The devastating impact of 15 months of war on Gaza

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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.

Smoke plumes rising from explosions above destroyed buildings in the northern Gaza Strip seen from Southern Israel, 14 January
Smoke plumes rise from targeted buildings in the northern Gaza Strip on 14 January this year. Photograph: Jack Guez/AFP/Getty Images

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.

Palestinians carry a body pulled from the rubble as civil defence teams conduct search and rescue operations in the rubble of the Deir al-Balah Municipality Building after an Israeli army attack
Palestinians carry a body pulled from the rubble as civil defence teams conduct search and rescue operations in the rubble of the Deir al-Balah Municipality Building after an Israeli strike. Photograph: Ali Jadallah/Anadolu/Getty Images

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.

Graphs

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.

Palestinians walk through the destruction left by the Israeli air and ground offensive on Khan Younis, 12 September
Palestinians walk through the destruction left by the Israeli air and ground offensive on Khan Younis on 12 September 2024. Photograph: Abdel Kareem Hana/AP

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.

Flood water surrounds buildings that have been heavily damaged in Israeli strikes
Streets are flooded due to the infrastructure damage caused by intense Israeli attacks at Nuseirat camp in Gaza City on 29 November 2024. Photograph: Ali Jadallah/Anadolu/Getty Images

‘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.

An image of a camp taken from above, showing temporary shelters
A camp for displaced Palestinians in Deir Al-Balah on 15 December 2024. Photograph: Ramadan Abed/Reuters

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.

Displaced Palestinians sit on a cart as they prepare to leave Khan Younis
Displaced Palestinians leave an area in east Khan Younis to head towards the west after the Israeli army issued a new evacuation order for parts of the city on 22 July 2024. Photograph: Bashar Taleb/AFP/Getty Images

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.

A Palestinian woman stands in a heavily damaged building
A Palestinian woman carrying a child checks the damage at the al-Zahra school used as a refuge by displaced Palestinians after it was hit by an Israeli strike in the Shujaiya neighbourhood of Gaza City on 8 August 2024. Photograph: Omar al-Qataa/AFP/Getty Images

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.

An aerial image of people taken in the dark after an Israeli strike
Palestinians looking at the damaged caused by an Israeli airstrike at a Unrwa-run school being used to shelter displaced people in Khan Younis son 15 December 2024. Photograph: Haitham Imad/EPA

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.

Destruction in the area surrounding Gaza’s Al-Shifa hospital after the Israeli military withdrew from the complex housing the hospital on April 1 2024.
Destruction in the area surrounding Gaza’s al-Shifa hospital after the Israeli military withdrew from the complex housing the hospital on 1 April 2024. Photograph: AFP/Getty Images

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.

Palestinians reach out to receive food with their empty containers as charitable organisations operating in the region distribute hot meals to Palestinians in Khan Younis on 9 January 2025.
Palestinians wait to be given food by charitable organisations distributing hot meals to Palestinians in Khan Younis on 9 January this year. Photograph: Abed Rahim Khatib/Anadolu/Getty Images

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.

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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.

A damaged animal farm after the Israeli attack on Al-Maghazi refugee camp
A damaged animal farm after the Israeli attack on al-Maghazi refugee camp. Photograph: Abed Rahim Khatib/Anadolu/Getty Images

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.

Satellite imagery from January 22 2024 shows the damage to the Sheikh Zayed reservoir, located in northern Gaza, 150 meters south of the Indonesian hospital.
Satellite imagery from 22 January 2024 shows the damage to the Sheikh Zayed reservoir, located in northern Gaza, 150 metres south of the Indonesian hospital. Photograph: Image © 2024 Planet Labs PBC. Courtesy of Human Rights Watch

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)

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