I returned to Gaza City last week, arriving at what remains of Al-Shifa Hospital at dusk. The once-premier medical facility now stands partially demolished, with medical students in faded white coats moving between makeshift wards set up in the still-functioning eastern wing.
“We’re not doctors yet, but Gaza can’t wait for our graduation,” said Nour Abdelrahman, 23, a fifth-year medical student at the Islamic University of Gaza. She hasn’t attended formal classes in nearly a year. Instead, Abdelrahman works 16-hour shifts alongside the handful of senior physicians still alive and functioning in the territory.
The devastating 13-month Israeli military campaign has transformed Gaza’s medical education system into a desperate field training operation. According to the Palestinian Ministry of Health, over 130 doctors have been killed since November 2023, creating a catastrophic personnel shortage in a health system already collapsing under bombardment and siege.
“I was supposed to be studying pediatric rotations right now,” Abdelrahman told me as she changed wound dressings on a 7-year-old boy with shrapnel injuries. “Instead, I’m essentially working as a resident without the degree. None of us had a choice.”
The World Health Organization confirms only 13 of Gaza’s 36 hospitals remain even partially operational. The territory’s only medical school at the Islamic University has been damaged in airstrikes, with clinical training now conducted entirely through emergency response work.
Dr. Mahmoud al-Haddad, one of the few surviving senior surgeons at Al-Shifa, oversees a team including 38 medical students. “These young people have become our lifeline,” he explained during a brief break between surgeries. “They’re performing procedures third-year residents would normally handle. It’s not ideal, but the alternative is patients dying without care.”
The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) estimates Gaza now has fewer than one doctor per 10,000 residents in functioning facilities – among the worst physician-patient ratios recorded in any conflict zone this century. This catastrophic shortage has thrust approximately 280 medical students into critical care roles.
Yesterday morning, I observed Khalil Bakr, a sixth-year student, assist in an emergency amputation using only local anesthetic due to critical supply shortages. “I never imagined performing surgery before graduating,” Bakr said afterward, visibly exhausted. “We’re learning trauma medicine at a pace no curriculum could prepare us for.”
Gaza’s medical students now operate in an educational vacuum. Clinical instruction happens during real emergencies, with senior doctors providing seconds of guidance between critical interventions. The traditional medical education pathway has been replaced by necessity-driven apprenticeship.
“Sometimes I dream about ordinary things – taking exams, studying late at night in the library,” said Fatima al-Najjar, a fourth-year student working at a field hospital in Deir al-Balah. “Then I wake up to the sound of drones and remember our reality.”
Médecins Sans Frontières (MSF) medical coordinator Dr. Elena MartÃnez, who recently completed an assessment mission to central Gaza, described the situation as “medical education through baptism by fire.” She told me: “These students are acquiring skills through trauma medicine that usually take years of specialized training. Their psychological burden is immense – they’re becoming doctors while losing their own families.”
Indeed, the emotional toll is staggering. At a small clinic converted from a former school in Khan Younis, I met Rami Salman, 24, who lost both parents and three siblings when their apartment building was hit in December. He continues treating patients while processing his own grief.
“I considered stopping, especially after my family was killed,” Salman said, organizing limited medication supplies between consultations. “But Gaza needs every person with medical knowledge right now. My professors taught us medicine is a sacred responsibility. I can’t abandon that, even without them here.”
The psychological impacts extend beyond the immediate crisis. Experts from the International Committee of the Red Cross warn about long-term consequences for these medical students, who are developing professional identities entirely within catastrophic conditions.
“These young clinicians are forming their medical practice in an environment of extreme resource limitations and moral injury,” explained Dr. Sarah Bartels, a ICRC mental health specialist who has worked with healthcare providers in multiple conflict zones. “They’re making impossible triage decisions daily that seasoned physicians would find traumatic.”
Despite these challenges, the students’ resilience is remarkable. They’ve developed innovations born of desperation – creating manual ventilation systems when electricity fails, repurposing everyday items for medical use, and establishing decentralized supply chains through neighborhood networks.
Outside the shattered nursing college that now serves as a pediatric ward, Abdelrahman showed me a notebook where she meticulously documents procedures and lessons learned. “We’re still students at heart,” she said. “We’re creating our own curriculum from this catastrophe, hoping someday to rebuild Gaza’s medical system with what we’ve learned.”
International medical educators have recognized this crisis as unprecedented. The World Federation for Medical Education has called for emergency credentialing and support programs for Gaza’s medical students, acknowledging their extraordinary circumstances.
As night fell over Gaza City, the students prepared for another shift change. Those arriving carried small backpacks containing precious personal medical supplies – stethoscopes saved from bombed homes, tattered textbooks, protein bars to sustain them through the night.
“In five years, if I survive, I’ll be a different kind of doctor than I imagined,” Bakr told me before heading inside. “We’ve learned medicine cannot be separated from politics, war, or human rights. When we rebuild our medical school, these lessons must be part of what we teach the next generation.”
In the darkness, with only generator power illuminating their work, Gaza’s medical students continue their dual journey – becoming doctors while trying to save what remains of their homeland’s healthcare system, creating a unique model of medical education forged entirely in catastrophe.
