Are Standard Surge Capacity Guidelines Feasible for all contexts? The Case of the Gaza Health System Struggling to Survive in Conditions of Siege and Armed Conflict

 In emergencies and disasters, the expansion of a health service beyond its routine clinical care capacity can be defined as surge capacity. This study aims to provide a comprehensive description of the surge capacity (material, staff, structural, spatial and systems) of the health system in Gaza under siege and the concept of 'siege surge capacity.

 In this study, a document review was conducted based on news and reports published on the institutional websites of OCHA Occupied Palestinian Territory and the World Health Organization between 7 October and 7 December 2023.

 Between 7 October and 07 December, 42 WHO and 138 OCHA news items or reports on Gaza were published. In particular, the study found that: (1) humanitarian supplies and personnel were prevented from entering and leaving Gaza; (2) limited medical evacuation from Gaza, acute fuel shortages and shortages of medicines and medical supplies affected health facilities and ambulances; (3) northern Gaza was evacuated at gunpoint; (4) lack of WaSH facilities in health facilities and shelters led to infectious diseases and outbreaks; and (5) lack of routine surveillance systems affected public health problems and surge capacity.

 Our findings show that the health system in Gaza has collapsed. Furthermore, the concept of surge capacity, which promotes preparedness for emergencies and disasters, was found to be inadequate. Therefore, it is recommended that the concept of siege surge capacity should be studied in a multidimensional way in order to protect the surviving health system.