As hopes of a cease-fire between warring Israeli and Hamas forces flicker, a new WHO report estimates that some 42,000 Gazans face life-changing injuries that will require years of sustained support in rehabilitation of injured people, as well as of the enclave’s shattered health services and critical water and sanitation infrastructure – not to mention transport and housing – most of which has now been razed to the ground.  

This, along with the legacy of a Palestinian death toll that has now surpassed 66,000 on on the second anniversary of the war, which began on 7 October 2023, when Hamas gunmen overran two dozen Israeli communities near the Gaza border, 1200 people, mostly civilians, in just one day – unleashing a fury of Israeli weaponry against the tiny Gaza enclave.

And while the initial trauma of 7 October fell on Israel, it is Gaza’s Palestinians that have sustained, by far, the brunt of the war’s bloody toll in the long weeks and months since.  Yet, however disproportionate the burden may be, both sides will ultimately have to face the dark side of their own respective narratives around the conflict if any kind of cease fire – and hopefully more durable peace plan – is to advance, some Israeli and Palestinian commentators have observed. 

$10 billion to rebuild shattered health system 

Gazans with serious, long-term rehabilitation needs represent about one-quarter of the 167 376 people injured since the war began, according to the new WHO report.  Over 5000 people have faced amputation. Other severe injuries, include damage to limbs (over  22 000); spinal cord (over 2000); brain (over 1300), and major burns (more than 3300). 

Among the seriously ill and wounded, some 15,600 Gazans, including 3800 children, are still awaiting medical evacuation, said WHO Director Tedros Adhanom Ghebreyesus, speaking at a WHO press conference last Thursday focusing on Gaza at the two-year anniversary milestone.  That’s double the number of patients (7841) that have been evacuated since the war began.

“I call for the frequency of evacuations to increase,” said Tedros. “I call on more countries to open their arms to these patients,” he said.

WHO has previously estimated that some $3 billion would be needed over just the next 18 months to rebuild Gaza’s shattered health system. Costs could be as high as $10 billion over the next several years. 

“Of course, rehabilitation services are also essential for people with noncommunicable diseases and disability,” Tedros added in his remarks.  “But just when they are needed most, attacks, insecurity and displacement have put them out of reach. The explosions that cause these injuries also destroy the health facilities and services needed to deal with them.”

Over the past two years, WHO has recorded 1719 attacks on health facilities, ambulances or health workers in Gaza and the West Bank, resulting in more than 1000 deaths and 1800 injuries.

Only 14 of Gaza’s 36 hospitals remain partially functional, while less than one-third of pre-conflict rehabilitation services are operating, with several facing imminent closure, said Tedros at the press briefing.  While Israel has repeatedly cited the presence of Hamas gunmen inside, around, and in tunnels under, health facilities, as justification for the miliary attacks, the narrative has become ever more muddy over the past year. In incidents such as the April shooting deaths of a busload of medics, Israel had to walk back its original account. In July, there was the deliberate destruction of a major WHO medical supplies warehouse by a series of drones. 

The 9 September Israeli evacuation order to over a million residents of Gaza City and its neighborhoods, requring them to move south to the Al Mawasi humanitarian zone, has now placed one more field hospital, two ambulance centres, 12 urban hospitals, and 23 primary health care centers, within conflict zones, according to WHO.  

Gaza City alone hosts 46% of all hospitals and field hospitals across the entire Strip, accounting for 36% of inpatient beds and nearly 50% of intensive care unit (ICU) beds. Meanwhile,  54% of essential medicines were at zero stock (as of August 2025), according to WHO, citing Gazan health officials. The most affected services include open-heart and orthopedic surgery where nearly 100% of medicines were out of stock, as well as chemotherapy and blood diseases (72%), primary healthcare (60%), and accines (58%). 

Famine, unsanitary living conditions 

Add to that continuing hunger and malnutrition, despite recent spikes in humanitarian aid deliveries, displacement of 90% of the population in unsanitary living conditions, and severe ongoing stress.   

Only on Saturday, two more children were reported to have died due to starvation and malnutrition. As of 11 September, a total of 349 deaths from malnutrition, including 92 children, had been confirmed by WHO since the start of the war, while the Gaza Ministry of health put today’s toll at 459 people, including 154 children.

“Displacement, malnutrition, disease, and the lack of assistive products mean that the true rehabilitation burden in Gaza is far greater than the figures presented here,” said Dr Richard Peeperkorn, WHO Representative in the occupied Palestinian territory in a press release, noting that the rehabilitation needs of people living with noncommunicable diseases were not considered in the findings.   

“Conflict-related injuries also carry a profound mental health toll, as survivors struggle with trauma, loss, and daily survival while psychosocial services remain scarce. Mental health and psychosocial support must be integrated and scaled up alongside rehabilitation,” Peeperkorn added. 

Since mid-September, the massive Israeli assault on Gaza City has added to the misery. So far, some 750,000 Gaza City residents have fled, leading to further crowding, as well as water shortages, in Gaza’s central and southern “humanitarian zones.”  Those remaining, meanwhile, lack access to food sources, as well as hospital services. 

 “The spread of infectious diseases also persists, driven by overcrowding, poor water and sanitation conditions, and malnutrition-related weakened immunity,” noted WHO in a mid-September bulletin. Since May 2025, a total of 1106 suspected meningitis cases have been reported, along with  110 suspected Guillain-Barre Syndrome (GBS) cases and a total of 11 TB cases. Last year, a massive WHO-led polio vaccination campaign conducted amidst humanitarian pauses in fighting managed to head off a major outbreak of the paralytic virus.

Israelis focused on hostages and 7 October legacy 

Meanwhile, within Israel, the 7 October legacy of random death, sexual violence and Israeli displacement, as well as the fate of the 50 hostages still remaining in Gaza among the initial 240 men, women and children who were taken away on that fateful day, continues to haunt Israelis – and define their outlook on the war.  

In the immediate aftermath of the Hamas 7 October bloodbath, between 200,000 and 250,000 Israelis near Gaza and along Israel’s northern border were displaced by the war. Around 10,000 remain displaced today. 

Beginning on the morning of 7 October, along with the Hamas onslaught into Israeli communities by land, the militant group also launched dozens of missiles into central Israel, while Hizbullah attacked with missile fire from the north. Between October, 2023 and June 2024 Hamas launched some 12,000 missiles and Hizbullah 8,000 into Israel, up until the November 2024, cease fire agreement with Hizbullah brought a reprieve to northern communities. At that point Hamas capacity to fire had also been degraded to almost nil by the massive Israeli ground invasion.  In July, a major report by a team of independent Israeli legal experts documented over a dozen cases of sexual violence during the 7 October Hamas invasion, including young festival goers fleeing Hamas paragliders and jeeps that overran the Nova music event near the Gaza border. 

Israeli Legal and Gender Advocates Call on UN to Hold Hamas Accountable for Sexual Violence on 7 October

That followed a report by a UN fact-finding mission last year that found “reasonable grounds” to believe that multiple incidents of sexual violence occured during the 7 October Hamas onslaught.  There was also “clear and convincing” that hostages held by Hamas in Gaza were subjected to sexual violence, said Pramilla Patten, UN Special Representative of the Secretary General on Sexual Violence and Conflict in a subsequent press release. 

Some 100,000 people demonstrated in Tel Aviv Saturday night in support for the US-brokered cease-fire proposal, with a lineup of former hostages, both tearful and angry, expressing hope that the grudging agreement by Israel and Hamas to the broad outlines of the plan might lead to the release of the final 50 captives, only 20 of whom are believed to still be alive.   

Outside of Israel, however, most of the 7 October events and their immediate aftermath have long been forgotten.

Big anti-Israeli demonstrations abroad have underlined the Jewish state’s growing social and political isolation due to the war, not to mention recent political and economic sanctions and the ongoing proceedings of South Africa’s genocide case against Israel in the International Court of Justice in The Hague.  In a preliminary ruling in January 2024, the ICJ found it “plausible” that Israel had committed acts that violate the Genocide convention. Israel, in turn, has called South Africa’s case “wholly unfounded”.

Public anti-Israel protests reached another crescendo only last week following the Israeli navy’s interception of the Freedom Flotilla to Gaza in the Mediterranean Sea, carrying around 470 international activists, including Swedish climate campaigner Greta Thunberg and French member of parliament Rima Hassan. Most were quickly deported. 

In Jewish communities abroad the demonstrations have stoked growing fear – dovetailing with a steep increase in anti-semitic attacks, including, most recently, last week’s car ramming and stabbing attack by Syrian refugee, Jihad al Shamie, of people leaving a synagogue in Manchester, England over the sacred Yom Kippur Jewish holiday, which left two dead.

Confronting a dark narrative

Ultimately, Israelis, as well as Palestinians, will have to confront the dark sides of their respective narratives to move forward, noted the prominent Israeli journalist Nir Hasson, in a probing commentary on the eve of the 7 October anniversary date, that explored why large parts of the Israeli public had turned their backs on Gaza.

“For Israelis, the sun that rose on October 7 has not yet set. That day continues, and with it, the revenge. The fact that we have since killed nearly 20,000 children changes nothing,” Hasson wrote, describing a series of videos of g children wounded in recent Gaza City bombardments, which were published simultaneous with Israeli Prime Minister Benjamin Netanyahu’s speech to the UN General Assembly on Friday, 26 September. 

“Netanyahu and his failed government are responsible for the two greatest disasters in Israel’s history: the massacre of October 7 and the Israeli response to the massacre of October 7. In the first disaster, about 1,200 people were murdered and killed, women and children were abducted, horrific crimes against humanity were perpetrated. 

“In the second disaster, we killed tens of thousands of civilians, caused the death of captives, inflicted destruction on a whole district, initiated mass starvation and committed countless war crimes and crimes against humanity,” Hasson wrote, adding, “As the truth continues to come to light, and the public internalizes the horror in all its grimness, more and more Israelis will seek to distance themselves from the crimes…. Already today many are refusing to take part in them…

“But these are only the margins of the disaster… The real catastrophe is the actual death of tens of thousands of people – buried under the rubble, shot by soldiers while waiting for food, or dying slowly of hunger in hospitals. The many lives that were cut off, the masses of people who have been maimed, the refugees whose body wanders by day and whose sleep wanders by night. The vast suffering that comes with the mourning, the wounds, the trauma. And the whole cities that have been erased and turned into heaps of ruins and dust.

Palestinian urges public to probe Hamas crimes alongside those of Israel

On the Palestinian side, Ahmed Fouad Al Khatib, a Gazan who has lost at least 20 family members in the war, has also urged Palestinians too look at their side in the conflict, and probe the crimes of Hamas against its own people – alongside those of Israel. 

“Hamas actually wants a famine in Gaza,” wrote Al Khatib, a senior fellow at the Atlantic Council, in The Atlantic in July, shortly before a formal declaration of famine was issued by the UN-backed food security assessment group, IPC. “Hamas has benefited from Israel’s decision to use food as a lever against the terror group, because the catastrophic conditions for civilians have generated an international outcry, which is worsening Israel’s global standing.”

Speaking to CNN over the weekend, Al Khatib said, “I want Israel’s bombardment of Gaza to end and for the suffering of Palestinians to stop. The concern is whether the initial phase of the agreement to stop the war and release the Israeli hostages and Palestinian prisoners can evolve into a durable peace, with Hamas still around… 

I want Israel’s bombardment of Gaza to end and for the suffering of Palestinians to stop. The concern is whether the initial phase of the agreement to stop the war and release the Israeli hostages and Palestinian prisoners can evolve into a durable peace, with Hamas still around. pic.twitter.com/QewUZcPrmL

— Ahmed Fouad Alkhatib (@afalkhatib) October 6, 2025

“The fear that I have is that Hamas will rein but not rule, a scenario in which it does not disarm, and has influence on who gets to be a part of a transitional phase, that is concerning to me and many Palestinians in Gaza… effectively continuing to hold two million Palestinians as hostages to an armed resistance narrative that has only resulted in war, death, destruction and loss of life.”

He called for the entry of an international stabilization force as the first step of any deal, noting that without that:  ”We could be looking at the spread of militias and a very low intensity civil war, in which Hamas, the clans, this new government, if it ever has any executive force, are vying for control… we could be looking at a scenario where Hamas creates basically areas for themselves and their supporters…they might be willing to give up some of their so-called offensive weapons, but they want to keep small arms and small munitions that actually would allow them to suppress local dissent and to control the population,” he said.

Hamas is getting ready to use the reprieve from the ceasefire to commit atrocities against Gaza’s clans, opposition, activists & has prepared lists for executions/torture. It’s a mistake not to include the entry of an international stabilization force as the first step of a deal. pic.twitter.com/Yf0lqG7cWO

— Ahmed Fouad Alkhatib (@afalkhatib) October 6, 2025

High stakes brinkmanship

As the high-stakes brinkmanship over the details of a plan continues, it’s clear that neither the Hamas leadership or the hard-right Israeli government is really happy.  If, a cease-fire could ultimately remove Hamas from power in Gaza, in Israel it could lead to the eventual collapse of Netanyahu’s hard line government – and even his defeat in the next round of elections, scheduled for 2026.  While Israeli Prime Minister has put on a brave face, it’s clear his agreement came against considerable US pressure – following the misbegotten Israeli attack on Hamas officials in Qatar in September.

In a Truth Social post Sunday night, US President Donald Trump urged the parties, which returned to Cairo for negotiations on Monday, to “MOVE FAST… “TIME IS OF THE ESSENCE OR, MASSIVE BLOODSHED WILL FOLLOW — SOMETHING THAT NOBODY WANTS TO SEE.”

According to the new map, on the  day after the ceasefire (if it takes effect) the IDF, which now controls about 80% of the 365 square kilometer enclave, will still control about 55% of the Gaza Strip. Israeli forces will continue to hold the perimeter, the Philadelphi Corridor, Rafah, and most of Khan Younis and the northern buffer zone.  

In a second phase of withdrawal, Israel would pull back to 40% of Gaza, and in a third phase, 15% to an interim “security buffer zone.” 

The feasibility of the plan remains full of question marks, including how directly the United States would really try to control Gaza through an interim governance arrangement, and how long would that arrangement really last? When would a transition to full Palestinian control take place, and would that include the internationally-recognized Palestinian Authority, which does not formally get a role in Gaza under the Trump plan right now. 

Even so, both the European Union as well as major Middle East leaders have welcomed the plan as a starting point for ending the bloodshed, disease and hunger of a shattered people – even if the joint statement issued by Qatar, Jordan, the UAE, Indonesia, Pakistan, Türkiye, Saudi Arabia, and Egypt, stressed the plan should lead to a “two state solution under which Gaza is fully integrated with the West Bank in a Palestinian state.”  

And that chorus of support includes WHO.  As Tedros said in his statement last Thursday: “Two years of conflict have brought nothing but death, destruction, disease and despair. The most courageous choose peace, so I call on all parties to this conflict to choose peace, now.”

Image Credits: WHO/EMRO , MSF, WHO , Truth Social , @susanabulhawa/X, m.saed.gaza/Haaretz.