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Lookup NU author(s): Anas Ismail, Dr Craig JonesORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
BackgroundGaza has faced numerous military attacks that resulted in mass casualty incidents (MCIs). The ongoing genocide in Gaza has destroyed much of the health system, including killing and injuring of hundreds of health care workers (HCWs). Current thinking on the health system reconstruction lacks empirical data and local HCWs’ perspectives. The study analyses locally driven innovations and lessons learned by HCWs who responded to MCIs between 2018 and 2021 to guide current and future planning of the reconstruction of the health system in Gaza.MethodsThis was a qualitative study using online and face-to-face interviews with HCWs who responded to the Great March of Return and the 2021 Israeli military attacks. Transcripts and extensive notes from the interviews were recorded and analyzed on NVivo using thematic content analysis. We used the health system building blocks as themes for deductive analysis with a seventh place-based theme (Gaza-specific) to account for the context of Gaza and the MCIs.ResultsProblems faced by HCWs mostly related to the nature and complexity of traumatic injuries, shortages in HCWs, particularly specialist doctors, poor coordination among actors, duplication of services, and shortages of supplies and equipment. Locally driven innovations and solutions included establishing new services centers, opening and expanding training programs, starting new coordination bodies, and task shifting of staff and facilities. Lessons learned included strengthening training and employment opportunities for staff, enhancing emergency preparedness and capacities, maintaining coordination bodies, enhancing community engagement and strengthening the governance of the Ministry of Health.ConclusionReconstruction of Gaza’s health system needs to be grounded in its political context and in the experiences of HCWs who have worked in and managed the system. Locally driven solutions and lessons learned can ensure that reconstruction serves as a vehicle for self-determination and sovereignty, rather than entrenching dependency.
Author(s): Ismail A, Salah M, Gilbert M, Abu Alreesh YH, Jones C
Publication type: Article
Publication status: Published
Journal: PLoS One
Year: 2026
Volume: 21
Issue: 2
Online publication date: 17/02/2026
Acceptance date: 27/01/2026
Date deposited: 18/02/2026
ISSN (electronic): 1932-6203
Publisher: Public Library of Science
URL: https://doi.org/10.1371/journal.pone.0342654
DOI: 10.1371/journal.pone.0342654
Data Access Statement: The study is based on qualitative data, which we are not able to make fully available without restrictions. Data access requests should be sent to Dr Craig Jones: craig.jones@newcastle.ac.uk. People and organizations can be easily identified from the transcripts and notes of the interviews. Therefore, making the data fully available without restrictions may divulge the identity of individuals or the organizations in which they worked. Such breach of confidentiality is against the health research ethics approval obtained from the Helsinki committee of the Palestinian Health Research Council. Moreover, due to the current situation in Gaza and the unprecedented attacks on healthcare workers and on organizations working in the health sector, we cannot risk putting any individual or organization, who may be identified through the transcripts, at risk. Hence we cannot make the data fully available.
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