death as Winter Approaches

Babies in Gaza at Risk of Disease and Death as Winter Approaches

Israel´s ongoing war on Gaza has forcibly displaced over 1.9 million people, leaving families to endure winter in fragile, makeshift tents with minimal protection from the cold. Children are especially vulnerable to various health risks as temperatures are dropping, and families continue to lack proper access to essential items such as water, food, and warm shelter.

On 25 December, three babies, all under one month of age were brought dead on arrival at Nasser Hospital, in Khan Younis, Gaza. They died because of cold temperatures, according to the Ministry of Health. These children were living in tents in Al Mawasi, Southern Gaza, where thousands of Palestinians have been forcibly displaced by the Israeli forces and live in overcrowded, unsanitary conditions. With winter setting in on worn-out tents, conditions in the area have become unbearable. Families are living in fragile tents that barely isolate the winter rain. Most families cannot afford the means to stay warm, including firewood, gas, or even warm blankets, which can cost up to $200, even when available in local Gazan markets.

Last winter - although people were already displaced and the conditions were harsh - there were still some buildings to take shelter in. Today, after 14 months of war and destruction of infrastructure, most of the people in Gaza are living in tents that barely isolate the cold wind and rain. Just in the past 12 hours the rain hasn´t stopped.
Pascale Coissard, MSF Emergency Coordinator

At the MSF-supported paediatric department of Nasser Hospital in Khan Younis, the impact of the humanitarian catastrophe on children’s health is evident. MSF teams in the neonatal intensive care unit (NICU) are treating children with respiratory infections, dehydration, and premature newborns with complications – conditions that can be life threatening to newborns and premature babies. From October 2024 to December 2024, the MSF supported neonatal intensive care unit has had 325 admissions.

“The exceptional conditions we have gone through in the past 14 months, as well as now the drop in temperatures further deteriorating the living conditions in the worn-out tents have made these kids more prone to hypothermia”, says Dr. Mohammad Abu Tayyem, MSF paediatrician at Nasser Hospital.

The health needs of children are so high that the paediatric department, including the NICU have been operating beyond its bed capacity since July with around 25 beds, all full. Over a quarter of the patients in the department are admitted for respiratory distress syndrome, a condition that can present in premature infants, making them even more vulnerable in dire living conditions many face in Gaza.

Even before their lives have started outside the womb, babies are at risk of disease and death. Once born, babies face immediate and extreme challenges: displaced in the cold of winter, without adequate access to warmth, shelter, or healthcare, as Israel continues to bomb Gaza and restrict essential supplies from entering the strip, while looting of aid trucks within the enclave is making it difficult for that small amount of aid allowed by Israeli authorities to reach those in need.
Pascale Coissard, MSF Emergency Coordinator

MSF’s activities in paediatric, neonatal, and obstetric care are just a drop in the ocean of high medical needs in Gaza. An immediate and permanent ceasefire in Gaza is the only solution to ease the suffering of Palestinians and guarantee access to healthcare and humanitarian aid. MSF calls on the Israeli authorities to ensure rapid, unimpeded and safe entry of humanitarian aid at the level sufficient to address people´s needs, including winterization supplies, and medical supplies. MSF calls for all parties to ensure safe routes to move humanitarian assistance inside the Gaza Strip.

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Gaza death trap: MSF report exposes Israel’s campaign of total destruction

Gaza death trap: MSF report exposes Israel’s campaign of total destruction

Amid continued attacks, siege, and blockade, Israel is destroying conditions of life in Gaza.

PARIS/BRUSSELS/BARCELONA/JERUSALEM, December 18, 2024—Repeated Israeli military attacks on Palestinian civilians over the last 14 months, the dismantling of the health care system and other essential infrastructure, the suffocating siege, and the systematic denial of humanitarian assistance are destroying the conditions of life in Gaza, according to a new Doctors Without Borders/Médecins Sans Frontières (MSF) report, “Gaza: Life in a death trap.” The international medical humanitarian organization is urgently calling on all parties, once again, for an immediate ceasefire to save lives and enable the flow of humanitarian aid. Israel must stop its targeted and indiscriminate attacks against civilians, and its allies must act without delay to protect the lives of Palestinians and uphold the rules of war.

“People in Gaza are struggling to survive apocalyptic conditions, but nowhere is safe, no one is spared, and there is no exit from this shattered enclave,” said Christopher Lockyear, MSF secretary general, who visited Gaza earlier this year.

“The recent military offensive in the north is a stark illustration of the brutal war the Israeli forces are waging on Gaza, and we are seeing clear signs of ethnic cleansing as Palestinians are forcibly displaced, trapped, and bombed,” Lockyear said. “What our medical teams have witnessed on the ground throughout this conflict is consistent with the descriptions provided by an increasing number of legal experts and organizations concluding that genocide is taking place in Gaza. While we don’t have legal authority to establish intentionality, the signs of ethnic cleansing and the ongoing devastation—including mass killings, severe physical and mental health injuries, forced displacement, and impossible conditions of life for Palestinians under siege and bombardment—are undeniable.”

In response to the horrific attacks carried out by Hamas and other armed groups in Israel on October 7, 2023—in which 1,200 people were killed and 251 people were taken hostage—Israeli forces are crushing the entire population of Gaza. Israel’s all-out war on Gaza has reportedly killed more than 45,000 people, according to the Ministry of Health, including eight MSF colleagues. The number of excess deaths related to the war is likely much higher due to the impacts of a collapsed health care system, disease outbreaks, and severely limited access to food, water, and shelter. The United Nations estimated earlier this year that more than 10,000 bodies remained buried under the rubble. Israeli forces have on numerous occasions prevented essential items such as food, water, and medical supplies from entering the Strip, as well as blocked, denied, and delayed humanitarian assistance, as documented in the report. Some 1.9 million people—90 percent of the entire population of the Strip—have been forcibly displaced, many forced to move multiple times.

Fewer than half of Gaza’s 36 hospitals are even partially functional and the health care system lies in ruins. During the one-year period covered by the report—from October 2023 to October 2024—MSF staff alone have endured 41 attacks and violent incidents, including airstrikes, shelling, and violent incursions in health facilities; direct fire on the organization’s shelters and convoys; and arbitrary detention of colleagues by Israeli forces. MSF medical personnel and patients have been forced to evacuate hospitals and health facilities on 17 separate occasions, often literally running for their lives. Warring parties have conducted hostilities near medical facilities, endangering patients, caretakers, and medical staff.

Meanwhile, Palestinians’ physical and mental health injuries are overwhelming, and the needs continue to grow. MSF-supported facilities have carried out at least 27,500 consultations for violence and 7,500 surgical interventions. People are suffering from war wounds as well as chronic diseases, made worse when they cannot get access to essential health care services and medicines. Israel’s forced displacement has pushed people into unbearable and unhygienic living conditions where diseases can spread rapidly. As a result, MSF teams are treating high numbers of people for illnesses like skin diseases, respiratory infections, and diarrhea—all of which are expected to increase as winter temperatures drop. Children are missing out on crucial immunizations, leaving them vulnerable to diseases like measles and polio. MSF has observed an increase in the number of malnutrition cases, however it is impossible to carry out a full malnutrition screening in Gaza due to widespread insecurity and the lack of proper deconfliction measures.

As medical care options dwindle in Gaza, Israel has made it even more difficult for people to be medically evacuated. Between the closure of the Rafah crossing in early May 2024 and September 2024, Israeli authorities have only authorized the evacuations of 229 patients—which amounts to 1.6 percent of those who needed it at that time. This is a drop in the ocean of needs.

The situation in northern Gaza is especially dire following Israel’s recent scorched earth military offensive that has depopulated large areas and reportedly killed almost 2,000 people. The northern part of the Strip, particularly Jabalia camp, has been besieged again by Israeli forces since October 6, 2024.  Israeli authorities have dramatically reduced the quantity of essential aid authorized to enter the north. In October 2024, the amount of supplies reaching the whole Gaza Strip hit its lowest point since the war escalated in October 2023: a daily average of 37 humanitarian trucks entered in October 2024, well below the 500 humanitarian trucks entering before October 7, 2023.

“For more than a year, our medical staff in Gaza have witnessed a relentless campaign by the Israeli forces marked by massive destruction, devastation, and dehumanization,” said Lockyear. “Palestinians have been killed in their homes and in hospital beds. They have been forcibly displaced time and time again to areas that are not safe or healthy. People cannot find even the most basic necessities like food, clean water, medicines, and soap amid a punishing siege and blockade.”

MSF calls on states, particularly Israel’s closest allies, to end their unconditional support for Israel and fulfill their obligation to prevent genocide in Gaza. Nearly a year ago, on January 26, the International Court of Justice (ICJ) ordered Israel to take “immediate and effective measures to enable the provision of urgently needed basic services and humanitarian assistance to address the adverse conditions of life faced by Palestinians in the Gaza Strip.” Israel has taken no meaningful action to comply with the court order. Instead, Israeli authorities continue to actively block MSF and other humanitarian organizations from providing lifesaving assistance to people trapped under siege and bombardment.

States must leverage their influence to alleviate the suffering of the population and enable a massive scale-up of humanitarian assistance across the Gaza Strip. As the occupying power, Israeli authorities are responsible for ensuring the rapid, unimpeded, and safe delivery of humanitarian aid at the level sufficient to address people’s needs. Instead, Israel’s blockade and continued obstruction of aid have made it close to impossible for people in Gaza to access essential goods, including fuel, food, water, and medicines. At the same time, Israel has decided to effectively ban the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), which is the largest provider of aid, health care, and other vital services for Palestinians.

MSF repeats its call for an immediate and sustained ceasefire. The total destruction of Palestinian life in Gaza must stop. MSF is also calling for immediate and safe access to northern Gaza to allow the delivery of humanitarian aid and medical supplies to hospitals. While MSF continues to provide lifesaving care in central and southern Gaza, we call on Israel to end its siege on the territory and open vital land borders, including the Rafah crossing, to enable a massive scale-up of humanitarian and medical aid.

The MSF report notes that even if the Israeli military offensive on Gaza ended today, its long-term impacts would be unprecedented, given the scale of the destruction and the extraordinary challenges of providing health care across the Strip. A staggering number of war-wounded people are at risk of infection, amputation, and permanent disability, and many will require years of rehabilitative care. The cumulative physical toll and mental trauma caused by the extreme violence, loss of family members and homes, repeated forced displacement, and inhumane living conditions will scar generations.  

Download the Full Report in PDF
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MSF ends operation of Geo Barents with commitment to return to Central Mediterranean Sea

MSF ends operation of Geo Barents with commitment to return to Central Mediterranean Sea

Rome – Médecins Sans Frontières (MSF) announced today that we have ceased operations on board our search and rescue vessel, Geo Barents, which had been operational since June 2021. Italian laws and policies have made it impossible to continue with the current operational model. We will begin a process to evaluate the best operational model for this challenging environment, with a promise to return to search and rescue activities.

MSF reaffirms our solid commitment towards people on the move, especially those taking the dangerous journey across the Central Mediterranean Sea, a route where over 31,000 people have died or gone missing since 2014.

“MSF will be back as soon as possible to conduct search and rescue operations on one of the deadliest migration routes in the world,” says Juan Matias Gil, MSF search and rescue representative. “We will come back to bear witness and speak out against the violations committed against people on the move by EU members states, particularly by Italy, and the other actors in the area.”

We will come back to bear witness and speak out against the violations committed against people on the move by EU members states, particularly by Italy, and the other actors in the area.
JUAN MATIAS GIL, MSF SEARCH AND RESCUE REPRESENTATIVE

In the past two years, Geo Barents faced four sanctions by the Italian authorities, imposing a total of 160 days detention in port. These sanctions only served to punish the vessel for merely fulfilling the humanitarian and legal duty to save lives at sea.

These punitive measures came under the Piantedosi Decree, a law that was introduced by the Italian government in the beginning of 2023. In December 2024, Italy further intensified the harshness of the sanctions by making it easier and faster to confiscate humanitarian search and rescue vessels.

The practice of Italian authorities to assign distant ports, frequently in the north, to disembark people rescued at sea has further undermined the capacity of the Geo Barents to save lives at sea and be present where it is needed the most. Since the implementation of the Piantedosi Decree, the Geo Barents has spent half a year navigating to and back from distant ports instead of assisting people in distress.

In June 2023 the Italian authorities instructed the Geo Barents, which can fit to up to 600 people on board, to head to La Spezia, in the north of Italy, to disembark 13 survivors. This amounted to navigating more than 1,000 kilometres, despite the availability of much closer ports.

“After careful consideration, we have come to the conclusion that it is untenable to operate the Geo Barents under such absurd and senseless Italian laws and policies,” says Gil. “The rescue capacity of humanitarian vessels is significantly under-utilised and actively undermined by the Italian authorities.”

“Italy’s laws and policies express genuine disregard for the lives of the people crossing the Mediterranean,” says Margot Bernard, MSF project coordinator. “The stories of tens of thousands of survivors are echoed everywhere on the Geo Barents. Babies have taken their first steps on these decks; people have mourned their loved ones. When the European deterrence policies cause so much suffering and cost so many lives, we have the duty to persist in favour of humanity.”

MSF has been active and engaged in search and rescue activities in the Central Mediterranean Sea since 2015, working on eight different vessels (alone or in partnership with other NGOs) and rescuing more than 94,000 people. MSF has been operating its latest rescue vessel, the Geo Barents, since June 2021, with 12,675 people rescued and brought to safety in 190 rescue operations. During this period, the team also recovered the bodies of 24 people and assisted in the delivery of one baby.

During the two years since the implementation of the Piantedosi Decree, MSF has exhausted all legal channels and appealed the punitive sanctions and the distant port practice in Italian courts, successfully obtaining two suspensions of 60-day detention orders. MSF and other NGOs have also submitted five individual complaints to the European Commission, urging it to examine the restrictions in light of EU law, which have been unsuccessful so far.

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Three things to know about what’s happening in Syria

Three things to know about what’s happening in Syria

Syria has been severely impacted by 13 years of war, causing hardship for people and economic instability. Over 14 million Syrians have been displaced by the war, and in 2024, 16.7 million require humanitarian aid. Recent political developments have led to the fall of the government in Syria, and the situation is changing quickly. Teams from Médecins Sans Frontières (MSF) are working in northeast and northwest Syria. Here’s what to know about what we’re seeing and how we’re responding.

1. Millions of people in northwest Syria are displaced as winter is setting in

In northwest Syria, there are 5.1 million people, including 3.4 million internally displaced, mostly women and children. After 12 years of civil war, conditions across the region, including in displacement camps, remain dire. Recent developments in northern regions like Aleppo have displaced thousands more and the winter conditions will make things worse.

People are also returning to their homes, but many are only temporarily leaving displacement camps. People come back to the camps for many reasons, including because people are finding that their houses are destroyed, especially in rural areas of Idlib and Aleppo. They are waiting for their homes to be rebuilt by authorities and organisations

Other obstacles to people staying in their homes include the lack of essential services like water, electricity, and medical care, and because of schooling or financial constraints or because they are waiting for better conditions.

MSF loading tent and NFIs at Atmeh warehouse.

2. Violence in the northwest has pushed people to the northeast

The escalation in northwest Syria began when opposition factions (Hayʼat Tahrir al-Sham) launched a military operation towards Aleppo and its surrounding countryside. As the conflict intensified in the first days of the operations, opposition factions (Syrian National Army) targeted Tal Rifaat, a town full of camps hosting people displaced from nearby Afrin.

After several days of fierce fighting, the opposition seized control of Tal Rifaat, triggering around 80,000 people to leave, marking the second time they were displaced. These people have now crossed into northeastern Syria, arriving in Tabqa, Raqqa, and Hassakeh, an already fragile region facing significant humanitarian challenges. These include a healthcare system that is almost totally reliant on international support and funding, which has been continuously cut in recent years.

Meanwhile, clashes have now spread to Manbij, west of Raqqa, further threatening the region with another wave of displacement and increasing instability.

3. MSF is responding across the north, while trying to assess other areas

MSF teams are working across northern Syria responding to needs. In the northwest, we continue to provide people with medical care through our existing mobile clinics, health facilities, and hospitals. Since the end of November, we have donated trauma and surgical equipment to hospitals across the northwest. We’ve also provided hundreds of families with hygiene kits, mattresses, and blankets.

In northeastern Syria, we continue to provide general healthcare, treatment for non-communicable diseases and malnutrition, and mental health support. We also provide medical care and water in Al-Hol camp. In recent weeks, we have distributed more than 10,000 bottles of water, 200 large tents, infant formula packs and diapers, blankets, and mattresses to those in immediate need in Tabqa, where we have also started a mobile clinic. MSF teams in Tabqa, Raqqa, and Hassakeh are also addressing water and sanitation needs.

MSF did not have access to areas that were under the control of the former government of Syria. We are now negotiating with the new authorities in Damascus to secure access to areas under the control of the new government. Our teams are in touch with health organisations and partners to assess the needs in other parts of Syria, and see the possibilities to work in new locations, to increase our medical and humanitarian support to people in Syria.

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Haiti: MSF partially resumes medical activities in Port-au-Prince

Haiti: MSF partially resumes medical activities in Port-au-Prince

Port-au-Prince – Médecins Sans Frontières (MSF) is partially resuming our medical activities in the Port-au-Prince metropolitan area, Haiti, after a 22-day suspension caused by repeated threats and violence against our staff and patients.

 

The decision to suspend our activities, even temporarily, was extremely difficult because the city is heavily affected by violence, and people’s medical needs are immense. Thousands of people are seeking basic healthcare, while the health system has been weakened by violence and mass displacement. The few remaining public and private facilities are overwhelmed by the growing needs, leaving many people without any option for care.

 

However, the seriousness of the attacks against MSF’s staff and ambulances forced us to suspend our activities.

 

MSF is now resuming activities thanks to a constructive dialogue with key stakeholders and involvement by the authorities to ensure respect for our teams and our humanitarian medical care.

These past three weeks have been especially painful. We had to suspend admissions of new patients, fully aware that many were unable to access the care they desperately needed.
JEAN-MARC BIQUET, MSF’S HEAD OF MISSION IN HAITI

Nevertheless, the risk for our teams and patients remains high, particularly in ambulances. As a result, our transportation of patients remains suspended for now, and Turgeau hospital remains closed because it can only operate when we can safely transfer patients to other facilities as needed.

 

Today, we are reopening the Tabarre, Carrefour, and Cité Soleil hospitals and the Pran Men’m clinic.
MSF is calling again for all parties to respect our staff, patients, and medical facilities. This respect is essential for our activities to continue.

 

“These past three weeks have been especially painful,” says Jean-Marc Biquet, MSF’s head of mission in Haiti. “We had to suspend admissions of new patients, fully aware that many were unable to access the care they desperately needed. We are continuing our efforts to ensure that it is safe enough to fully resume our activities.”

 

“Despite the commitments made by the authorities, the risks remain high, and our ability to continue our work in Haiti is uncertain as we move ahead,” says Biquet. “We call on all parties to respect our medical and humanitarian work so that we can respond to medical needs to the full extent of our capacity.”

 

Our services resuming as of 11 December 2024:

Tabarre trauma centre

  • Emergency medical and surgical care, including trauma and burn treatment.
  • Outpatient care for wound dressing, physiotherapy, and physical rehabilitation.
  • Surgical procedures for trauma and burns.
  • Physiotherapy sessions and 3D compression masks for burn patients.

Drouillard hospital

  • Intensive and emergency care, including trauma and obstetric emergencies.
  • Hospital admissions in paediatrics and adult internal medicine.
  • Outpatient consultations.
  • Support and care for survivors of sexual and gender-based violence.

Carrefour hospital

  • Emergency trauma care.
  • Trauma surgery.
  • Trauma care and hospital admission.
  • Specialised trauma consultations.
  • Mental health support.
  • Physiotherapy.

Pran Men'm clinic and Carrefour maternity hospital

  • Support for survivors of sexual and gender-based violence.
  • Medical care.
  • Psychological support.
  • Social assistance.

Water, sanitation, and hygiene services

  • Access to drinkable water and latrine installation in displaced persons’ sites.
  • Health and hygiene awareness.

Isaïe Jeanty maternity hospital

  • Construction and rehabilitation.
Our services that are still suspended as of 11 December 2024:

Patient transport via ambulance and services at the Turgeau hospital remain suspended until further notice due to the current security context.

Médecins Sans Frontières is an international medical humanitarian organisation providing emergency care in more than 70 countries. Present in Haiti for 33 years, our teams respond to the most severe crises to save lives, regardless of political, religious, or economic considerations.

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Obstacles to essential supplies deepens Gaza’s catastrophic humanitarian and medical situation

Obstacles to essential supplies deepens Gaza’s catastrophic humanitarian and medical situation

Jerusalem – As humanitarian aid entering Gaza reaches its lowest level in months, Médecins Sans Frontières/Doctors Without Borders (MSF) warns that patient care is critically compromised while medical conditions linked to shortages of food, water, and shelter materials are expected to surge with the onset of winter.

“Shortages of critical supplies have reached such levels that we are now forced to turn away patients in some facilities,” said Caroline Seguin, MSF’s emergency coordinator in Gaza. “Restrictions and obstacles to the entry of aid by the Israeli authorities continue to severely hamper our ability to provide care. Meanwhile, the looting of aid trucks within the enclave is making it difficult for that small amount of aid allowed by Israeli authorities to reach those in need. Ultimately, it’s the patients who suffer the consequences.”

According to the United Nations, October 2024 marked the worst month for humanitarian aid entering Gaza since the conflict began, and November doesn’t look much better. The number of trucks entering Gaza has decreased fourfold since July 2024. This is equivalent to 40 humanitarian trucks entering per day, compared to the 500 trucks entering per day prior to October 7, 2023. 

Lack of medicine and basic bandages

The facilities where MSF provides essential care are not immune to these shortages.

“Our patients are increasingly vulnerable to serious infections,” says Seguin. “In the burn units we support in the Nasser hospital, Khan Younis, even basic wound care supplies like gauze and bandages are running out. This forces our teams to extend the intervals between dressing changes, increasing the risk of infections for patients who desperately need proper care.”

In Deir al-Balah, central Gaza, the field hospital set up by MSF to run outpatient activities and paediatric hospitalization is now running low on antibiotics and painkillers for children. This shortage is hampering treatment for conditions such as low respiratory infections and is preventing adequate pain management for young patients. Medications for hypertension, a common but potentially deadly condition if left untreated, are also lacking now, leaving many patients untreated and at risk of acute complications, including cerebrovascular accident (CVA).

At Nasser Hospital in southern Gaza, MSF teams are unable to set up a much-needed clinical bacteriology laboratory – a key piece of equipment for diagnosis and administering the right antibiotics – because the cold chain needed to operate it is constantly opened and damaged by Israeli officers at the crossing point. Beyond medicines and medical equipment, MSF teams are also facing increasing challenges in the provision of sufficient food to hospitalized patients, as there is a dire scarcity of food supplies throughout the Strip. Several bakeries have closed while others are struggling to remain open due to the lack of flour and fuel. MSF teams have now begun to conduct systematic nutritional screenings for children in our clinic in Gaza City and at our field hospitals as malnutrition is a growing concern.  

Increasing the provision of water and sanitation services is another rising challenge for MSF as its teams are yet to receive authorisation from Israeli authorities to import desalination units or generators.

“Quite simply, this means that there is not enough clean drinking water for people. The only alternative to desalination units is water trucking, which MSF does, but this is extremely expensive, especially due to the cost of fuel, which is also strictly rationed by Israel. Last week, our team had to cut water trucking activities in half because of this problem,” says Seguin.

A massive and secure flow of aid is imperative

The severe deterioration of the situation in Gaza is a direct result of Israel’s extensive restrictions and obstruction of aid over the past year, which remain the primary barrier to the delivery of essential supplies. These restrictions have created an environment of desperation and instability, contributing to a rise in looting and criminality that further hampers aid efforts. In recent weeks, several trucks, including those carrying MSF supplies, have been attacked and stripped of their goods. Meanwhile, other supplies cleared for entry remain stuck at the border, waiting for conditions to become safe enough to proceed.

Every minute that lifesaving medicines or supplies such as hygiene kits, plastic sheeting for tents, and life-saving drugs are delayed or denied by the Israeli authorities, or when items are not delivered to those in need due to looting, our patients are the ones who suffer the consequences.
Caroline Seguin, MSF's emergency coordinator in Gaza

For months, people in Gaza have been trying to survive despite massive shortages of basic goods such as flour, soap and eggs. Winter, cold, hunger, heavy rains and flooding are increasing medical needs, and MSF teams are concerned that this could push people over the edge.

“Humanitarian organisations have been warning for months that the woefully inadequate supply of aid would worsen the already dire situation in Gaza. We have now reached a tipping point”, continues Seguin. “A massive and secure flow of aid is imperative to begin meeting the needs of people in Gaza who otherwise will face deadly consequences in the coming winter months”.

An immediate and sustained ceasefire throughout Gaza is needed to prevent further death, suffering and societal collapse.
Caroline Seguin, MSF's emergency coordinator in Gaza
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“Love of my life, who could have imagined what the world had in store for us?”

“Love of my life, who could have imagined what the world had in store for us?”

An 85-year-old woman’s journey through war in Lebanon

“At first, I started crying out and praying to God, thinking our son Ali, who lives with us along with his wife and five children, was injured,” Sekna Fakih says, tears in her eyes. “I thought the strike had hit us and that he was hurt because I heard him yelling.” Later she learned Ali was calling them to get into the car and flee.

At 85 years old, Sekna remembers the moment she had to flee her home in Aita Al Jabal, a village in southern Lebanon. She had received the so-called evacuation orders from the Israeli forces. These sometimes come just 15 minutes before attacks begin, meaning entire families are forced to leave their houses with no certainty on how to reach safety.  

It was the beginning of the war’s intensification, as Israeli bombing and shelling escalated across the Lebanon in September 2024. As windows shattered and rubble fell, people had no choice but to abandon everything they knew. Sekna left with her husband, who struggles with mobility due to multiple health issues. Together, they embarked on a harrowing 14-hour journey north to Akkar—a trip that normally takes just four hours but was extended due to the large number of people fleeing north in search of safety.

Since the onset of cross-border attacks between Hezbollah and Israel on 8 October 2023, Israeli airstrikes have intensified, spreading across the country into densely populated areas, killing over 3,500 people and injuring 15,000 more. Majority of these attacks occurred in recent weeks.[1]  

The conflict has also displaced more than 896,000 people mainly from South Lebanon, southern Beirut as well as Baalbek- Hermel governorate, according to the International Organization for Migration.[2]

[1] Lebanon: Flash Update #46 – Escalation of hostilities in Lebanon, as of 21 November 2024 – Lebanon | ReliefWeb

[2] Mobility Snapshot – Round 64 – 21-11-2024 | Displacement Tracking Matrix

Dire living conditions, lacking water, heating, sanitation

Most displaced people have moved to other governorates, with 66 per cent seeking refuge in areas like Mount Lebanon, located in the central part of the country, Akkar in the north, and northern Beirut.[1]

Some people have been able to stay with friends or family, others have rented houses. But many are forced into overcrowded shelters already at capacity that often lack basic services such as clean water, heating and sanitation.

“I am lucky to stay in a house, but many are in shelters, like my daughters and their families who are scattered across the country,” Sekna says. “It was only thanks to my brother-in-law’s son, who is helping us pay for this rented house, that we were able to find shelter.” She says he wanted to help his uncle knowing his medical conditions would make it very difficult to stay in a shelter.

Despite the roof over her head, Sekna struggles with the cold like so many others. “We can’t afford heating; we just pile on blankets.”

[1] Mobility Snapshot – Round 64 – 21-11-2024 | Displacement Tracking Matrix

Overwhelming needs, attacks on medical facilities

As winter approaches, the lack of proper preparations in many overcrowded shelters leaves people vulnerable to preventable diseases. The 22 MSF medical mobile teams currently spread across the country are already seeing cases of skin infections and respiratory illnesses, particularly among children and older adults.

Without access to clean water, proper sanitation and heating, people’s health is further threatened, Lebanon’s healthcare system is already overstretched and this only adds pressure.
Itta Helland-Hansen, MSF Deputy Emergency Coordinator in Lebanon

Heavy Israeli airstrikes have also made it even harder for people to access medical care and impeded its delivery. Since mid-September 2024, WHO’s Surveillance System for Attacks on Healthcare has documented 137 attacks on healthcare facilities, with 226 health workers killed and 199 injured while on duty since 8 October 2023[1].

Sekna is deeply worried about her son-in-law, who volunteers with the Lebanese Red Cross.

“May God protect him,” she says. “He refused to leave. He insisted on staying for his duty but I worry for him every day. Just a few weeks ago, a hospital near him in Tebnine, south of Lebanon, was hit. I can’t stop thinking about him.”

Due to the violence, road damage and security risks, MSF is unable to reach people in some affected areas in Lebanon. MSF has been forced to close our clinic in the Burj el Barajneh Palestinian camp in Beirut’s southern suburbs and temporary suspend activities in Baalbek-Hermel, relocating medical supplies from the northeast. Vulnerable people in these areas, particularly those who used to get treatment at our clinic now find it more challenging to reach essential care.

[1] Lebanon: Flash Update #46 – Escalation of hostilities in Lebanon, as of 21 November 2024 – Lebanon | ReliefWeb

Economic collapse, healthcare strain and war

The toll of the ongoing conflict is compounded by years of hardship. Lebanon has endured one of the worst economic crises in the world, leaving more than 80 per cent of people living in poverty. The country’s financial collapse has wiped out savings, caused widespread unemployment and the cost of living has skyrocketed.

People in Lebanon have been pushed to their limits. For many, even those who receive some solidarity from relatives or their community or can rely on their savings, this support is not sustainable and will eventually be depleted. Others, particularly Palestinian and Syrian refugees, migrant workers, and those displaced outside of the established shelters without basic services or support, are in even worse situations, as their already vulnerable conditions are exacerbated by constant fear for their lives.

“International actors need to step up their efforts to stop the violence and prevent further suffering and loss of life in the region,” says Itta. “The humanitarian situation in Lebanon is already dire and expected to be prolonged. It could worsen if urgent action is not taken. People who are holding on will reach their breaking point – things are not sustainable, and the humanitarian situation will get worse. For those who are already vulnerable, we will only see more threats to their health and more lives lost.”

Sekna reflects on the life she built with her husband, Abu Ali, and the memories they created together.

“Even if it was humble, with a few olive trees, it was my life and my memories,” she says.

The south of Lebanon, where Sekna and Abu Ali come from, is known for its rich olive groves, producing some of the best olive oil in the country. The olive harvest, a labour-intensive process passed down through generations, provides many families with their main source of income.

The economic collapse had already filled Sekna’s life and others in Lebanon with uncertainty. Everything she built with her husband was taken away. But now, with this new war, that sense of uncertainty has deepened into a profound loss. The memories she cherished seem to be slipping away in the chaos of displacement and destruction. For people like Sekna, who have lived through Lebanon’s many crises, it feels as though the war has wiped away not just their homes but their sense of being and purpose.

“This man you see here, he was the most handsome guy in the town. He used to work in the hospital and they used to think he was its director because of how elegant he was.” Her voice softens, and she sighs, seeming to long for the past. “Oh, love of my life, who could have imagined what the world had in store for us?”

MSF response to the humanitarian crisis in Lebanon 

In response to the ongoing escalation of conflict and intense Israeli bombing in Lebanon, MSF has sent 22 mobile medical teams across various regions of the country. These teams are providing psychological first aid, general medical consultations, medication, and mental health support. MSF is also distributing essential items such as blankets, mattresses, and hygiene kits, as well as supplying water by trucks to schools and shelters where displaced people have gathered. Additionally, we are offering hot meals and drinking water to hundreds of displaced families. MSF has also donated fuel and trauma kits to several hospitals, prepositioned 1,922 kilograms of medical supplies and trained over 400 healthcare workers in trauma care and mass casualty management across the country.  As of Nov. 11, 2024, our medical teams have also started to provide direct hands-on support to the Baabda hospital (Beirut governorate) in its emergency room and one operating theatre, and to the Turkish hospital (Southern governorate) in its operating theatre, emergency room and inpatient department.

MSF is an independent international medical humanitarian organisation that provides aid and free healthcare to people in need, without discrimination. MSF first began to work in Lebanon in 1976, and our teams have worked in the country without interruption since 2008.   

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Three questions about the “apocalyptic” situation in Gaza

Three questions about the “apocalyptic” situation in Gaza

Caroline Seguin, emergency coordinator for Médecins Sans Frontières (MSF), visited the northern part of the Gaza Strip, Palestine, where fighting has been raging for over 45 days, following an offensive launched by the Israeli forces in early October. She answers three questions about the apocalyptic situation in the north of the Strip, and recounts how 1.7 million people are living in frightful conditions in the south.

Since 6 October 2024, the governorate of North Gaza has been under continuous attack by the Israeli forces. You managed to reach Gaza City just south of the North Governorate, what’s the situation on the ground?

It’s very difficult and dangerous to get to northern Gaza. You have to cross the Netzarim corridor, a line that separates northern and southern Gaza. This corridor, which was a simple road at the start of the war, is now eight kilometres long and controlled by Israeli forces. Despite the fact that NGOs coordinate their movements with Israeli forces to ensure their safety, incidents are frequent and, recently, NGO cars have been hit within the corridor.

Once out of the corridor, you arrive in Gaza City. It’s like arriving in a ghost town: destruction everywhere, everything flattened out. There’s not a single building left standing. There are vast areas with no-one left, apart from a few wandering inhabitants trying to salvage what’s left of destroyed houses.

On the night of 28 November, at around 1 am, there was a bombardment 70 metres from our clinic. Shrapnel hit the building, fortunately without injuring anyone. There are around 25,000 displaced people around the MSF clinic, and medical activity has doubled since their arrival in October, following the Israeli forces’ destructive offensive on north Gaza.

The fighting is raging, and the situation is apocalyptic, with attacks by drones, quadcopters, and bombardments. Two of our colleagues are still trapped in Beit Lahia and in Jabalia, and we have been unable to evacuate them. On 21 November, Kamal Adwan hospital was bombed again, with medical staff injured.

What are the consequences of Israel’s obstruction of humanitarian aid to Gaza?

We thought the worst was behind us, but I think the worst is yet to come. Today, we’re facing several major problems, the first of which is the delivery of humanitarian aid into the Gaza Strip. We still have recurring problems of validation by COGAT1 to bring in humanitarian aid. All medical equipment, medicines, food, etc., transported by truck is systematically checked by the Israeli authorities. This deliberately complex system of physical and bureaucratic obstacles is designed by Israel to hinder the flow of aid into Gaza.

Looting is increasingly frequent and organised, and the few trucks that do manage to get in are almost systematically looted by gangs at the Kerem Shalom and Kissoufim crossings. On 16 November, of the 109 World Food Programme trucks that entered Gaza, 98 were looted. On November 30, UNRWA2 also tried to bring in food trucks through Kerem Shalom and they were all taken.

Beyond food, there are also fuel problems. Recently, the United Nations managed to bring in a few trucks, but the flow remains very tense. Ten days ago, we were forced to halve our distribution of drinking water because there wasn’t enough fuel for the trucks. MSF is currently among the largest humanitarian suppliers of water in Gaza, but the needs are enormous, and we can’t meet them all.

The banning of UNRWA and its activities by a law passed by the Israeli parliament on 28 October, is a devastating blow and a major source of concern: it is a vital support for Palestinians and the biggest provider of healthcare in Gaza. UNRWA is also responsible for almost all United Nations aid distribution. So, we don’t know how we’ll manage without them, the implications will be catastrophic on the already dire humanitarian situation in Gaza.

MSF also works in southern Gaza, where over 1.7 million people are concentrated. What are people’s living conditions and the consequences of the onset of winter?

That’s 1.7 million people piled on top of each other in the rain, in the mud, with hunger in their stomachs and bombs falling on them. It’s catastrophic.

Winter came quickly and the shelters aren’t ready after a year of being exposed to sun, wind, and rain. They are not at all adapted to the cold or the torrential rains we’ve seen in Gaza over the last few weeks. Some areas have been completely flooded, and the tents by the sea have also been partially submerged.

The Israeli authorities’ obstruction of the delivery of humanitarian aid and commercial trucks is causing shortages, particularly of food. Markets are beginning to empty, bakeries are closing, and prices are rising. A small loaf of bread that cost a few cents a few weeks ago now costs 5 shekels (just over €1). In this context, malnutrition is truly a growing concern.

The whole situation is creating very strong tensions within communities and families, which have sometimes ended in violence. The population is on edge.

Teams are trying to meet medical needs, particularly at Nasser hospital in Khan Younis, which is permanently full. We also have the field hospital that MSF has set up in Deir al-Balah, in central Gaza, where teams offer paediatric care, sexual and reproductive healthcare for pregnant women, physiotherapy, and general medical consultations. Preparations are underway to increase the number of beds, in view of the likely increase in the number of sick children due to the cold weather and living conditions.

Gaza today means cold, hunger and bombs. We need a ceasefire at all costs, a massive and unrestricted influx of aid to put an end to the suffering of thousands of people, the majority of whom are women and children – who also account for the majority of deaths in this war.

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Living conditions in Gaza are putting the lives of Palestinian children and newborns at serious risk

Living conditions in Gaza are putting the lives of Palestinian children and newborns at serious risk

From June to October 2024, MSF treated more than 10,000 children under 5 for upper respiratory tract infections at Nasser Hospital

After more than one year of relentless war and destruction in Gaza, Médecins Sans Frontières (MSF) teams are witnessing how dire living conditions, attacks in densely populated areas, poor access to food, and repeated displacements are leading to severe health issues for Palestinian children, newborns, and mothers.

We are treating infants who have infectious diseases, respiratory diseases, and skin diseases. Of course, we saw this before the war, but today we see it much more, and the figures continue to rise. We see overcrowding in the department, including children with acute pneumonia
Dr. Mohammad Abu Tayyem, an MSF Paediatrician working at Nasser Hospital in South Gaza

MSF teams face an overwhelming number of patients: between June and October 2024, 3,421 babies and children aged under 5 were treated by MSF at the inpatient paediatric ward in Nasser hospital, with almost a quarter (22 percent) related to diarrhoea and 8.9 percent to meningitis. During the same period, 168 newborn babies less than 1 month old, and more than 10,800 children between 1 and 5 years old, were admitted at Nasser for upper respiratory tract infections. Moreover, around 1,294 children aged between 1–5 years old were admitted in Nasser for lower respiratory tract infection with around 459 pneumonia cases.

A year of war has decimated health system and access to care

In the so-called “humanitarian zone” where displaced populations are cramped, MSF provides neonatal, obstetric, and paediatric care at three Primary Healthcare Clinics (PHCCs) and in Nasser Hospital, which has one of the sole functional maternity wards in the south of Gaza. Of the 36 hospitals in Gaza, only 17 remain partially functional as of November 19 (OCHA).

Mothers in Gaza are taking risks when bringing their newborns and children to the few hospitals and health centres still available. They are forced to travel long distances on unsafe routes on foot or by animal cart, in dusty and densely populated areas, to reach medical facilities. This journey exposes children and newborns to more danger of being attacked and puts them at high risk of health complications. Even after receiving treatment, newborns and children return to unsanitary living conditions, which in turn leads to a deterioration of their health conditions and ability to heal properly. 

Faced with inadequate living conditions, shortages of hygienic products and food, and under constant stress, significant number of mothers – themselves malnourished – give birth to premature babies and increase the risk of postpartum complications. This crisis is further worsened by the acute shortage of essential medical and non-medical supplies in the health facilities and hospitals.

Colder temperatures bring new health risks

Families are living in crowded tents or under plastic sheeting and mixed fabrics, with lack of access to clean water, sanitation, hygienic items including soap and other basic needs. Conditions are worsening with the upcoming winter and dropping temperatures, increasing risks of diseases such as skin and respiratory infections, scabies, acute diarrhoea, and viral infections, especially among newborns and children.

In addition to that, the rise in prices due to the drastic reduction in aid entering the Gaza strip, the people are not able to afford a nutritious food, which is already insufficient to meet the needs, leading to malnutrition especially in infants and children. Unhindered humanitarian aid into Gaza is a crucial solution to alleviate the suffering of people trapped in the strip. It will allow to improve the lack of essential live saving medical and non-medical supplies for the communities including newborn, children and mothers.

“I have no diapers for my son”, says Yasmin, a mother whose son is being treated in Nasser Hospital. “I do not even have suitable clothing for him; I must use a plastic bag, and this exposes his skin to more infections and rashes. Living in a tent is exposing my children to extreme conditions, and they are sleeping without even a proper bed.”

“This period has been very difficult and long. It has been over a year now since the beginning of the war, and it has affected everyone greatly, especially the children who are in the growth stage,” says Dr. Abu Tayyem. “This has been due to the lack of nutritious food and essential nutrients, which has impacted on the newborn’s and children’s health and building immunity, making them more vulnerable to the infectious diseases.”

Yasmin says, “My son is always coughing. I spend most of my time in the hospital. My son doesn’t laugh, doesn’t play, doesn’t drink milk. He sleeps all the time. The doctor says we must keep him away from fire [to help prevent the coughing], but how could we? Everything is cooked on a fire.”

To respond to ever-increasing medical needs, In Khan Younis, South Gaza, MSF teams support the paediatric department at Nasser Hospital, including the emergency room (ER), paediatric intensive care unit (PICU) with nine beds and the newborn intensive care unit (NICU) with 23 beds.

MSF’s activities in paediatric, neonatal and obstetric care are just a drop in the ocean of high medical needs in Gaza. An immediate and permanent ceasefire in Gaza is the only solution to ease the suffering of the Gazan population and guarantee access to healthcare and humanitarian aid.

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‘Dealing with Antibiotic Resistance Every Day,’ MSF Raises Awareness About AMR in Afghanistan

‘Dealing with Antibiotic Resistance Every Day,’ MSF Raises Awareness About AMR in Afghanistan

For the last two weeks, Said Dawood has been stuck alone in an isolation room in the Médecins Sans Frontières (MSF) Kunduz Trauma Center, still trying to recover from an injury sustained eight months ago.

Working as a skilled laborer in the northern Afghan province of Kunduz, Dawood fell from the fourth floor of a building and suffered open fractures to both of his legs. He was discharged from the trauma center in March, but twice now has had to be readmitted due to infection. Recent results from the microbiology laboratory confirmed the suspicions of his doctors – the bacteria that caused the infection is resistant to commonly used antibiotics and requires targeted treatment.

The news shocked Dawood, who didn’t know anything about antimicrobial resistance (AMR). But it comes as no surprise for Dr. Letizia Ottino, an MSF infectious disease specialist, who has spent the last year working on AMR in Afghanistan.

“We are dealing with antibiotic resistance every day,” she says. “It has a serious impact on the healthcare system. Multidrug-resistant infections require more resources to be treated. They require longer hospitalization, expensive antibiotics, and specialized doctors.”

These very serious infections increase the risk of death, particularly for vulnerable people such as newborns, pregnant women, children with severe acute malnutrition, and those with trauma-related injuries.

New mothers at MSF’s Khost Maternity Hospital face that fear every day as they put on medical gowns to visit their preterm babies lying in neonatal intensive care beds.

At the first sign of infection, MSF staff send a blood sample to the newly installed mini-lab –an easily transportable small-scale standalone bacteriology lab that MSF has rolled out in low-resource settings – so they can identify the infection-causing bacteria and tailor antibiotic treatment.

Across MSF projects in Afghanistan, we are implementing a package of services to address AMR, including strengthened infection, prevention, and control (IPC) measures and the creation of antimicrobial stewardship committees, with staff responsible for ensuring the appropriate choice and correct use of antibiotics for patients.

MSF has also opened two bacteriology labs, in Kunduz and Khost, to help identify bacteria and select the right antibiotic to treat the infection.

We are dealing with antibiotic resistance every day. It has a serious impact on the healthcare system. Multidrug-resistant infections require more resources to be treated. They require longer hospitalisation, expensive antibiotics, and specialised doctors.”
DR. LETIZIA OTTINO, MSF INFECTIOUS DISEASE SPECIALIST

 Patient and Prescriber Practices Are Key to Addressing AMR

These activities are a good start toward addressing AMR in MSF projects, but far more is needed to tackle this public health problem, Ottino says.

Although data on antibiotic resistance in Afghanistan is limited, Ottino notes that available scientific literature shows high levels of AMR in the country.

A new MSF report on AMR in humanitarian contexts highlights broad structural challenges—such as poor access to quality healthcare, water, sanitation and hygiene services, IPC measures, vaccines, and medical and laboratory supply chains—as key drivers of AMR in low-resource settings like Afghanistan.

But patient and prescriber practices also play a significant role, says Dr. Zabihullah Fazalzoi, a pediatrician in the MSF-supported pediatric department at Herat Regional Hospital.

“Over-prescription, overuse, misuse, and the widespread availability of antibiotics over the counter all contribute to the growing problem of AMR,” he says.

This has been a long-standing issue, according to an MSF mixed-methods study that looked into perceptions of antibiotics and their use among patients, prescribers, and pharmacists at a district hospital in Kabul in 2015.

The study found that patients often had limited knowledge about antibiotics and frequently overused or misused them—for a wide range of conditions, including common colds, infertility, and general body pain. It also revealed that antibiotics were widely available for over-the-counter purchase in private pharmacies.

Raising Awareness about AMR

Health promoters in MSF projects are trying to increase public education about AMR and encourage better practices in the community.

Haji Abdul Rehman Niamatullah gathers a group of patients in the MSF-supported Boost Provincial Hospital in Lashkar Gah, Helmand. With a flip chart in hand, he explains that antibiotics fight infections caused by bacteria but have no effect on common viruses responsible for coughs, colds, or the flu.

“Antibiotic resistance occurs when bacteria, after exposure to antibiotics, stop responding to these medications over time. This natural process is triggered and accelerated by the misuse of antibiotics—such as skipping doses or not completing the full course of treatment”, Niamatullah explains. “When antibiotics fail to kill the bacteria, treating the infection becomes much more difficult”, he adds.

Back at the Kunduz Trauma Center, Dawood has learned firsthand how challenging it can be to treat infections caused by a multidrug-resistant organism. His infection was caused by a highly resistant organism that is called methicillin-resistant Staphylococcus aureus.

After more than two weeks in the trauma center’s isolation ward, Dawood says he can tell his infection is starting to heal. While grateful for the treatment from MSF staff, Dawood looks forward to going home soon.

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