The pattern and severity of traumatic injuries and medical conditions suffered by international healthcare workers who have been working in Gaza during the ongoing military invasion have been laid bare in a paper published in The BMJ today (26 September).

Healthcare workers described ‘unusually severe’ traumatic injuries including complex blast injuries, firearm-related injuries and severe burns. Many of the respondents who took part in the study with previous experience of conflicts said the pattern and severity of injuries in Gaza were greater than those they had encountered in previous war zones.

The study – whose first author is Manchester-based Omar El-Taji – is said to be the first to provide such detailed data from frontline clinicians during the conflict. The authors say it offers critical insights into the injuries and conditions most relevant to immediate management, rehabilitation, and long- term health planning.

Since October 2023, Gaza has faced high intensity Israeli bombardment and ground military incursions. Publicly reported figures show that more than 59,000 Palestinians have been killed and over 143,000 wounded during the conflict, but other analyses suggest these figures may be higher.

Respondents’ make-up

To address this gap, healthcare workers were invited to take part in a survey about the nature and pattern of injuries and medical conditions they managed while in Gaza, ranging from explosive and firearm injuries to infections and chronic diseases.

Seventy-eight doctors and nurses completed the survey using logbooks and shift records between August 2024 and February 2025, within three months of their deployment end date.

Participants represented 22 non-governmental organisations and were mainly from the US, Canada, the UK and European Union member states working in trauma surgery, emergency medicine, paediatrics, or critical care and anaesthesia.

‘These findings highlight the urgent need for resilient, context specific surveillance systems, designed to function amid sustained hostilities, resource scarcity, and intermittent telecommunications, to inform tailored surgical, medical, psychological, and rehabilitation interventions’ [Omar El-Taji et al]

Many respondents had worked in conflict zones before

Almost two respondents in three (65 per cent) had prior experience working in an active conflict zone and their deployment to Gaza ranged from two-12 weeks, contributing to a total of 322 weeks of frontline clinical care.

Overall, 23,726 trauma related injuries and 6,960 injuries related to weapons were reported. The most common traumas were burns (4,348, 18 per cent), leg injuries (4,258, 18 per cent) and arm injuries (3,534, 15 per cent).

There were 742 obstetric cases reported, of which more than a third (36 per cent) involved the death of the fetus, mother or both. Psychological trauma was also reported, with depression, acute stress reactions, and suicidal ideation being most common.

Some 70 per cent of healthcare workers reported managing injuries across two or more anatomical regions and experiences of mass casualties were widespread, with 77 per cent reporting exposure to five-10 events and 18 per cent managing more than 10 such scenarios. 

Explosive injuries accounted for the majority of weapon related trauma (4,635, 67 per cent), predominantly affecting the head (1,289, 28 per cent) whereas firearm injuries targeted the legs (526, 23 per cent).

The most common general medical conditions reported were malnutrition and dehydration, followed by sepsis and gastroenteritis. Healthcare workers also reported 4,188 people with chronic disease requiring long term treatment.

In free text responses, healthcare workers frequently described injuries as unusually severe, including multi-limb trauma, open skull fractures and extensive injuries to internal organs. Severe burns were also emphasised, particularly in children.

Caveats and conclusions

Despite the strength of this data, Omar El-Taji and colleagues acknowledge that relying on logbooks and shift records inevitably introduces uncertainty, especially during periods of large influxes of injured people. The authors admit they cannot rule out the possibility of duplication, although further analyses indicated minimal impact on overall estimates.

However, they say the volume, distribution, and severity of injuries seem to indicate patterns of harm that exceed those reported in previous modern-day conflicts. 

‘These findings highlight the urgent need for resilient, context specific surveillance systems, designed to function amid sustained hostilities, resource scarcity, and intermittent telecommunications, to inform tailored surgical, medical, psychological, and rehabilitation interventions,’ Omar El-Taji and colleagues conclude.

To access the full version of the article – titledPatterns of war related trauma in Gaza during armed conflict: survey study of international healthcare workers doi: 10.1136/bmj-2025-087524 – see: https://www.bmj.com/content/390/bmj-2025-087524

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