Hybrid warfare is a complex conflict paradigm blending conventional, irregular, cyber, and political tactics to inflict harm on an opponent.Reference Tin, Granholm and Helou ¹ Hybrid warfare mainly aims to undermine the enemy by exploiting vulnerabilities across multiple domains, frequently operating below the threshold of overt armed combat to perpetuate plausible deniability.Reference Tin, Granholm and Helou ¹

The conflict in Gaza exemplifies a unique form of modern hybrid warfare, characterized by the use of military operations to systematically dismantle the health care system and inflict harm.Reference Kunichoff, Mills and Asi ² Although attacks on health have been described in other conflicts, the scale and impact have been exceptionally severe in Gaza due to its unique status as an occupied territory under siege. These conditions have hindered the replenishment of medical supplies and precluded any rebuilding efforts while simultaneously restricting civilian mobility and limiting access to refuge or medical care beyond Gaza’s borders.Reference Mann, Aburass, Leibowitz and Shalev ³

Israeli bombing of health care facilities has been a prominent feature of the current conflict.Reference Kunichoff, Mills and Asi ² Geospatial data revealed that 83% of Gaza’s hospitals had at least one M-84 bomb crater within 800 meters, while 25% were within the “lethal” 360-meter range, leading to 34 out of 36 hospitals being partially or fully damaged by May 30, 2025.Reference Kunichoff, Mills and Asi ² In addition, Israeli military sieges have been systematically implemented against hospitals in Gaza, using disproportionate force against non-military facilities, blocking medical evacuations, preventing patient movement in and out of the hospital, destroying medical equipment, and denying entry of essential resources.Reference Mann, Aburass, Leibowitz and Shalev ³ Finally, the targeting and detention of health care workers has eliminated key expertise within the system, with reports from the Office of the United Nations High Commissioner for Human Rights (OHCHR) and the World Health Organization (WHO) confirming that 1,581 health care workers have been killed and over 400 detained as of 2025. ^{4 , 5}

Beyond the direct trauma-related morbidity and mortality of the war, which has resulted in an estimated 75,200 violent deaths, there has been a significant rise in indirect deaths (i.e., mortalities related to the indirect effects of the war).Reference Spagat, Pedersen and Shikaki ⁶ These indirect deaths are thought to be a result of a lack of access to proper medical care, increased infection rates, and increasing rates of malnutrition.Reference Ashour, Abu-Jlambo and Abuzerr ^{7 ,} Reference Abu Dalal, Irfan and Elmanama ⁸ Altogether, the systematic dismantlement of Gaza’s health care system amidst conditions that have amplified health care needs has led to a drastic drop in life expectancy from 75.5 years pre-war to an estimated 40.5 years post-war, a decrease of approximately 46.3%.Reference Khatib, McKee and Yusuf ⁹ Moreover, recent estimates extrapolating from a Lancet study on excess deaths suggest that the overall death toll may be up to 186,000 deaths by June 2024, translating to 7.9% of the total population in the Gaza strip.Reference Khatib, McKee and Yusuf ⁹

Urgent and decisive action is required to confront this new form of hybrid warfare that violates the principle of medical neutrality necessary for impartial and humane care during conflict.Reference Abi-Rached, Sharara, Nasrallah and Abiad ¹⁰ Thus, it is imperative that the global medical community unequivocally condemns the deliberate targeting of health care facilities, personnel, and the systematic deprivation of access to care as a war strategy.Reference Abi-Rached, Sharara, Nasrallah and Abiad ¹⁰