Optimal Strategies for Recovering the Healthcare System and Interdependent Infrastructure in the Gaza Strip and Their Impact on Public Health

Abstract

BACKGROUND: The Gaza Strip's health system has been disrupted by conflict since October 2023, alongside damage to electricity, water, sanitation and transport systems. This study assessed healthcare functionality, infrastructure disruption and public health outcomes, and identified priority recovery strategies. METHODS: A retrospective quantitative analysis used secondary data from October 2023 to February 2025 from WHO HeRAMS, the Palestinian Ministry of Health, OCHA and UNOSAT. Indicators covered hospital functionality, workforce availability, medical supply continuity, energy, water, sanitation, transport access and communicable disease incidence across five governorates. Descriptive statistics, Spearman correlation, Success Tree Analysis (STA), Multi-Criteria Decision Analysis (MCDA) and spatial mapping were applied. RESULTS: Of 38 hospitals, 23.7% were fully functional, 44.7% partially functional and 31.6% non-functional; North Gaza had the highest non-functionality (50%). Physician density declined by 45%, and only 48% of facilities reported essential medicines. Electricity and water functionality fell to 27% and 35%. Diarrhoeal disease and respiratory infection incidence reached 72.4 and 96.5 cases per 10,000 population. Electricity availability correlated strongly with hospital functionality (ρ = 0.82, p < 0.001), while water functionality correlated inversely with diarrhoeal disease incidence (ρ = -0.76, p < 0.001). STA estimated that integrated restoration of energy, water, workforce and supplies could increase hospital functionality to 89% within 5 months. MCDA prioritised rapid infrastructure repair, renewable energy integration and water network rehabilitation. DISCUSSION: Healthcare recovery in Gaza depends on coordinated restoration of interdependent infrastructure and health-system components. Recovery planning should be integrated, multi-sectoral and geographically targeted to reduce disease burden and strengthen resilience in conflict-affected settings.