Gaza: Three years later, a sham ceasefire, and a “yellow line” that suffocates the population

In the past year, the physical trapping of people in Gaza has been made increasingly definitive by the establishment of Israel’s Yellow Line. Originally presented as a temporary, first-phase military withdrawal position and a key part of maintaining the so-called ceasefire – it is now reinforced by military positions, berms and ongoing demolitions and has continued to move west, squeezing people into a smaller and smaller area. Israeli forces use this line to confine the inhabitants of Gaza to less than 35% of the territory.

The Yellow Line cannot be treated simply as a line on a map.” says Amande Bazerolle, MSF head of emergency response in Gaza, Palestine. 

"It has become a mechanism of encirclement and ethnic cleansing, while cutting communities off from the infrastructure, healthcare, water and other essentials they need to survive.” 

As the "yellow line" is deliberately shifted, the danger also shifts for people living in its immediate vicinity. Since its route is neither clearly nor consistently marked, those who approach it risk being targeted by Israeli forces. MSF teams continue to treat people with gunshot wounds sustained nearby. Its encroachment is also disrupting the delivery of essential assistance: MSF water trucking has had to stop when shooting occurs near communities living close to the Yellow Line.  

Burns, explosions and gunshot wounds: 1200 trauma cases treated in two months

Nor is violence confined to the areas around the Yellow Line. In June and July alone, despite a so-called ceasefire, MSF teams treated more than 1,200* cases of violent trauma across Gaza, including blast injuries, burns, gunshot wounds and injuries resulting from physical assault. Since October 2023, our teams have treated more than 200,000 trauma cases*, including injuries resulting from intentional physical violence, while Israel’s military offensive has killed more than 74,000 people, including more than 20,000 children. 

As Israel confines Palestinians into increasingly limited areas, families are being pushed into overcrowded and unlivable conditions, without sufficient access to clean water, sanitation, shelter or healthcare. These conditions are contributing to the spread of disease. MSF teams have treated more than 11,000 cases of skin diseases such as scabies this year alone, while seeing more than 1,500 cases of chickenpox in June and July. MSF distributed around 2.1 million litres of drinking water per day in August, yet the scale of need remains far beyond what can be met under these restrictions. 

 Most people have less than six litres of domestic-use water per day and limited access to basic hygiene items such as soap and detergent,” says Dr Murad Asaliyya, medical activities manager in Gaza. 

“We are treating gastroenteritis, acute respiratory infections, a lot of skin conditions, hepatitis, bacterial skin infections, scabies and lice. At the same time, we are facing severe shortages in terms of medical supplies. Even the cream we need to treat scabies has been restricted by the Israeli authorities.” 

Increasingly severe shortages of equipment and medicines

Over the past three years, access to healthcare has deteriorated dramatically, with hospitals increasingly running out of basic supplies and patients unable to access essential medicines and treatment. Restrictions on essential supplies such as engine oil and spare parts are also crippling the infrastructure needed to keep hospitals, ambulances and water systems running, with generators already breaking down and water-trucking operations reduced.  

The deliberate destruction of Gaza’s healthcare system, damage to more than 80 per cent of all structures in Gaza, alongside the lifelong physical and mental health impacts of repeated violence and displacement, will extend far beyond the present and prevent any meaningful recovery for years to come. 

Nor is this crisis limited to Gaza. Since 2023, violent settler attacks, military operations and raids on homes, displacement camps and agricultural land, illegal settlement expansion, displacement, home demolitions and movement restrictions have rapidly escalated across the West Bank and East Jerusalem, particularly this year. Patients at MSF clinics tell teams about homes being demolished by Israeli forces, attacks by settlers and livestock being stolen. The policies of violence, harassment and forced displacement affecting Palestinians extend beyond Gaza, causing further fragmentation of the occupied Palestinian territory. 

It will take generations to recover from the harm that has already been done over the past three years, and in the preceding decades, while the excruciating consequences of Israel's ongoing genocide are still being felt every day,” says  Bazerolle. 

“Destruction, displacement and deprivation have become normalised practices Israel is carrying out with impunity. Governments must act now to ensure Israel stops the destruction and killing, prevents ethnic cleansing, and stops denying Palestinians the means of survival.” 

* This refers to cases not patients, including new or follow up consultations.