The devastating impact of 15 months of war on Gaza

Israel began bombing Gaza on 7 October 2023, after Hamas crossed the border, killed about 1,200 people and took 251 others hostage to Gaza.

When ground operations began a week later, most observers inside the country and beyond expected the fighting to last weeks. Instead, it extended for 15 months

until Wednesday’s announcement of a ceasefire

, to become Israel’s longest war since the 1948 conflict that led to the country’s creation.

The majority of those killed by militants on 7 October were civilians, and the scale and ferocity of the attack was unprecedented. So was the scale and ferocity of Israel’s response.

After one

brief ceasefire and hostage release deal

in November 2023, Israeli prime minister Benjamin Netanyahu vowed to keep fighting, promising “total victory” over Hamas.

The impact of the campaign on civilians living in Gaza led to accusations of genocide, including from rights groups, scholars and foreign governments. South Africa

brought a case

to the international court of justice.

Omer Bartov, a former Israel Defense Forces (IDF) soldier and historian of genocide,

wrote

that by May 2024 “it was no longer possible to deny that Israel was engaged in systematic war crimes, crimes against humanity and genocidal actions”.

The UN Human Rights Office said

in November

that data on verified deaths indicates “an apparent indifference to the death of civilians and the impact of the means and methods of warfare”.

Even Israel’s staunchest ally, the United States,

restricted

some weapons shipments over the concerns, and in September the UK

suspended

some arms export licences over Israel’s conduct of the war.

Netanyahu and his former minister of defence Yoav Gallant have been issued with arrest warrants by the international criminal court for alleged war crimes relating to the conflict.

Hamas military leader Mohammed Deif

has also been issued with an arrest warrant.

Below is a summary of the cost of the war for Gaza and its people.

The dead and wounded in Gaza

More than 46,000 Palestinians have been killed inside Gaza by Israeli attacks, according to health officials in the territory. Most of the dead are civilians, and the total represents about 2% of Gaza’s prewar population, or one in every 50 residents.

More than 40,000 have been identified, including 13,319 child victims, the

youngest only a couple of hours old

. The elderly dead include a 101-year-old great-great-grandfather.

Another 110,000 have been wounded, over a quarter of whom now live with life-changing injuries including amputations, major burns and head injuries.

Yet these figures do not tell the full story of Palestinian losses. The official count of the war dead includes only those killed by bombs and bullets, whose bodies have been recovered and buried.

About 10,000 people killed by airstrikes are thought to be

entombed in collapsed buildings

, because of the lack of heavy equipment or fuel to dig through steel and concrete ruins looking for them.

A study published in the Lancet magazine

this month

found the official toll underestimated deaths from traumatic injuries in the first nine months of the war, failing to capture two in every five casualties. That would suggest that by October 2024 “the true mortality figures probably exceeded 70,000”, the authors noted.

Hunger, lack of shelter and medication, the rapid spread of infectious diseases and the collapse of the healthcare system have killed many other Palestinians during the war. Authorities

plan to count those dead when the fighting stops

, Dr Marwan al-Hams, the director of field hospitals at the ministry of health, has said.

Israeli officials question the death toll given by the authorities in Gaza, arguing that because Hamas controls the government there, Gaza’s health officials cannot provide reliable figures.

But doctors and civil servants in the territory have a

credible record from past wars

. After several conflicts between 2009 and 2021, United Nations investigators drew up their own lists of the dead and found they closely matched ones from Gaza.

‘Domicide’ and displacement

Israel’s campaign of intense aerial bombing and mass demolitions has levelled swathes of Gaza, and left whole neighbourhoods barely inhabitable.

Nine out of 10 homes in the territory have been destroyed or damaged, the latest UN figures

show

. Schools, hospitals, mosques and cemeteries, shops and offices have also been repeatedly hit.

The devastation is so intense that some experts say that the large-scale destruction of homes and the infrastructure of daily life should be recognised as a new war crime, “

domicide

”.

Even when homes are still standing, many residents have been forced to leave. Eighty percent of Gaza’s territory was placed under evacuation orders that were

still active

in late December.

Some 1.9 million people have been displaced,

90% of the population

, with many of them forced to move repeatedly.

Hundreds of thousands now are living in tent cities and severely overcrowded shelters with poor sanitation and access to little clean water. Shelters have also been attacked.

For rebuilding to start Gaza will need a staggering clean-up operation. The war has left over 40m tonnes of debris, in collapsed buildings that may be laced with explosives including boobytraps and unexploded bombs. It could take over a decade to remove, a top UN de-mining official warned

in spring

.

The Israeli military says that its fight is against

Hamas and not Gaza

, that its bombardment is

proportional

to threats and that it makes

every effort to warn citizens of imminent attacks.

Schools and education

Almost every school building in Gaza has been damaged or destroyed, and none are in operation. Gaza’s 660,000 school-age children have not had any access to formal education for over a year.

The war will set education back there by up to five years, and risks creating a lost generation of permanently traumatised youth,

a study

by Cambridge academics and the UN found.

There were 564 school buildings in Gaza on 7 October 2023. Of these, 534 have been damaged or destroyed and 12 are classified as “possible damage”. The status of the remaining 18 schools is “currently not known”, Unicef said in an

October report.

Schools run by the Unrwa agency for Palestinian schools have been converted into emergency shelters. They host large numbers of displaced people and are clearly marked on maps, but many have been bombed, with some

targeted multiple times

.

Israel says strikes targeted

Hamas

fighters, claiming they shelter in the buildings and use civilian residents as human shields.

Hospitals and healthcare

Israeli forces repeatedly bombed, besieged and attacked hospitals in Gaza throughout the war. Medics were killed, injured, detained and tortured.

There were 654 attacks on health facilities

recorded

since the start of the war, the World Health Organization (WHO) said in January 2025.

Over 1,050 healthcare workers, including nurses, paramedics, doctors, and other medical personnel, many in their place of work. Dozens of others were detained, and at least three

died in Israeli custody

.

At the end of 2024, just 17 of Gaza’s 36 hospitals were even partially functional. Services were boosted by 11 field hospitals, but Israeli controls on the entry of aid and relief workers meant these were

often short of doctors and medical supplies

.

A UN commission concluded that Israel’s “relentless and deliberate attacks on medical personnel and facilities” constituted war crimes.

They amounted to “a concerted policy to destroy Gaza’s healthcare system as part of a broader assault on Gaza”, the UN Independent International Commission of Inquiry on the Occupied Palestinian Territory

found

.

The lack of hospitals, healthcare staff and medication compounded the suffering of people injured in the war, and suffering from diseases caused or compounded by lack of shelter, food and clean water.

In 2024, more than 1.2 million respiratory infections were recorded, along with 570,000 cases of acute diarrhoea,

UN figures showed.

Hunger and aid shortages

Israeli controls on aid entering Gaza, and the destruction of agricultural production inside the territory, led to widespread hunger and malnutrition.

In November 2024, the UN said aid and commercial shipments into Gaza were at the

lowest levels

since October 2023, and an international watchdog said famine

was likely “imminent”

in the northern Gaza Strip.

In January the UN

said

over 96% of children under two years old and women in Gaza were not getting their required nutrients, 345,000 people faced catastrophic food shortages, and 876,000 faced emergency levels of food insecurity.

Malnutrition in pregnancy and childhood stunts mental and physical development, so many children who survived the war will endure lifelong impacts from food shortages.

Israel said it did not limit aid shipments and blamed logistics failures at aid agencies, or Hamas theft of food aid, for any shortages.

Environment

At least half Gaza’s tree cover

has been razed

, soil and water have been contaminated and there is huge damage to agricultural land. The destruction will have long-term impacts on ecosystems, biodiversity, food security and the health of residents, ecologists and academics say.

Some damage has come directly from Israeli attacks on farms and other infrastructure.

By March this year, approximately 40% of the land in Gaza previously used for food production

had been destroyed

, an investigation by Forensic Architecture found. Satellite analysis

revealed to the Guardian

shows farms devastated and nearly half of the territory’s trees razed.

The Israeli military damaged or destroyed least 31 of 54 water reservoirs by late August, Human Rights Watch

found

. Toxic residue from munitions and fires have polluted both soil and water supplies.

Other forms of damage have been indirect. When Israel cut off fuel, electricity and chemical supplies within the first week of the war, all wastewater treatment and most sewage pumping plants were forced to shut down, leading to sewage overflows into the sea and groundwater.

Amid widespread aid shortages Gaza’s hungry and freezing residents have also burned toxic plastics and cut down trees to use the wood for fuel and cooking.

The war in numbers

Palestinians killed in Gaza:

46,707

Children confirmed killed in Gaza:

13,319

Palestinians reported buried under rubble in Gaza:

11,000

Palestinians injured in Gaza:

110,265

Palestinians displaced in Gaza:

1.9 million

(90% of the population)

Attacks on healthcare facilities during the war:

654

Health workers killed:

1,060

Schools damaged or destroyed:

534

(95% of schools)

Children out of formal education:

660,000

(all school-age children)

Homes damaged or destroyed:

436,000

(92% of total)

People killed inside Israel on 7 October 2023: about

1,200

People abducted to Gaza from Israel on 7 October 2023:

251

Hostages still in Gaza in January 2025:

101

(37 believed dead)