There is nothing voluntary about leaving a place where hospitals have been destroyed, doctors have been detained or killed, medicine is running out and thousands of patients are unable to access treatment that exists only a few kilometres beyond a sealed border.
Yet this is the language Israeli officials increasingly use when discussing the ongoing Genocide in Gaza. In recent months, Israeli Defence Minister Israel Katz has reiterated support for what he calls the “voluntary migration” of Palestinians from the territory, while Prime Minister Benjamin Netanyahu has spoken about expanding Israeli military control over large parts of Gaza This framing turns ethnic cleansing into a matter of personal choice, obscuring the extent to which Israel has spent years systematically dismantling the conditions that allow Palestinians to remain in Gaza in the first place, particularly through the destruction of its healthcare system.
This is the subject of our conversation this week with Norwegian emergency physician Mads Gilbert, who has worked alongside Palestinian doctors for more than four decades. Gilbert first arrived in Gaza during the First Intifada and later became one of the most recognisable international medical voices documenting Israeli assaults on the territory. During Operation Cast Lead in 2008-09, when Israel barred most foreign journalists from entering Gaza, his reports from Al-Shifa Hospital became one of the few accounts reaching audiences globally.The conclusion he drew from those experiences is one he has spent years returning to: Israel’s attacks on hospitals are not simply about the immediate casualties they produce. They are part of a broader ethnic cleansing project that seeks to make Palestinian life in Gaza impossible.
For more than sixteen years, before October 7th, Israel’s blockade restricted the movement of people and goods into and out of the besieged Gaza strip, shaping almost every aspect of life, including healthcare. Patients requiring specialist treatment unavailable in Gaza often needed Israeli permits to leave. According to the World Health Organisation, one in five patient permit applications in December 2022 was either delayed or denied, including requests from cancer patients, cardiac patients and children requiring specialised care. Access to chemotherapy, surgery or advanced diagnostics was often dependent on Israeli approval rather than medical need alone. The blockade also restricted the import of equipment, spare parts and materials needed to maintain hospitals and medical infrastructure.
Medical workers have also been targeted long before October 2023. During the Great March of Return protests in 2018, Israeli forces killed 21-year-old volunteer medic Razan al-Najjar while she was treating wounded protesters near the fence. Earlier that year, paramedic Musa Abu Hassanin was shot and killed while assisting the injured. Even at the time, these incidents reflected a broader pattern in which Israeli forces repeatedly targeted ambulances, healthcare workers and patients, despite the protection afforded to them under international humanitarian law.
What Israel has done to Gaza’s healthcare system since October 2023 represents an escalation of that pattern on an extraordinary scale. By August 2025, the World Health Organisation reported that Israeli attacks had damaged 34 of Gaza’s 36 hospitals. Médecins Sans Frontières has gone further to describe Gaza’s healthcare system as being “systematically dismantled, while WHO officials have repeatedly warned that it is approaching collapse.
The assault has extended far beyond buildings, targeting the very people responsible for keeping the system functioning. Dr Adnan al-Bursh, head of orthopaedics at Al-Shifa Hospital, died in Israeli detention in 2024. Before his death, he had reportedly been beaten in prison, with his body showing signs of torture. Dr Hussam Abu Safiya, director of Kamal Adwan Hospital, remains imprisoned after Israeli forces raided the hospital and detained him in December 2024. This week, he appeared by video link at an Israeli Supreme Court hearing in Jerusalem, where relatives said he showed visible signs of torture and severe physical decline, underscoring growing concerns about the treatment of Palestinian healthcare workers in Israeli detention.
These cases matter not just because they reveal the suffering of individual doctors, but because they also represent the removal of some of Gaza’s most experienced medical professionals at the very moment they are needed most. Hospitals cannot function without people. By killing, imprisoning or disabling senior clinicians and hospital leaders, Israel is deliberately hollowing out the expertise needed to sustain healthcare during genocide and erasing expertise that often takes decades to build.
Meanwhile, thousands of Palestinians continue to wait for treatment that cannot be provided inside Gaza. According to the UN, more than 18,500 patients, including approximately 3,800 children, currently require urgent medical evacuation for life-saving care unavailable in the territory. In February, Save the Children warned that at the existing rate of evacuations, it would take more than four years for all those requiring urgent treatment to leave Gaza. The organisation reported that more than 1,200 patients had already died while waiting for permission to access medical care elsewhere.
Taken individually, a denied permit, a destroyed hospital, a detained doctor or a patient unable to access care might appear as separate developments. But healthcare, especially during Genocide, is what makes it possible to manage chronic illness, survive cancer, receive emergency surgery, give birth safely and recover from injury. Once those systems disappear, the consequences extend far beyond the immediate victims. Entire communities begin to lose the conditions necessary for life itself.
This is why the destruction of healthcare cannot be understood as a secondary consequence of Israel’s genocide in Gaza. Under the Genocide Convention, genocide includes the deliberate infliction of conditions of life calculated to bring about the physical destruction of a group in whole or in part. The International Court of Justice has recognised the plausibility of South Africa’s genocide case against Israel, while a UN Special Committee concluded that Israel’s methods of warfare in Gaza were consistent with the characteristics of genocide. The destruction of hospitals, the restriction of medical care, the targeting of healthcare workers and the prevention of medical evacuations must be understood within that context.
This is also why discussions of “voluntary migration” deserve far greater scrutiny than they usually receive. By the time Israeli ministers began openly discussing the removal of Palestinians from Gaza, Israel had already destroyed much of the infrastructure that allowed Palestinians to remain there. The assault on Gaza’s healthcare system is not separate from that project. When hospitals are destroyed, doctors imprisoned, medical evacuations blocked and essential treatment rendered inaccessible, displacement ceases to be a freely made decision. The destruction of healthcare is therefore not only one of the ways Israel is carrying out genocide in Gaza, but part of the broader project of ethnic cleansing, which creates conditions intended to push Palestinians from their land while presenting their displacement as a choice.