“We see injuries rarely observed in recent history”

The scope of the attacks on the civilian population perpetrated by Israel in Gaza will take time to know each other exactly, but, meanwhile, the scientific and sanitary community is trying to document it. Beyond the provisional figure of more 60,000 dead Palestinians and 143,000 injured, a team of researchers has tried to describe what the panorama faced by the toilets in the hospitals, under the harassment of the bombs and in the midst of a genocide.

The result is published this Friday in the magazine The BMJ and is based on the testimony of 78 international doctors and nurses who were in Gaza between August 2024 and February 2025. The scientists passed a survey to describe the nature and pattern of the medical injuries and conditions they faced. The panorama they reflect, dominated by explosive and firearms injuries, is not precedent in previous conflicts, according to the authors.

In free text responses, the toilets often described unusually serious injuries, including multiextremities trauma, exposed cranial fractures and extensive lesions in internal organs. It also emphasized serious burns, especially in children. Respondents with previous experience of deployment in other conflict areas commented that the severity and pattern of the injuries found in Gaza were greater than those previously handled.

The numbers of the massacre

The report reports 23,726 injuries related to traumas and 6,960 lesions related to weapons. The most common traumas were burns (4,348, 18%), leg injuries (4,258, 18%) and injuries in arms (3,534, 15%). About 70% of the toilets said they had attended injuries in two or more anatomical regions and the experiences of mass victims were generalized: 77% reported having been exposed to between 5 and 10 events and 18% having managed more than 10 scenarios of that type.

Explosion lesions represented most of the trauma related to weapons (4,635, 67%), which predominantly affected the head (1,289, 28%), while the lesions due to firearms mainly affected the legs (526, 23%).

The most common general medical conditions reported were malnutrition and dehydration, followed by sepsis and gastroenteritis. 742 obstetric cases were also reported, of which more than a third (36%) implied the death of the fetus, the mother or both. The report includes 4,188 cases of people with chronic diseases that required long -term treatment and psychological traumas, with depression, acute stress reactions and suicidal ideation such as the most common.

“Israeli forces have repeatedly used explosive weapons in densely populated areas, including refugee camps, which provokes serious concerns under the Geneva Convention and International Humanitarian Law, including the principle of distinction and the obligation to protect civilians,” the authors write. “The images from the satellite indicate that two thirds of Gaza's structures are damaged or destroyed; in this context, the concentration of explosive and incendiary heavy ammunition in the narrow urban corridors have driven patterns of injuries rarely observed in recent history.”

For the authors, these results provide critical information to adapt the humanitarian response if at any time the Israel block is raised. “These findings highlight the urgent need to have resilient and specific surveillance systems for each context, designed to function in sustained hostilities, shortage of intermittent resources and telecommunications, to base surgical, medical, psychological and personalized rehabilitation interventions,” they emphasize.

Lethal ammunition against civilians

Salvador PeiróEpidemiologist and researcher at Fisabio, believes that the study has exceptional value, although it seems to him that the survey method used probably infrastim the number of cases. However, the data “show an unprecedented scenario in which high energy ammunition has been used and with an area effect (thermobaric pumps, incendiary, dispersion projectiles) in densely populated urban environments,” he declared to SMC. “Tens of thousands of people with trauma and wounds, burns that cross bone and muscle, children with open skull fractures or with the destroyed extremities, etc. are not the expected data of a 'conventional' conflict and, not even, in recent conflicts (Iraq, Afghanistan, Syria) that seemed especially cruel,” he says.

Rafael Castro-DelgadoAssociate Professor of Emergency Medicine at the University of Oviedo, emphasizes that the study describes severe injury patterns, with a direct comparison by professionals experienced in other conflicts. “Therefore, it provides evidence to plan the humanitarian and health response, including surgery, intensive care, mental health and rehabilitation,” he says. “And it is noteworthy that he documes other health problems beyond war wounds, such as malnutrition, sepsis, chronic diseases and psychological trauma, offering an integral vision of the health crisis.”

The report refers fundamentally to surviving wounds. It is necessary to detail the consequences of infections, malnutrition, sick with chronic and vulnerable diseases

Isabel Portillo
— Secretary of the Board of Directors of the Spanish Society of Epidemiology

Isabel PortilloSecretary of the Board of Directors of the Spanish Society of Epidemiology, emphasizes that it is a quality study, made with a lot of scientific rigor and methodology. “In addition, it is not a conventional war since both wounds and characteristics fundamentally affect civilians, which is very different from what is found in other conflicts,” he explains to the SMC. On the other hand, it believes that it is important to note that the report refers fundamentally to survivors wounds. “It is necessary to detail the consequences of infections, malnutrition, sick with chronic and vulnerable diseases,” he says. “It is already estimated that they can add more than 680,000 deaths, as announced by the UN Rapporteur over the Palestinian territories, Francesca Albanese.”