The healthcare crisis in Gaza has grown more catastrophic as a result of the continued shelling by the Israel Defense Forces—a grotesque contradiction in nomenclature—of the 140-square-mile enclave that is home to 2.3 million people.

Approximately 1.7 million Palestinians (three-quarters of the population of Gaza) have been internally displaced, without adequate shelter, water or food or access to medical treatment. According to a World Health Organization (WHO) report published on November 8, nearly 725,000 people had by then sought refuge at 149 United Nations Relief and Works Agency (UNRWA) facilities. Another 122,000 were sheltering in “hospitals, churches and other public buildings.” Approximately 131,000 were being kept at 94 non-UNRWA schools, and the remainder with host families.

The report noted:

As people face food shortages, malnutrition, and impending cold weather, they will be even more susceptible to contracting diseases. This is especially concerning for the more than 50,000 pregnant women and approximately 337,000 children under the age of five currently in Gaza.

Clearly, the targeting of hospitals, mosques and schools is intended both to terrorize the remaining population and to inflict as much damage as possible wherever large numbers of civilians are gathered to avoid attack from weapons of mass destruction.

Fundamentally, the attack on the healthcare system serves to ensure that no medical attention can be given to those who may have escaped immediate death from bullets and missiles, but have sustained potentially life-threatening injuries that require immediate care. If blood loss combined with lack of access to hydration and nutrition is not sufficient to ensure that the injured succumb, infection and disease will assuredly cause a horribly gruesome demise.

The current death toll is nearly 15,000 people, according to the Palestinian government media office, of which half are children. This figure is likely an undercount. More than 7,000 people are unaccounted for, including close to 5,000 children who are either buried under the rubble or whose remains have been decimated by the intense bombardment.

Given the complete and rapid collapse of the healthcare infrastructure in northern Gaza and the mass displacement of people, leading to the inundation of the remaining hospitals in southern Gaza, it can be expected that within the next few weeks, once Israel rearms and presses into southern Gaza, the entire healthcare delivery system in Gaza will become non-existent, worsening and compounding the already horrifying statistical indices of human devastation.

The recent images of mass graves with piles of bodies, both large and small, shrouded in white linen or blue plastic sheets—recalling the scenes of bodies piled high at the height of the COVID-19 pandemic—provide only a small window into the horrific crisis that has consumed the Palestinians over the last seven weeks, with the complete support of the Biden administration and the European heads of state.

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Former British Prime Minister Boris Johnson’s injunction during the most deadly period of the pandemic to “let the bodies pile high” is equally descriptive of the policy of US and European imperialism today, as the US and its NATO allies foment a new world war, whose initial fronts are Ukraine and Gaza.

The favorable comments being made by political figures on the current pause in the fighting do not mean they are walking back their previous statements opposing a ceasefire or the drawing of “red lines” to limit the Netanyahu government’s policy of mass killing and ethnic cleansing. In point of fact, they are in complete agreement with Israel’s Final Solution to the Palestinian “problem.” Those politicians who praise the “humanitarian pause” as a step toward peace—such as Bernie Sanders in the US—consciously seek thereby to deflect the mass and intense opposition from the international working class to the genocidal policies being pursued by their respective national leaders, as witnessed by the hundreds of demonstrations demanding a ceasefire.

A statement issued on November 24 by Samantha Power, the administrator of the United States Agency for International Development, drips with hypocrisy and dishonesty. It reads:

The United States welcomes the pause in hostilities in Gaza as an opportunity to ramp up the safe delivery of life-saving humanitarian assistance to Palestinian civilians in grave need and facilitate the release of hostages captured by Hamas after 48 harrowing days of captivity.

Power, a veteran exponent of “human rights imperialism,” promoted the US regime-change military operation that overthrew Libya’s Gaddafi in 2011 as a member of Obama’s National Security Council. She then propagandized in support of the US effort to overthrow Bashar al-Assad in Syria while serving as US ambassador to the UN in 2013.

Her statement on the Gaza pause went on to boast of Washington’s “humanitarian efforts” to deliver food [500,000 pounds—a pittance] and solemnly pledged that “we will continue to emphasize to the parties the critical importance of protecting civilians in accordance with international humanitarian law.”

Needless to say, she made no mention of the billions in bombs, missiles, shells and other instruments of war funneled by the US to Israel to enable Washington’s military outpost in the Middle East to brutally suppress Palestinian resistance and now engage in genocide against the population of Gaza.

Such cynical statements are issued under conditions where sewage is flowing in the streets of Gaza. Health authorities are raising the alarm that dysentery and gastrointestinal diseases, including infectious diseases like cholera, will rapidly escalate.

Safe drinkable water is almost impossible to come by, and people are resorting to drinking contaminated water or seawater.

The WHO reports that there have been 40,000 cases of diarrhea, the bulk of them among children under five, and 70,000 acute respiratory infections. There have also been over 1,000 cases of chickenpox, amid concerns over a rise in the incidence of typhoid, cholera and measles. As winter approaches and the rains begin to fall, the inclement weather will worsen an already impossible situation.

Richard Brennan, the regional emergency director for the Eastern Mediterranean region at WHO, told Al Jazeera:

We are hearing about several hundred people per toilet at the UNRWA centers and those have been overflowing, so people are doing open defecation. They have to find a place to go to the bathroom in the grounds where they are staying. That’s a huge public health risk and also very humiliating.

While nearly the entirety of northern Gaza’s infrastructure has been devastated, in the south, to which people have been fleeing, all 76 water wells in the governates of Dier el-Balah, Khan Younis and Rafah are no longer operable, according to the UNRWA. The inoperable facilities include two main drinking water plants and 15 sewage pumping stations.

The average Gazan is currently limited to just 3 liters of water for drinking and sanitation, far less than the 7.5 liters the international agency recommends in emergency situations. Meanwhile, Israel is only allowing enough water for 4 percent of Gazans to trickle in.

The agency also noted that on Wednesday the Israeli authorities allowed just 23,000 liters of fuel into Gaza via Egypt, when 160,000 liters a day are required to adequately address the ongoing and urgent humanitarian crisis.

General Philippe Lazzarini, the UNRWA’s general commissioner, said at a press conference:

This fuel cannot be used for the overall humanitarian response, including for medical and water facilities or the work of UNRWA. It is appalling that fuel continues to be used as a weapon of war. This seriously paralyses our work and the delivery of assistance to the Palestinian communities in Gaza.

The coordinated attacks on Al-Shifa Hospital and now the Indonesian Hospital and Al-Awda Hospital in northern Gaza continue. Several doctors were killed at the latter on November 21—Mahmoud Abu Nujaila, Ahmad Al Sahar and Ziad Al-Tatari.

Doctors Without Borders (MSF) wrote of the situation at Al-Awda:

At time of writing, more than 200 patients are still in Al-Awda and are unable to receive the level of care they need. These patients must be urgently and safely evacuated to other hospitals that are still functioning, although all hospitals in Gaza have been working beyond their capacities since October due to ongoing shortages, attacks, and extremely high caseloads.

The group added:

This is yet another incident that MSF staff have been subjected to in the last few days. Our colleagues who are assisting hundreds of patients in Gaza are facing extremely difficult times in providing the little medical care they can. Seeing doctors killed next to hospital beds is beyond tragic, and this must stop now. Attacks on medical facilities are a serious violation of International Humanitarian Law, and this has become systematic in the past weeks.

Israel, in an attempt to defend its carnage against these healthcare systems, has been promoting the lie that Al-Shifa and other hospitals are being used as centers for Hamas’ operations, without providing a shred of evidence to back these claims. After taking over the besieged medical complex, the IDF arrested the director of Al-Shifa and held several doctors for questioning as they were evacuating patients via a WHO convoy.

A November 22 Flash Update noted that only two small hospitals in northern Gaza remain partially operational, with 22 out of service. In the south, only 7 of 11 medical facilities are still functioning, of which only one has the capacity to perform critical trauma care and complex surgery. Hundreds of patients with life-threatening injuries (including spinal cord injuries) and illnesses, including infants and children, remain in these non-functioning facilities.

That Israel is deliberately targeting healthcare systems is confirmed by a November 19 column in Yediot Ahronot by by retired IDF Major General Giora Eiland titled, “Let’s not be intimidated by the world.”

Eiland explains why it is important to ensure Israel’s success in the conflict not just through “military combat” but also by destroying Gaza’s economic stability and access to energy. He writes:

Israel must therefore not provide the other side with any capability that prolongs its life. Moreover, we say that [Hamas Leader Yahya] Sinwar is so evil that he does not care if all the residents of Gaza die. Such a presentation is not accurate, since who are the “poor” women of Gaza? They are all the mothers, sisters or wives of Hamas murderers.

He adds:

The way to win the war faster and at a lower cost for us requires a system collapse on the other side and not the mere killing of more Hamas fighters. The international community warns us of a humanitarian disaster in Gaza and of severe epidemics. We must not shy away from this.