Displaced Palestinians move with their belongings southwards on a road in the Nuseirat refugee camp in the central Gaza Strip as smoke billows during Israeli strikes in Gaza City on September 14, 2025. [AFP]
More than one million people in Gaza are facing renewed terror after receiving an emergency order to evacuate Gaza City ahead of a major ground offensive by the Israeli military. For many, escape is impossible – the elderly, critically unwell, heavily pregnant or wounded. Those left behind have been handed a death sentence.
People who attempt to flee will do so under intensifying bombardments. Those who survive the journey will reach overcrowded areas in central and southern Gaza where they will find neither safety nor the basics they need to exist. A population pushed to the brink by almost two years of extreme brutality faces catastrophe.
What is happening in Gaza is not just a humanitarian catastrophe, it is the systematic destruction of a people. MSF is clear: Israel is committing genocide against Palestinians in Gaza and doing so with absolute impunity.
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The human toll is staggering. According to the latest Ministry of Health figures, more than 64,000 people have been killed, including 20,000 children. The true death toll is likely higher, with many more buried under the rubble of hospitals, schools, and homes.
There is no safe place in Gaza. Entire families have been wiped out sheltering in their homes. Health workers have been killed whilst tending to the sick. Journalists have been targeted for bearing witness. The Israeli military has attacked everything and everyone in Gaza.
High intensity weapons designed for open battlefields – some sold to Israel by US and European governments – are being used in densely populated urban areas where people are sheltering in tents. We are treating devastating injuries as a result.
The Israeli authorities have systematically targeted Gaza’s healthcare system – bombing hospitals, raiding medical facilities, and endangering the lives of staff and patients – acts that may amount to war crimes. The few hospitals that remain are overwhelmed and under-supplied. Patients suffer and die needlessly.
Twelve of our colleagues have been killed and MSF orthopedic surgeon, Dr Mohammed Obeid, remains detained by Israel since October 2024. In total, more than 1,500 health workers have been killed. Each one is a devastating loss – for their families and for Gaza’s besieged health system.
The impact of the genocidal war extends beyond direct attacks. Israeli authorities have deliberately choked Gaza, imposing a total siege, with severe restrictions on fuel, water, food, and medical supplies.
A policy of collective punishment, including starvation by design, has achieved its brutal objective – famine has been declared. A recent survey at our clinics in Gaza showed 25 per cent of pregnant or breastfeeding women were malnourished, which can increase the risk of stillbirth, miscarriage and premature birth.
The limited food assistance available has been cynically weaponised. An Israeli-run, US-funded operation is responsible for killing 1,400 people and injuring 4,000 more. We have treated children shot in the chest while reaching for food, and people crushed or suffocated in stampedes. This level of brutality is unconscionable.
Deliberate shortages of water are fuelling disease. Last month, MSF treated 4,000 people for watery diarrhoea – potentially deadly for malnourished children. MSF could increase the supply of clean drinking water but are regularly blocked from doing so.
Meanwhile, settler and state violence in the occupied West Bank is accelerating. Land theft, forced displacement, and attacks on communities are intensifying, as part of policies designed to change the demographic make-up of the West Bank.
Governments around the world – through political, military, or material support to Israel, or through silence – are complicit in the genocide. They have a moral and legal obligation to respond. This means real political pressure, not empty words, using every available political, diplomatic, and economic measure to stop these atrocities.
States must urgently secure a ceasefire, lift the siege and ensure that Israeli authorities allow immediate and unhindered delivery of large-scale, independent humanitarian aid. Medical facilities and health workers must be protected. The evacuation orders, and mass, forced displacement of people must stop.
Borders must be opened to allow the evacuation of people who want to leave, and patients in urgent need of specialist care. Governments must actively facilitate these lifesaving pathways and a right of return when conditions are truly safe to do so.
The attacks by Hamas in October 2023 were horrific, and all the remaining hostages must also be allowed to return home, as must Palestinians held in arbitrary detention.
Countries that have expressed outrage and solidarity for Palestinians can and must do more to increase the political pressure on others to act. This includes ensuring all countries halt transfers of arms used to kill and injure people and destroy civilian infrastructure in Gaza.
Each day, our 1,118 colleagues working in Gaza face the devastating reality that they cannot stop a genocide. But world leaders can, if they choose to act. As the two-year anniversary of this relentless and extreme violence approaches, the political choices required to bring it to an end are long overdue.
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By Christopher Lockyear