Access to emergency medical services and associated barriers among war-affected patients evacuated from Gaza: a cross-sectional study.

Abstract

Background: This study aims to evaluate civilians' experiences in accessing emergency medical services (EMS) within the ongoing conflict in Gaza and to identify the structural, systemic, and human rights-related barriers encountered throughout this process. The literature provides extremely limited quantitative field data focusing on the emergency healthcare experiences of war-affected individuals medically evacuated from regions under siege to other countries. In this respect, the study seeks to contribute to the understanding of possible impairments to the right to health, based on patient experinces during an ongoing conflict situation, while also analyzing measurable access-related factors such as comorbidities, evacuation timelines, and infrastructure adequacy.

Methods: This cross-sectional study included 81 patients medically evacuated from Gaza to Türkiye for treatment due to the escalation of violence following the events of October 7, 2023. Ethical approval was pre-obtained, and written informed consents were secured from all participants. Structured questionnaires were administered, collecting sociodemographic data, medical history, barriers to access, and responses concerning human rights. Descriptive analyses, Chi-square tests, and Spearman correlation analyses were employed for statistical evaluation.

Results: The study included 81 participants, predominantly female (60.5%), with a median age of 26 years. The most frequent conditions were malignancies (35.4%) and extremity trauma (34.1%). A total of 74% reported that healthcare facilities were damaged during the conflict, and 87.6% cited severe equipment shortages in emergency departments. Ambulance services never arrived for 34.5%, and 33.3% could not reach hospital EDs. Patients with comorbidities experienced significantly longer wait times for both ambulance arrival (p = 0.013) and ED access (p = 0.001). Those waiting over 30 min for ambulances had longer ED treatment durations (p = 0.036), whereas delays in reaching the ED were paradoxically associated with shorter in-department stays (p = 0.026).

Conclusion: This study identifies measurable weaknesses in Gaza's emergency healthcare system, including ambulance inaccessibility, delays in reaching emergency departments, and widespread shortages of equipment and personnel. These findings, derived from patient-reported data, reflect systemic barriers to effective emergency care. By identifying specific gaps in infrastructure, care delivery, and coordination, the study offers evidence-based insights to inform targeted humanitarian interventions in conflict settings.