V3I8P6

Accessibility to Speciality Clinics During the War on Gaza (2023-2025)- Case of Urology Services 

Mohammed Al-Jadbah¹, Mohammed Migdad², Mohamed Buheji^3*

Abstract

The ongoing war on the Gaza Strip since October 2023 has caused catastrophic destruction to the healthcare system, creating an unprecedented humanitarian crisis affecting all medical specialties. Urology services—critically dependent on advanced infrastructure including dialysis machines, operating theatres, and diagnostic imaging equipment—have been disproportionately affected, yet remain understudied in conflict settings.

This descriptive-analytical study aims to document and analyze the impact of war on access to urology department services in the Gaza Strip, assess the associated economic burdens on patients and families, identify service delivery gaps, and propose evidence-based recommendations for urgent response and sustainable reconstruction.

A systematic review of secondary data from WHO, UNRWA, OCHA, the Palestinian Ministry of Health, the World Bank, and UNCTAD was conducted, supplemented by peer-reviewed field surveys from Gaza. Health economics frameworks—including catastrophic health expenditure analysis, burden of disease measurement (DALYs/YLLs), and gap analysis—were employed to quantify the economic and health impacts.

At least 94% of hospitals sustained severe damage or complete destruction, with dialysis capacity at major centers falling below 15% of pre-war levels. Over 417 dialysis patients died due to interrupted treatment—approximately 38% of registered kidney failure patients. Emergency urological surgeries (lithotripsy, prostatectomies, cancer resections) were suspended almost entirely. Approximately 70% of surveyed households reported increased healthcare costs, while Gaza’s economy contracted by 83% in 2024 alone, with per capita GDP falling to just $161 annually. Three interconnected levels of catastrophic health expenditure were identified: individual (inability to afford life-saving dialysis), familial (disruption of household economic stability), and societal (accumulated human capital loss from preventable deaths and disabilities). The study also documents the emergence of war-related urological injuries (kidney/bladder trauma, crush syndrome) and the near-collapse of care for vulnerable populations—including children with kidney failure, pregnant women with untreated urinary tract infections, and urological cancer patients whose diagnosis and treatment were interrupted.

The urological crisis in Gaza represents a compounded medical-economic emergency requiring immediate international intervention (guaranteed humanitarian corridors for dialysis supplies, mobile emergency units), medium-term reconstruction (rehabilitation of damaged departments, staff training), and long-term systemic reform (integrated health insurance, national patient registries, and ongoing health economics monitoring). Early intervention is substantially less costly than addressing the consequences of prolonged neglect, both financially and in terms of preventable human loss. The study underscores that urology care in conflict settings is not a narrow specialty concern but a human rights, health equity, and economic justice imperative.

Keywords:

Gaza Strip, Urology, Kidney Failure, Dialysis, Health Economics, Catastrophic Health Expenditure, Armed Conflict, Healthcare Access, Health System Collapse, Humanitarian Crisis