Responding to Gaza’s Medical Crisis: The Role of US Hospitals

On the heels of the recent violence in Gaza, 2 years after October of 2023, with a traumatized population whose health care system has been nearly completely decimated, it is incumbent on us as US physicians and health care leaders to accept the wounded and ill from Gaza into our hospitals and clinics for definitive medical care. As a pediatrician who is connected to others working to evacuate ill and injured children, I am part of a burgeoning call to our hospital leaders and physician groups to commit to hosting the care of patients needing treatment from the Gaza Strip through a charity care model.The statistics on the health care needs of Palestinians in Gaza at the time of writing this in August of 2025 are devastating. According to the United Nations Office for the Coordination of Humanitarian Affairs, out of 36 hospitals in Gaza, only 14 remain partially functioning. According to a spokesperson from the World Health Organization (WHO), bed occupancy at the major remaining hospitals exceeds 200% to 300%, 52% of medicines are at zero stock, and key items such as intensive care unit equipment, anesthesia machines, and cold chain supplies have not been allowed to enter.1 An estimated 130 ambulances have been destroyed, and over 1000 health care workers have been killed in the past year’s violence.2 This leaves the Gaza Strip, one of the most densely congested areas in the world, with an estimated population of over 2.1 million residents living in a 25 mile–long piece of land, in an untenable situation with regard to access to health care.Complicating this is the difficulty of exiting Gaza and, despite the heroic efforts of Palestinian health care workers in Gaza to continue to care for the sick and wounded there, the need to ensure transfer of care to places outside of Gaza with more resources. The United Nations (UN) estimates that there are currently more than 14 000 patients needing urgent medical evacuation outside of Gaza, and, according to Médecins Sans Frontières, it is estimated that 4500 children are in need of urgent medical evacuation.2,3 Shockingly, from July 2024 to October 2025, only 28 patients have been evacuated to the United States, as compared with patients evacuated to Egypt (11 623), the United Arab Emirates (616), or Italy (110).4 While it may be faster to travel to a nearby country initially, those countries that have taken on thousands of evacuees are also experiencing overburdened health care systems, hosting Gazan patients whose care could be spread across other countries as well.In addition to the need for medical and trauma care is the concern for severe malnutrition due to the restriction of food aid, and Gaza has been described as being in stage 5 of famine. The UN estimates that 50 000 children are in need of treatment for malnutrition and that 91% of all Gazan citizens are considered food insecure.2 As physicians, we are aware that malnutrition affects many systems, including wound healing after trauma. Reports from physicians who have volunteered in Gaza indicate that an increased number of amputations have happened because of lack of access to proper nutrition and the subsequent inability to properly heal wounds.5 Comparing the numbers out of Gaza with another concurrent war, the number of patients medically evacuated out of Ukraine since the start of the war with Russia in 2022 has been in the tens of thousands, with several hundred being granted access to treatment in the United States alone (most impressively through the SAFER Ukraine program).6 Thus, a record of longitudinally providing this type of care exists; what matters is our commitment to make it happen.The process of getting a patient out of Gaza is onerous and involves several steps including the identification of patients needing evacuation by the Gaza Ministry of Health and the WHO, a subsequent approval by the Israeli Coordinator of the Government Activities in the Territories (COGAT) (the entity that controls the borders, airspace, and maritime waters out of Gaza), and a final approval by the US State Department to enter the United States. The number of patients that are approved for evacuation by COGAT is diminishingly few as compared with the identified need.7 A partner organization or entity helps connect patients needing to be evacuated with physicians and hospital leaders willing to accept them. A letter from an accepting physician or hospital leader is needed to present to the US State Department, and once approved, the patient can then be evacuated via the partner organization, who usually covers the cost of flights, housing, and often some of the cost of the medical treatment. These costs can be significant, but there are many incredible communities across the United States who, along with partner organizations (such as HEAL Palestine, the Palestinian Children’s Relief Fund, and Human Concern International), have stepped up to fundraise, host patients and family members, ensure access to translation and other trauma-informed and culturally appropriate services, and be the medical and community homes for these patients and their guardians. The ultimate goal is for these patients to return to Gaza once that is possible. If a child needs ongoing care (such as ongoing rehabilitation and prosthetic care), the partnering US organization will work with a more “local” entity, such as with rehabilitation providers in Egypt, to ensure this can continue once the child is able to complete the international portion of their treatment.In the United States, in speaking with pediatricians volunteering with the previously listed partner organizations across the country, we know of children needing care who have issues that span the spectrum from outpatient to inpatient needs, and from medical to trauma related. In my inbox is a list of children whose issues range from multiple amputations requiring prosthesis and rehabilitation, children with metabolic disorders and severe malnutrition needing specialized attention to refeeding, children with hydrocephalus and spina bifida needing repair, children with osteogenesis imperfecta and multiple fractures needing orthopedic care and rehabilitation, children with congenital and acquired heart disease needing cardiac surgery, children with Hirschsprung disease needing corrective surgery, children with various cancers needing chemotherapy—the list goes on. As a pediatric emergency physician familiar with the treatment of all of these medical issues, and as someone who is trained to care for any and all children who show up at the doors of my emergency department regardless of their country of origin or immigration status, it is devastating to read this list and know that our ability to help these children is dependent on many factors outside of our control. What is within our control, and, I would argue, within our duty as US physicians, is the commitment to accept the care of these children. The rate-limiting step for definitive care for many of these patients is finding hospital leaders and physicians who are willing to commit to hosting these children and providing charity care. Most large children’s hospitals in our nation are considered nonprofits and have a charge to provide charity care for children within their catchment areas. As these children and their families arrive to the United States and establish residence, enroll in schooling, and become active members of communities, our children’s hospitals and health care systems should thus reframe them as members of our local communities and commit to providing charity care through this model.There has been an apocalyptic amount of destruction in Gaza, with over 67 000 reported fatalities and over 100 000 injuries: numbers that are widely thought to be an inaccurate reflection of the true toll of this conflict. Gaza is home to the largest cohort of pediatric amputees in recorded history, and over 1 million of its children are in need of mental health support.8 What these statistics and first-hand accounts from US doctors who have returned from working there make clear is that it is our duty as physicians to uphold our profession’s primary ethical principle—to first, do no harm. We have a vital role to play in the repair of that harm. As American physicians, one function that we can serve in the restitution needed in Gaza is to aid in the healing of medically critical and wounded individuals. Additionally, if these individuals are to be considered international patients, large children’s hospitals often have international patient programs with established processes and insurance/payment structures to onboard such patients, making the processing of such patients not an extra process development burden to the hospital.Since August of 2025, all medical evacuations to the United States out of Gaza have been paused, further contributing to devastating delays for dozens of children who would have received their medical care in the United States. As individuals in our professional societies and among our hospital and health care networks, we should use our advocacy to speak with our representatives and ask that the State Department rapidly lift this pause. Once the pause is lifted, each of us should work in conjunction with our hospital leaders and partnering entities to commit to hosting a number of these patients through a charity care model going forward—the need is immense and will likely necessitate a response over several years. Indeed, according to the WHO, “It will take five to 10 years to evacuate all the critically ill people from Gaza waiting for urgent treatment if the ‘excruciatingly slow’ pace of approvals continues.”9More than 14 000 patients, including thousands of children, currently need urgent medical evacuation, with many at risk of deteriorating and dying while waiting to be evacuated. We, American physicians and health care leaders, have a principal role to play in ensuring their safe medical evacuation and treatment, and the time for us to act is now.The author wishes to acknowledge the incredible work of the organization HEAL Palestine and its cofounders Dr Zeena Salman and Steve Sosebee.