Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 25:390:e087524.
doi: 10.1136/bmj-2025-087524.

Patterns of war related trauma in Gaza during armed conflict: survey study of international healthcare workers

Omar El-Taji  1 , Ameer Ali  2 , Osaid Alser  3 , Abdullah Ghali  4 , Ahmad Jomaa  5 , Muhammad Junaid Sultan  6 , Bilal Irfan  7   8   9   10 , Anisa Jafar  11 , Mohammed Qandil  12   13 , Ana Jeelani  14 , Ammar Darwish  15 , Ahmed Mokhallalati  16   17 , Morgan McMonagle  18 , Victoria Rose  19 , Nizam Mamode  20 , Suheal Khan  21 , Nick Maynard  22 , David Nott  15   18 , Ang Swee Chai  23 ; International Medical Responders for Gaza collaborators
Collaborators, Affiliations

Patterns of war related trauma in Gaza during armed conflict: survey study of international healthcare workers

Omar El-Taji et al. BMJ. .

Erratum in

Abstract

Objective: To systematically document the patterns of war related injuries in Gaza, Palestine.

Design: Survey study of international healthcare workers, August 2024 to February 2025.

Setting: Gaza, Palestine.

Participants: 78 international healthcare workers deployed to Gaza.

Main outcome measures: The main outcome was the type of injuries observed by international healthcare workers during the conflict in Gaza. A Delphi informed survey was distributed through non-governmental organisation rosters and secure WhatsApp and email groups. Respondents completed the survey using contemporaneous logbooks and shift records.

Results: The survey collected data on 12 anatomical regions, mechanisms of trauma, and general medical conditions. 78 healthcare workers reported 23 726 trauma related injuries and 6960 injuries related to weapons. The most common traumatic injuries were burns (n=4348, 18.3%), lower limb injuries (n=4258, 17.9%), and upper limb injuries (n=3534, 14.9%). Explosive injuries accounted for most of the weapon related trauma (n=4635, 66.6%), predominantly affecting the head (n=1289, 27.8%), whereas firearm injuries disproportionately affected the lower limbs (n=526, 22.6%). Healthcare workers reported 4188 people with chronic disease across 11 domains requiring long term treatment.

Conclusion: Healthcare workers deployed to Gaza reported an injury phenotype defined by extensive polytrauma (≥2 anatomical regions), complex blast injuries from high yield explosives, firearm related injuries to upper and lower limbs, and severe disruption to primary care and the treatment of chronic diseases. The results provide actionable insights to tailor humanitarian response and highlight the urgent need for structured, resilient clinical surveillance systems.

Editor's note: This paper is based on research from an active war zone, where conventional research methods may be impossible to apply.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; OA cofounded OxPal 2.0, an initiative supporting medical education in Palestine in partnership with consultants from the University of Oxford, Oxford, UK and other medical schools in the UK and USA. MQ is head of Emergency Medicine at Nasser Medical Complex, Gaza. AD is medical director of the David Nott Foundation, a British non-governmental organisation (NGO). DN is cofounder of the David Nott Foundation, a British NGO. AM previously served as head of Plastic and Reconstructive Surgery at Al Shifaa Hospital, Gaza. SK is founder and director of Mobile International Surgical Teams Foundation, a UK NGO. NMay is chairman of Medical Aid for Palestinians. ASC is an honorary patron of Medical Aid for Palestinians, a British NGO. OET, AG, MJS, AJe, AD, MM, VR, NMam, SK, NMay, DN, and ASC have volunteered on multiple medical missions worldwide, including in Gaza, with various NGOs. All authors declare no other competing interests.

Figures

Fig 1
Fig 1
Body atlas of trauma injuries in Gaza, including distribution of trauma injuries across anatomical regions. Absolute counts are presented, and represented by circle sizes, using area based calculations. The top three injury subtypes per body region are presented. Burns are further subdivided by severity: first degree burns involve only the epidermis (superficial), second degree burns involve the epidermis and a portion of the dermis (partial thickness), third degree burns involve the entire epidermis and dermis (full thickness), and fourth degree burns are full thickness, extending into underlying muscle, tendon, ligament, or bone
Fig 2
Fig 2
Mechanisms of trauma by anatomical region. Total injury counts and distribution between firearm and explosive injuries are presented. The injury counts are also represented by circle sizes, using area based calculations
Fig 3
Fig 3
Distribution of mass casualties reported by healthcare workers deployed to Gaza. Mass casualties defined as ≥10 patients with trauma presenting simultaneously
See this image and copyright information in PMC

References

    1. World Health Organization. Recommendations by the Director-General for improving health conditions in the occupied Palestinian territory, including East Jerusalem (WHA77/12). Geneva: WHO. 2024. Accessed 26 Jul 2025. https://apps.who.int/gb/ebwha/pdf_files/WHA77/A77_12-en.pdf
    1. United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA). Reported impact snapshot. Gaza Strip (17 Sep 2025). 2025. Accessed 23 Sep 2025. https://www.ochaopt.org/content/reported-impact-snapshot-gaza-strip-17-s...
    1. Khatib R, McKee M, Yusuf S. Counting the dead in Gaza: difficult but essential. Lancet 2024;404:237-8. 10.1016/S0140-6736(24)01169-3. - DOI - PubMed
    1. Jamaluddine Z, Abukmail H, Aly S, Campbell OMR, Checchi F. Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture-recapture analysis. Lancet 2025;405:469-77. 10.1016/S0140-6736(24)02678-3. - DOI - PubMed
    1. Chevalley K, Zimmerman J, Mittendorf A, et al. Civilian pattern of injuries in armed conflicts - a systematic review. Scand J Trauma Resusc Emerg Med 2024;32:125. 10.1186/s13049-024-01299-7. - DOI - PMC - PubMed