Introduction
Medical education programs rely on stable institutions, protected learning environments, and dependable access to training sites. However, in recent years, armed conflicts have increasingly targeted education and health infrastructure, undermining these prerequisites and medical education in itself.Reference Brennan, Martinez and Rubenstein 1 This report from the field examines how educators, clinicians, and partner institutions in Gaza and Ukraine have developed transnational collaborations to mitigate disruptions to medical education in conflict settings. The focus is on operational responses implemented during these active conflicts rather than a comprehensive review of published literature.
Narrative
Gaza: The Collapse of Medical Education Infrastructure and a Coordinated Education Continuity Response
As of December 2025, the war in Gaza has resulted in the deaths of an estimated 70,000 Palestinians, as well as over 170,000 injuries and 1.9 million people displaced. 2 , 3 Attacks by the Israeli Defense Forces (IDF) have destroyed or severely damaged more than 80% of buildings in the Gaza Strip, including nearly all hospitals and its only 2 medical schools, Al-Azhar University and Islamic University. The destruction of such infrastructure disrupted the training of approximately 3,000 medical students, including more than 1,700 students in their clinical years. 2 , Reference Albhaisi 4
While a ceasefire has fragilely persisted since October 2025, Gaza continues to lack the infrastructure needed to support basic necessities, let alone medical education. 2 In response, educators and clinicians have partnered with academic leaders inside and outside Gaza to develop mechanisms allowing for the continuity of medical education.
Gaza Educate Medics (GEM) initiative, led by PalMed Academy in collaboration with the deans of Gaza’s 2 medical schools and other partners, developed a model to support 2,101 students in continuing their medical education. It uses a custom-built platform developed as a donation from a South African company. The platform provides access to necessary learning materials for students from both medical schools, as they have different curricula and requirements. Over 760 international faculty volunteers deliver interactive online lectures, and 1,004 volunteers contribute to various committees, including student mentorship and assessment. Formally launched in June 2025, GEM supports 80.9% of medical students who remain in Gaza, as reported on PalMed Academy’s website, and coordinates with organizations to support those displaced. Most recently, PalMed Academy expanded its focus to include dental and nursing training, fields both crucial but often neglected. 5
Complementing GEM, the Union of Gazan Medical Students Initiative (UGMSI) is a non-political, non-profit organization founded by Gazan medical students that serves as a coordinator and central point of contact for displaced medical students. UGMSI links students with international organizations and emerging opportunities, helping them continue their education outside of Gaza. UGMSI has also maintained close coordination with the deans of Gaza’s 2 medical schools, sustaining student connection to an academic community despite the destruction of physical institutions. This role became particularly important for displaced students attempting to navigate placement options while maintaining alignment with curricular requirements and credentialing pathways. 6
Additional supporters of displaced medical students are international partners. The Gaza Health Initiative (GHI), in collaboration with the National Arab American Medical Association (NAAMA), has secured clinical placements for displaced students in neighboring countries. 7 , 8 Furthermore, universities across several countries have offered placements and resources to displaced students, including 37 placements in South Africa, 18 in Turkey, 10 in Norway, and over 100 in Pakistan. 5 , 9
Ukraine: Hybrid Instruction, Cross-Border Campuses, and Clinical Partnerships
In Ukraine, Russia’s invasion starting in February 2022 similarly disrupted medical education through attacks on education and health infrastructure, the displacement of learners and educators, and power and internet outages.Reference Koshak, Smiyan and Bilukha 10 Since 2022, at least 1,554 health care facilities and at least 100 higher education sites have been damaged or destroyed.Reference Andrienko, Goriunov and Grudova 11 These disruptions have threatened medical training models, which depend on supervised clinical instruction in teaching hospitals.
In response, Kyiv Medical University (KMU) implemented adaptations to maintain education for displaced trainees and those remaining in Ukraine. A central component was the relocation and expansion of portions of KMU’s operations to Poland. The Poland-based campus in the Katowice region provided a safer learning environment for approximately 4,000 students and residents and created 900 work placements, supporting faculty retention and reducing the disruption of KMU’s academic capacity. 12 The campus has maintained instruction in Ukrainian and issues Ukrainian diplomas. In addition to sustaining training, these measures help preserve students’ connection to Ukraine, which may be critical for post-war recovery. 13
To preserve clinical learning, KMU partnered with dozens of Polish health care facilities, enabling students to complete supervised clinical training while gaining exposure to European health systems. 14 For those remaining in Ukraine, the university implemented a flexible hybrid model capable of responding to changing security conditions; it shifts didactic content online during elevated risk periods while maintaining in-person practical skills sessions when feasible. To mitigate the impact of predictable disruptions, KMU invested in its physical and digital infrastructure by investing in bomb shelters, diesel generators, and Starlink terminals. These efforts were complemented by an expanded e-library, digital textbooks, and virtual simulations to supplement skills development when physical clinical exposure was limited. 13
Beyond sustaining medical curricula, KMU has used transnational collaborations to support its humanitarian mission. These partnerships have facilitated the creation of expert-led training centers in Ukraine and Poland focused on tactical, disaster, and prehospital medicine. 15 These centers equip health care professionals with critical emergency response skills, ensuring the preparedness of Ukraine’s healthcare system amid active conflict.
Across Gaza and Ukraine, sustaining medical training was an academic necessity that came with operational challenges; it required reliable communication, instruction in accessible formats, sustained mentorship and assessment processes, and supervised clinical alternatives when routine training sites were unavailable. Transnational partnerships served as continuity infrastructure, allowing training to proceed despite attacks on medical institutions and broader health and education infrastructure.
Discussion
The field examples from the Gaza and Ukraine wars demonstrate implementable ways to sustain medical education when it is attacked. In both settings, educators and clinicians resisted waiting for ideal conditions to return; they instead developed workable systems that preserved core functions of training under active conflict. These responses demonstrate that even when campuses and clinical sites are destroyed, educational systems can partially be reconstituted through coordinated networks that maintain communication with students and deliver instruction, mentorship, and assessments in accessible formats. To meet these operational challenges, transnational partnerships have functioned as emergency infrastructure for medical education.
Differences in mobility largely explain the distinct approaches taken to sustain medical education for Ukrainian and Gazan students. In Ukraine, access to cross-border movement to neighboring European countries, particularly Poland, has enabled students to relocate and continue in-person training. The creation of jobs for Ukrainian physicians and educators has further allowed students to train under Ukrainian faculty abroad. 12 , 13 Movement out of Gaza, by contrast, is highly restricted due to the blockade and border controls imposed by Israel and Egypt, limiting students’ ability to leave the territory. 2 , 3 Displacement is almost entirely internal, confined to a territory where hospitals and medical schools have been destroyed. 3 , Reference Albhaisi 4 As a result, the most viable option for medical education in Gaza has been remote and asynchronous learning, which lacks in-person clinical training.
While transnational collaborations preserve curriculum delivery, they cannot entirely replace the clinical environments and institutional protections needed for medical training. In Gaza, remote learning enables the continuation of education, but it cannot provide a substitute for essential clinical exposure, which remains unfeasible due to the destruction of hospitals and other sites. Similarly, externally displaced trainees often face uneven pathways determined by the varying capacity and administrative flexibility of host systems. Even in Ukraine, where cross-border partnerships have successfully preserved educational progression, these models remain vulnerable to local infrastructure failures and security threats faced by students remaining in-country. Transnational support serves as an important mitigator, but it ultimately cannot eliminate the fundamental need for stable, local clinical resources.
Together, these cases suggest that preserving medical training during conflict requires both adaptive educational mechanisms and broader structural protections for medical institutions. While high counts of student participation in these emergency interventions have been documented, future research should evaluate their impacts. Specifically, studies should assess clinical competency attainment and the quality of supervision and patient exposure in substitute placements. Equally crucial, future studies should investigate the retention and career trajectories of students trained in these impromptu models to determine how well these temporary measures protect against the permanent disruption of medical careers. Such evaluations will be essential to determining the true scope (and true limits) of current medical education adaptations in conflict zones.
Conclusion
In Gaza and Ukraine, attacks on education and health infrastructure disrupted medical training by destroying institutions, displacing trainees and educators, and disrupting electricity and connectivity. Transnational collaborations—including but not limited to GEM and UGMSI in Gaza and KMU’s dual-campus, hybrid approach in Ukraine—provide imperfect but practical models for sustaining curriculum delivery, preserving mentorship and assessment functions, and protecting clinical competency amid conflict.
Acknowledgments
The authors received no financial support for the research, authorship, or publication of this manuscript.
Author contribution
Rouba Ali-Fehmi: Conceptual guidance and design oversight; supervision and mentorship; critical revision of the manuscript.
Quentin Eichbaum: Conceptualization; project coordination; manuscript editing.
Neil Nakkash: Drafted the abstract, introduction, discussion, and conclusion sections; revised the Gaza and Ukraine narrative sections; manuscript editing.
Ziad Fehmi: Drafted and revised the Gaza and Ukraine narrative sections; manuscript editing.
Ryan Jaroudi: Drafted and revised the Gaza narrative section; manuscript editing.
Judy Effendi: Drafted and revised the Gaza narrative section; manuscript editing.
Mahmoud Loubani: Drafted and revised the Gaza narrative section; manuscript editing.
Oleksandr Pokanevych: Drafted and revised the Ukraine narrative section; manuscript editing.
Competing interests
None.
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