The Urgent Struggle for Health Justice in Gaza: A Crisis of Human Rights and Inequity

In Gaza, health justice is a matter of life and death. The ongoing war has torn apart the already fragile health system, leaving behind not only death, despair, distress, damaged infrastructure, but also severe moral crisis. Sadly, Gaza's health system has faced decades of deliberate neglect, blockade-induced shortages, and repeated damage due to armed-conflict [1]. Amidst the ongoing war, the international community remains stuck in a cycle of rhetoric, while Gazans struggle to navigate a shattered health system with many healthcare workers, killed or traumatised, injured and often displaced [2]. Gazans are not only fighting illness but also confronting systemic injustices that disrupt their basic right to health.

This war in Gaza shows a critical link between human rights violations and health inequities, as civilians endure dire conditions marked by displacement and severe shortages of basic needs. Over 1.7 million Gazans have been displaced, with essential infrastructure like water, sanitation, and healthcare systematically destroyed [2, 3]. The United Nations has warned that this damage creates severe violations of humanitarian law, making Gaza “the world's biggest graveyard” with the scale and intensity of violence [3].

Health justice in Gaza goes beyond access to healthcare, involving breaking up the institutional and political forces that systematically deprive people of their most basic human rights. In this context, health planning and management, if approached with urgency, inclusivity, and political will, can offer more than just an opportunity to rebuild the health system [4]. Health planning and management can offer a pathway to empower people—communities and health workers - suffering the persistent burden of war and injustice.

Health justice is fundamentally about ensuring that everyone, regardless of their circumstances, has access to the healthcare they need to live a full, healthy life [5]. However, this right is severely threatened in Gaza, as health itself is under attack.

The blockade imposed on Gaza by Israel since 2007, coupled with periodic escalations of violence, has created a state of constant emergency. Since October 2023, the situation has become catastrophic. Health facilities have been bombed and health workers attacked. Hospitals, overwhelmed with casualties and damaged infrastructure, struggle to function and operations are taking place without anaesthesia (Médecins Sans Frontières) [6]. More than half of Gaza's hospitals have either been partially or completely destroyed [2]. Health workers are either fleeing or being killed, resulting in a massive shortage of health staff [2]. Essential supplies of food, water, electricity, and medicine are blocked, creating a massive humanitarian crisis which will have long lasting impacts. This situation hinders the ability of civilians, especially vulnerable populations, to access essential health services [6]. Furthermore, the collapsed health system alongside the overcrowded living conditions, and disrupted sanitation services are contributing to the spread of infectious diseases such as poliomyelitis, cholera, measles and meningitis amid unhygienic and challenging conditions. This deepens the crisis for most people trapped in Gaza, particularly vulnerable groups [6, 7]. Under these dire conditions, health is not considered a top priority. Sadly, the primary concern now is to stay alive [3]. Immediate survival needs like food, shelter, and security take priority over healthcare, leaving short and long-term health concerns overlooked, with implications for future health and well-being.

In fact, it is exceptionally difficult for Gaza's health system to provide justice to its people when healthcare infrastructure has been dismantled, not just by the damage of war but by years of political blockade and economic deprivation. In these settings, health justice is not just about rebuilding the health system. It is about addressing the underlying factors that create these injustices such as occupation, political oppression, blockade, systemic violence and human rights violations, which have led to social inequities and poor health outcomes [8]. In light of this, health justice can be considered as both an outcome and a process, but how can the process take place in Gaza and other contexts experiencing conflict and fragility?

Here is the painful truth, achieving health justice in Gaza is very challenging, but it is not beyond reach. The key to health justice lies not only in the immediate delivery of humanitarian aid but in the long-term and strategic planning of a health system that can endure, adapt, and eventually thrive in the face of crisis [3]. Health planning and management can provide a critical, though challenging, pathway forward.

In fragmented and war-torn contexts, effective health planning is not about pursuing idealistic goals but navigating the devastating reality of limited resources, damaged infrastructure, and ongoing instability. Only a health system that is robust, adequately resourced, and has a supported, protected, and resilient health workforce can withstand and respond efficiently and equitably to such crises [9]. So, how can health planning and management become a mechanism for achieving health justice in Gaza?

Finally, we must broaden the discussion. Health justice in Gaza cannot be achieved through healthcare alone; it is deeply intertwined with justice in the political, economic, and social realms. Achieving this requires coordinated efforts across multiple sectors, support from international organisations, and a commitment to political neutrality [3, 4]. A health system operating under occupation, constantly undermined by political and military forces, cannot be fully just. True health justice will only be possible when Gaza is free to determine its own future, without interference from external powers. The war on health in Gaza is part of a broader assault on its humanity, and until the underlying systemic injustices are addressed, health justice will remain hard to attain.

In conclusion, the ongoing war in Gaza underlines the critical role of health system resilience as a path to health justice. Health planning and management in Gaza are not just survival strategies, instead they could serve as a foundation for long-term peace and justice. They are powerful tools for fighting back against the embedded systems of inequities and occupation that deprive Gazans of their basic human rights and dignity. To achieve health justice, in Gaza and beyond, we must look beyond the immediate impacts of war and focus on the broader structural changes necessary to create a just, resilient and equitable health system. Health justice is not a luxury in war zones; it is an urgent necessity.

The authors declare no conflicts of interest.