{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:34:53Z","timestamp":1790922893594,"version":"4.1.0"},"reference-count":194,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp;amp; Management"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Gaza's health system has been devastated by a confluence of political determinants that long predated the 2023\u201325 Israeli military assault and were dramatically intensified during it. Using historical, political economy, ethical, and health systems lenses, this article argues that settler colonialism, military occupation, and a protracted blockade created chronic shortages, workforce erosion, and institutional fragility, leaving services acutely vulnerable to targeted destruction of facilities and personnel. We examine the role and limitations of international medical deployments and field hospitals, which provided lifesaving care but operated under stringent access controls, supply interdictions, and security risks. Short rotations, poor continuity of care, and donor restrictions that discourage engagement with local authorities contributed to parallel systems, fragmentation, and dependency. We then identify four intersecting barriers to reconstruction: ongoing blockade and humanitarian access denials; lack of protection and accountability for attacks on health; governance fragmentation and the sidelining of Palestinian leadership; and donor fatigue amid politicised aid. The article proposes a justice\u2010centred pathway for recovery that prioritises accountability and reparations, an end to the blockade and occupation, inclusive Palestinian\u2010led governance, alignment of aid with national plans, avoidance of parallel structures through early transition to local ownership, workforce stabilisation, and long\u2010term partnerships. Without these political preconditions, reconstruction efforts will remain fragile and inequitable.<\/jats:p>","DOI":"10.1002\/hpm.70025","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T04:13:48Z","timestamp":1758600828000},"page":"259-275","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Political Determination of Gaza's Health System Destruction and Reconstruction and the Limitations of International Medical Deployments"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5822-7528","authenticated-orcid":false,"given":"Bilal","family":"Irfan","sequence":"first","affiliation":[{"name":"Center for Bioethics Harvard Medical School  Boston Massachusetts USA"},{"name":"Center for Surgery and Public Health Brigham &amp; Women's Hospital  Boston Massachusetts USA"},{"name":"Department of Neurology University of Michigan Medical School  Ann Arbor Michigan USA"},{"name":"Department of Epidemiology University of Michigan School of Public Health  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Omeish","sequence":"additional","affiliation":[{"name":"Harvard College  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulwhhab Abu","family":"Alamrain","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Al\u2010Quds University  Jerusalem Palestine"},{"name":"Al\u2010Aqsa Martyrs Hospital  Deir Al\u2010Balah Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9186-4039","authenticated-orcid":false,"given":"Belal","family":"Aldabbour","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza City Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arham","family":"Ali","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Department of Pediatrics Loma Linda University Children's Hospital  Loma Linda California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yassar","family":"Arain","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Texas Christian University School of Medicine  Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abeerah","family":"Muhammad","sequence":"additional","affiliation":[{"name":"Baylor Scott &amp; White Health  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khansa","family":"Irfan","sequence":"additional","affiliation":[{"name":"University of Central Lancashire  Preston UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Fawaz","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousef","family":"Barakat","sequence":"additional","affiliation":[{"name":"Intensive Care Unit Al\u2010Shifa Hospital  Gaza City Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruba","family":"Musallam","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza City Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osaama","family":"Khan","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Fikry","sequence":"additional","affiliation":[{"name":"Lahey Hospital and Medical Center  Burlington Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Hamza","family":"Shah","sequence":"additional","affiliation":[{"name":"School of Medicine Queen's University Belfast  Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Halimy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza City Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izzeddin","family":"Lulu","sequence":"additional","affiliation":[{"name":"Al\u2010Shifa Hospital  Gaza City Palestine"},{"name":"Al\u2010Ahli Arab Hospital  Gaza City Palestine"},{"name":"Islamic University of Gaza  Gaza City Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer","family":"Alkurd","sequence":"additional","affiliation":[{"name":"Department of Surgery Indonesian Hospital  North Gaza Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadeel","family":"Obeid","sequence":"additional","affiliation":[{"name":"Department of Nursing Indonesian Hospital  North Gaza Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Sirvent","sequence":"additional","affiliation":[{"name":"Center for Bioethics Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Global Health and Social Medicine Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Smith","sequence":"additional","affiliation":[{"name":"Centre for Humanitarianism and Social Inclusion University College London  London UK"},{"name":"Medact  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(24)01648\u20109"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/heq.2024.0027"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2024.117332"},{"key":"e_1_2_11_5_1","unstructured":"Genocide in Gaza.University Network for Human Rights. 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