{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:11:20Z","timestamp":1776078680166,"version":"3.50.1"},"reference-count":17,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:00:00Z","timestamp":1775952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The concept of \u201cHealthocide,\u201d first defined by Abi-Rached and colleagues, describes the deliberate and systematic destruction of health systems as a weapon of war. Nowhere is this phenomenon more extensively documented than in Gaza, where the collapse of healthcare infrastructure since October 2023 has been rapid, wide-ranging, and intentionally sustained. The consequence is not only immediate excess mortality, but also profound, long-term loss of population health measured in life-years, a metric that captures both premature death and reductions in expected lifespan. To address the aftermath of such destruction, we propose the framework of \u201cHealthogenesis,\u201d defined as a Palestinian-led, equity-driven, and rights-anchored approach to health system reconstruction in which international actors serve as enablers rather than agenda-setters. The aim of Healthogenesis is not merely to restore pre-war capacity, but to build a resilient, sovereign, and future-proof health ecosystem. Using available demographic and mortality data, we estimate that more than three million life-years have already been lost in Gaza since October 2023. Projection models suggest that an additional 1.1 to 2.2 million life-years could be lost over the coming decade unless an organized programme of reconstruction begins immediately. Quantifying harm in life-years reframes the discourse from moral outrage to measurable obligation. If Healthocide names the crime, then Healthogenesis outlines the cure: a coherent, data-anchored, ethically grounded roadmap for rebuilding a devastated health system and protecting the health futures of an entire population.<\/jats:p>","DOI":"10.3390\/ijerph23040484","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T10:19:14Z","timestamp":1776075554000},"page":"484","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Over Two Million Life-Years at Risk: Why Gaza\u2019s Health Reconstruction Is a Moral Imperative"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4548-8308","authenticated-orcid":false,"given":"Alessandro","family":"Vitale","sequence":"first","affiliation":[{"name":"Chirugia Generale 2, Department of Surgical, Oncological, and Gastroenterological Sciences, Padua University, 35128 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3162-4639","authenticated-orcid":false,"given":"Mohammad","family":"Abu Hilal","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton SO16 6YD, UK"},{"name":"Department of Surgery, School of Medicine, The University of Jordan, Amman 11942, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2310-0245","authenticated-orcid":false,"given":"Umberto","family":"Cillo","sequence":"additional","affiliation":[{"name":"Chirugia Generale 2, Department of Surgical, Oncological, and Gastroenterological Sciences, Padua University, 35128 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7616-4226","authenticated-orcid":false,"given":"Isabella","family":"Frigerio","sequence":"additional","affiliation":[{"name":"Unit of Hepatobiliary and Pancreatic Surgery, Pederzoli Hospital, 37019 Peschiera del Garda, Italy"},{"name":"Collegium Medicum, SAN University, 90-113 \u0141\u00f3d\u017a, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew A.","family":"Gumbs","sequence":"additional","affiliation":[{"name":"Minimally Invasive Digestive Surgery, Hospital Antoine Becl\u00e8re, Assistance Publique\u2013H\u00f4pitaux de Paris, 92140 Clamart, France"},{"name":"Department of General, Visceral, Vascular and Transplantation Surgery, University of Magdeburg, Haus 60a, Leipziger Str. 44, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e018656","DOI":"10.1136\/bmjgh-2024-018656","article-title":"Healthocide and medical neutrality: A call for action and reflection","volume":"10","author":"Sharara","year":"2025","journal-title":"BMJ Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"r2120","DOI":"10.1136\/bmj.r2120","article-title":"Where genocide, healthocide, and atrocities start, medical neutrality ends","volume":"391","author":"Abbasi","year":"2025","journal-title":"BMJ"},{"key":"ref_3","unstructured":"World Health Organization (WHO) (2026, February 01). Public Health Situation Analysis (PHSA) [Internet]. Available online: https:\/\/cdn.who.int\/media\/docs\/default-source\/documents\/emergencies\/who-phsa-opt-100925.pdf?sfvrsn=367c45e4_1."},{"key":"ref_4","unstructured":"World Health Organization (WHO) (2026, February 01). Gaza\u2019s Many Injured Will Need Rehabilitation Care and Support for Years to Come, WHO Report [Internet]. 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