V3I6P120

How the (2023 – 2026) War on Gaza Created New Necessities for Healthcare Insurance Development? 

Ghada Abu Nada¹, Mohammed Migdad², Mohamed Buheji^3*

Abstract

This study analyzes how the 2023–2026 Gaza conflict reshaped Palestinian healthcare financing, service delivery, and human capital, with a specific focus on the implications for health insurance development. Using a descriptive-analytical design, we analyzed public finance and clinical data from PCBS, Ministry of Health, World Bank, and UN agencies, complemented by field interviews with 15 key clinical and administrative informants.

By 2024, public funding fell to 41.7%, raising household out-of-pocket costs to 44.9%—far above the WHO catastrophic threshold. The Outside Medical Referrals (OMR) bill reached 960 million NIS, with public debt to private providers at 2.7 billion NIS. Gaza lost 94% of hospital capacity and 73% of primary centres, with 52% essential medicines and 71% consumables at zero stock. Six of seven dialysis units were destroyed, leaving only 641 active patients by January 2026. Of 11,000 oncology patients, only 564 were evacuated.

The fragmented insurance architecture—with four parallel schemes covering 32%, 29%, 6%, and 3% of the population while 30% remain uninsured—has proven inadequate to absorb these shocks. The conflict has rendered the pre-war insurance model obsolete, creating new necessities for: (1) compulsory universal coverage with a single risk pool; (2) Gaza-specific provisions including full premium subsidies and evacuation coverage; and (3) integration of humanitarian and public financing streams.

The researchers propose that the Palestinian healthcare system requires structural financing reform. Implementing tax-funded universal insurance, expanding local tertiary capacity in oncology and dialysis, and enforcing capped contracts with private providers will stabilize public debt and reduce referral costs. Without such reform, the post-conflict health system will remain trapped in emergency mode, perpetuating the catastrophic expenditure pattern documented in this study.

Keywords:

Health Economics, Health Insurance, Public Health Expenditure, Medical Referrals, War on Gaza, Palestine