How disability can become a death sentence in Gaza today

A man sits near the destroyed al-Shifa hospital in Gaza City, on 17 September 2024 (Omar al-Qattaa/AFP)

We are witnessing sanitascide, as Israel violently maims the host population while disabling the very infrastructure that supports life in the territory

Since 7 October 2023, Gaza has experienced what Unrwa’s commissioner-general, Philippe Lazzarini, has described as a "pandemic of disabilities", with thousands of Palestinians subjected to the horrors of limb amputation, spinal cord injury, life-changing burns and traumatic brain injury at the hands of Israeli occupying forces.

There have been more than 4,500 documented amputations, and many thousands of cases of spinal and brain injuries, a disproportionate number afflicting children. A year ago, a World Health Organisation analysis estimated that between 13,455 and 17,550 Palestinians in Gaza had suffered severe limb injuries, placing an unimaginable burden on near non-existent rehabilitation services.

In Israel’s genocide of Palestinians, the production of mass individual disability, and the institutional disablement of a once-functioning society in Gaza, are both critical elements in advancing Israel’s Zionist goal of eliminating Palestinians.

According to a report by UN Humanitarian Coordinator Sigrid Kaag, in less than a year, Israel had inflicted life-changing injuries on more than 22,500 people in Gaza - a figure that has undoubtedly risen dramatically.

Genocide is a process, developing over many years. It begins with practices of institutional dehumanisation, ends in erasure, and throughout involves periodic massacres, practices of apartheid segregation, systematic weakening and social reorganisation.

Genocide necessarily involves the prior and organised weakening of those to be eliminated. The process is attritional and includes state strategies of physical destruction through overcrowding, malnutrition, starvation, targeted disablement, epidemics, denial of healthcare, torture and rape; and state strategies of psychological destruction through humiliation, abuse, persistent violence, denial of basic rights, and the undermining of community solidarity through collective punishment and collaboration.

Evidence of both the physical and psychological components of Israel’s strategy to destroy Gaza has long been provided by human rights organisations. Systematic weakening is enabled through practices of segregation and apartheid, and is most potent once the target group has been physically and socially isolated.

Total siege

When Israel’s former defence minister, Yoav Gallant, on 9 October 2023 announced the complete siege of Gaza with "No electricity, no food, no water, no gas", Gaza’s infrastructure had already been weakened to a point that made daily life in the territory almost untenable.

For the disabled, newly injured and chronically ill, access to life-saving and life-enhancing treatments and assistive devices had been restricted for many years. Before the current annihilation phase of Israel’s genocide, Gaza had been placed under a brutally restrictive Israeli air, sea and land blockade, which the UN anticipated would make Gaza “uninhabitable” by 2020.

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During the 16 years prior to 7 October, Israel exerted total control over the movement of goods and people into and out of the enclave. Access to essential items was severely constrained or simply prohibited, including certain medicines, batteries essential for assistive devices, water and sewage pipes, concrete and diesel fuel, which Israel claimed had "dual functions" and could potentially be used to support "terrorist infrastructure".

Israel’s prohibition on the import of carbon fibre elements (used to stabilise and treat limb injuries) and epoxy resins (used in the production of lightweight and comfortable prosthetics) has meant that people with injuries and amputations in Gaza were being denied assistive technologies that would allow for independence, mobility and a greater quality of life.

Israel had achieved an orchestrated humanitarian collapse long before 7 October. Its persistent refusal to facilitate the entry of humanitarian aid into Gaza following the Hamas attacks, and its calculated undermining and subsequent disabling of Unrwa, are all in keeping with its intention to pursue its genocidal goal - and a blatant manifestation of a plan to accelerate death-inducing famine and disease.

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Decades of systematic and targeted attacks on Gaza’s health and rehabilitative structures - coupled with almost two decades of blockade and now, mass bombardment and a total siege - have ensured that the newly injured, the chronically ill and the disabled are denied adequate healthcare and rehabilitation resources, such that they remain in a state of injury rather than transitioning into a state of what Jasbir Puar calls “functioning disability”.

To be functionally disabled (as opposed to being in a state of injury) represents for Israel an act of Palestinian resistance, a resistance that must be suppressed. Any assertion of Palestinian resilience and recovery represents an existential threat to Israel’s identity. By disabling the capacity of Gaza to heal and rehabilitate the injured, to feed the starving, to educate the young, to house the dispossessed, Israel attempts to weaken resilience and the possibility of resistance.

Israel’s calculated, wholesale and relentless decimation of healthcare in Gaza represents something hitherto unseen in modern genocides. Sanitascide, derived from the Latin term sanitas, meaning health, is the term we have developed to describe this targeted and comprehensive destruction of healthcare.

Scholars such as Rashid Khalidi, Puar, Lena Obermaier, and Neve Gordon and Nicola Perugini have documented Israel’s long history of targeting Palestinian health infrastructure. By debilitating healthcare infrastructure, Israel has ensured that the injured are more likely to become “permanently wounded”, placing even greater strain on Gaza's health infrastructure, already disabled by the blockade.

Annihilation phase

But in the annihilation phase of genocide, in post-7-October Gaza, Israel has turned hospitals into killing fields. On 13 November 2023, the Israeli army posted - but later deleted - a tweet in which it called hospitals and ambulances “legitimate military targets”. As well as bombing hospital infrastructure, murdering patients, and destroying incubators, ambulances, medications and life-support systems, the Israeli army has tortured and assassinated hundreds of doctors, nurses, physiotherapists and paramedics.

In April 2024, Gaza's Ministry of Health announced that 496 medical sector staff had been murdered and 1,500 injured by Israel, with 155 health facilities damaged, and 32 hospitals and 53 health centres rendered non-functional. The ministry further reported that 309 medical staff, including hospital directors in Gaza, had been kidnapped and detained by Israeli forces.

By debilitating healthcare infrastructure, Israel has ensured that the injured are more likely to become 'permanently wounded', placing even greater strain on Gaza's health infrastructure

In Puar’s Right to Maim, she argued that in Gaza, “the infrastructure that ought to sustain life is transformed into a system threatening life itself”. By creating a population that is heavily reliant on a healthcare system to survive, while simultaneously decimating this system, Israel was able to create much more damage than it caused with the initial injury event.

Causing an injury that makes one’s existence reliant on a certain medical device or treatment vital to their lives - sterile dressings, catheters, stoma bags, feeding tubes, medication, antibiotics, prosthetics, mobility aids - and then denying that resource, spreads the stigmata of injury and disability far further. In such a context, where the very structures designed to treat, assist and rehabilitate are themselves dismembered, the injured cannot transform into the functioning disabled.

Violently disabling large numbers of the group and disabling the very infrastructure that supports life in the Gaza Strip are central means by which Israel has advanced its organisational goal of imposing a Jewish ethnonationalist state in Palestine.

The consequences of using the Gaza Strip as a "weapons laboratory" have been profound. During the Second Intifada, for example, the deployment of high-velocity fragmented bullets - which left a “lead snowstorm” - resulted in multiple cases of disability.

'Deliberately shooting protesters'

Dr Adnan al-Bursh, before he was tortured to death, described what he witnessed working as a doctor, and the way in which Israel creates "a disabled generation by using destructive types of bullets and deliberately shooting protesters in their joints".

Ghassan Abu Sitta, a plastic and reconstructive surgeon who worked in al-Shifa hospital for 43 days, described in tweets the devastating impact of Israel’s deployment of quadcopter drones with sniper guns: "One night we had 30 injuries when they were sent to shoot at people trying to get to Al Ahli hospital."

Reham Shaeen, a humanity and inclusion rehabilitation expert, suggests that the types of weapons used in Gaza mean “70 to 80 percent of the people coming to hospital have been amputated or have spinal cord injuries”. These particular injuries require immediate intensive care and rehabilitation and equipment provision. Spinal cord injury rehabilitation in the UK requires a minimum three-month inpatient stay and the involvement of multiple different specialists.

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As well as sniper and gunshot wounds, vast quantities of explosives have rained upon Gaza, all of which directly contribute to traumatic amputations, traumatic brain injuries, spinal cord injuries and other serious internal injuries, often due to collapsing rubble. There have also been eyewitness reports of white phosphorus being used in densely populated areas of Gaza, which “poses a high risk of excruciating burns and lifelong suffering”.

According to Unicef, more than 1,000 children underwent limb amputations in the first three months alone of the genocide, and an estimated 10 children per day continue to lose one or more limbs through bombardments, crush or sniper injuries. As a consequence, “Gaza is home to the largest cohort of child amputees in modern history,” according to the UN.

A report published in the Lancet in July 2024 reported that up to 186,000, or even more, deaths are likely attributable to Israel’s genocidal assault on Gaza. This shocking - yet, as acknowledged by the authors, conservative - calculation factors in the indirect and premature deaths caused by reproductive, communicable and non-communicable diseases that are the inevitable consequence of the total siege, mass bombardment, orchestrated starvation, mental and physical trauma, and mass deaths and injuries inflicted by Israel on the population of Gaza.

Increased susceptibility

Evidence of hepatitis and meningitis outbreaks have been reported by Gaza’s health ministry, and the highly infectious poliovirus has been detected in sewage outlets in Khan Younis and Deir al-Balah. Lack of access to sufficient food and water slowly disables a previously able population by causing vitamin deficiencies, muscle wasting, cognitive impairment and immune suppression, increasing susceptibility to infectious diseases.

While physical injuries and the consequences of starvation and illness in the context of genocide are so extensive as to be difficult to enumerate, the scale of mental health damage will impact every single Palestinian in Gaza.

The scale of mental trauma and its attendant pathologies of PTSD, depression, anomie and more is incalculable. Nonetheless, the Gaza Community Mental Health Programme anticipates that as the war continues, “every child will need mental health support”.

The disablement of the Gaza Strip through bombardment, ground invasion and siege mean that every single Palestinian trapped within its narrow confines has effectively been disabled

Haunting images of families impossibly pushing loved ones in antiquated wheelchairs through rubble and devastation as bombs explode behind them; the starving child with cerebral palsy, Yazan El Kafarneh, staring from a stretcher in Rafah’s Abu Youssef al-Najjar hospital; Nour al-Huda, an 11-year-old girl with cystic fibrosis admitted to Kamal Adwan hospital suffering from malnutrition, dehydration and a lung infection; deaf sisters Iman and Abir, who cannot hear the bombs or warnings of those around them; Muhammad Bhar, who could not understand the murderous intent of Israeli soldiers and their dog - these are the faces of disability in Israel’s genocide.

Evidence from other genocides suggests that some of the earliest and most damaging effects of genocide are likely to be felt by the disabled community.

Following 16 years of an illegal blockade, which systematically and comprehensively weakened the whole population of Gaza, disabled people were disproportionately impacted, having been long denied adequate access to liberating assistive devices, including power-assisted attachments for wheelchairs, crutches, latest development prostheses and hearing aids.

Extreme barriers

Gaza’s disabled population faces a host of extreme barriers as they experience the destruction of genocide through the lens of their own disability, in effect becoming doubly disabled. As Israeli bombs rain down on civilian homes, and in the wake of evacuation orders, the medical and physical assistive devices essential to their health, well-being and ultimately life are frequently lost, left behind or destroyed in the chaos of bombing, terror and flight.

The disabled become separated from their essential caregivers, a terrifying situation for people who rely on trained caregivers for their most basic daily needs. Without catheters and other continence essentials, adaptive toilet seats, wheelchairs, prostheses, walking frames and other mobility equipment, hearing and sight aids, as well as life-saving medications, disabled people become dangerously vulnerable. For those members of that population relying on total parenteral nutrition and other forms of medical tube feeding, the impact is immediately devastating.

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Electric wheelchairs and other assistive devices require a constant source of power. The siege renders these devices unusable, and the consequences can be devastating. Without electricity, lifts do not function, rendering the many physically disabled people who live above the ground floor in Gaza’s high-rise apartment blocks, unable to evacuate.

In an orphanage in northern Gaza, evacuation was an impossibility given the high-need requirements of 12 of its disabled children. For those able to flee, leaving accessible homes and supportive devices for a future of certain inaccessibility imposed an added terror.

More than 90 percent of the population has been forced to flee their homes, sometimes multiple times, and the tents and shelters to which they have fled are inhospitable for those who require assistive devices, disabled toilets, medical mattresses and sterilised conditions. For the disabled whose mobility was impeded, death was often the consequence.

Israel’s mass annihilation solution for the Palestinians of Gaza has followed decades of state-orchestrated dehumanisation, apartheid, sporadic violence and systematic weakening. The disablement of the Gaza Strip through bombardment, ground invasion and siege mean that every single Palestinian trapped within its narrow confines has effectively been disabled.

The purposive lives they lived - the places where they loved, worked, socialised, maintained health and were educated - have vanished, as homes, schools, hospitals, universities and public offices have been obliterated.

Through wholesale sanitascide, Israel has ensured that death, rather than functional disability, now follows injury and trauma. By these means and the physical obliteration of Gaza’s social and economic infrastructure, Israel has attempted to destroy the Palestinian national identity.