Gaza: the grim reality of genocide – David Keys’s comprehensive analysis of the cost of inhumanity

Journalist goes into depth on the terrible consequences of Israel’s crimes on the people of Gaza, even if the genocide stopped today

This article is an updated version of one first published in North-East Bylines, with the permission and assistance of the author.

At least a quarter of a million Gazans are likely to face debilitating lifelong physical, mental or cognitive impairment as a result of Israel’s continuing war against Gaza.

More than a thousand Gazans were injured and at least 130 killed in a single day of Israel’s genocidal war on Gaza last week. The other days were little to no better. Many others have been slaughtered as they queue for food – while others have starved to death, especially children. Many thousands are now in ‘stage 5’ starvation, likely to die even if they received food from today unless they receive specialised medical treatment and management.

Eight factors, rarely seen in such total combination in other war zones, are likely to make the long-term impact on Gazan health particularly severe:

• Chronic malnutrition
• Very high child bereavement levels
• Constant and repeated evacuation and displacement
• Very high intensity and length of bombardment
• Extremely high levels of destruction
• Unusually high levels of civilian deaths and injuries
• Appalling levels of mental stress and trauma
• Inability to escape

Psychologists, psychiatrists and neurologists fear that it is that almost unprecedented combination of factors that is likely to generate particularly serious long-term medical and social consequences.

The details of those eight factors are horrifying:

Malnutrition: A majority of Gazan children under the age of five are now malnourished – and at least 3,000 have now entered the potentially fatal severe stage – acute malnutrition. Many others have already died.   

Child bereavement: Over 17,000 Gazan children have lost both parents as a result of Israel’s bombs and bullets – and over 23,000 have lost one parent.

Displacement: Like the population as a whole, over 90% of Gaza’s children have been displaced from their homes – and, in most cases, have then suffered multiple additional displacements – sometimes being forced to move up to 20 times. So far, over the past 20 months, Israel has issued more than 122 so-called ‘evacuation orders’, forcing Gazans to leave their homes or temporary shelters. Most such orders have each displaced tens of thousands of people, with the biggest one forcing up to a million to quit their homes. Since Israel broke the Gaza ceasefire on 19 March this year, the rate of evacuation-order-generated displacements has massively increased – with the average area subject to such orders post-ceasefire being roughly four times the average monthly figure for September 2024 to January 2025. Since the war began most Gazans have been displaced multiple times – with some being forced to move on up to 20 occasions. 

 Bombardment: More explosives have been dropped on Gaza in the past 20 months than the combined tonnage dropped on Dresden, Hamburg and London in World War Two. So far, over 100,000 tonnes of explosives have been dropped on the strip – that’s almost 50 kilos of TNT-equivalent explosive for every man, woman and child in Gaza. It is also more than six times the explosive force of the nuclear bomb dropped by the Americans on Hiroshima in 1945.

Destruction. Over 90% of people’s homes have been completely destroyed or very severely damaged (mainly by bombs – but also by Israeli bulldozers).  Around 60 square miles (some 70% of Gaza’s urban area) has been destroyed or made uninhabitable. That’s 12 times the area devastated by the Hiroshima atom bomb, 30 times the area destroyed at Nagasaki and around four times the area devastated in the World War Two firebombing of Dresden or Hamburg or even Tokyo. Israeli attacks have destroyed or rendered unusable most of Gaza’s key infrastructure – including the vast majority of its hospitals and clinics, 90% of its schools, it’s universities, over 70% of its road network, its water supply systems and it’s waste management and sanitation systems. What’s more, a majority of the territory’s agricultural land has also been destroyed or damaged.

Death and injury. Fear of death and injury has dominated daily life in Gaza for the past 20 months. An estimated 20% of Gaza’s population have been killed or injured – and the majority of the victims have been women and children. Israeli bombs, drones and snipers have slaughtered between 80,000 and 100,000 people, mostly civilians (this figure includes the number of bodies (estimated at around 14,000) still buried under rubble. Approximately 4.5% of the population have been killed (not including tens of thousands of others who have died from war-generated disease, non-availability of medical care and starvation:  That 4.5% is almost double the death rate in the firebombing of Hamburg in World War Two – and horrifyingly similar to the death toll in Dresden. So far 18,000 children have been slaughtered (including more than 1200 babies, less than one year of age). Additionally, an estimated 60,000 children have been injured or maimed. An estimated 15% of the roughly 2.1 million population (ie around or more than 300,000) has been injured or maimed. At least 30,000 of those injuries will be physically life-changing and thousands more less major injuries (especially to children) are likely to have longer-term psychological impacts. Even the doctors and nurses who tend to the injured have themselves been slaughtered. Well over a thousand medical workers have so far been killed.  

But the available physical injury data in the current Gaza war is almost certainly very incomplete – probably partly because of the Israelis’ destruction of Gaza’s medical infrastructure, but also because of under-reporting of less major injuries. Being guided by the sort of ratio one might expect in an increasingly medically under-resourced war zone like Gaza, the likely ratio would probably be something like 3 or 4 injured people for every death. If war-generated disease, starvation and medical-care-collapse-related deaths are included (along with physical trauma-generated deaths [from bombs etc] and still unrecovered bodies), the total number of Gazan deaths caused by the war almost certainly now exceeds 200,000.

Psychological stress and trauma: 20 months of often intense fear – and frequent proximity to death and horrific injuries – have almost certainly generated very high levels of traumatic stress in both adults and children. Those factors – together with the constant noise of Israeli drones and frequent explosions – have also led to sleep deprivation. Trauma and exhaustion have also impacted many parents’ abilities to reassure their equally traumatised children. And the long-term psychological impact on hundreds of thousands of adults (and future adults) is likely to create widespread current and future parenting problems and to therefore pass the impact of the ongoing war on to future generations (as evidenced by studies of past conflicts elsewhere in the world).  Constant grief and anxiety – and fear of death, injury and starvation – are further exacerbating the stress many Gazans experience. What’s more, it’s likely that chronic malnutrition (through its impact on cognition) has weakened many children’s resilience and ability to cope with high stress levels.

Inability to escape. In most conflicts, people can flee across borders or into relatively safe areas. But, for Gazans, it has been and still is virtually impossible to escape. Israeli forces completely surround the strip – as well as physically occupying substantial areas of it. What’s more, even the very few children who were allowed out for emergency medical treatment in Jordan during the ceasefire were (for political reasons) forced back into the war zone after their treatment. And, even if it could give sanctuary to Gazan civilians, the strip’s biggest neighbour, Egypt, refuses to do so for both internal political and geopolitical reasons. Even the various so-called ‘safe zones’, that Gazans have been ordered by the Israelis to evacuate to over the months, have proved not to be safe and have been attacked by the Israeli military. Gazans’ inability to flee, their de facto imprisonment in a very violent war zone – is likely to have further exacerbated psychological stress and trauma. It has also helped destroy any sense of hope and any sense of confidence in the future which will have further added to the psychological pressures.

It is the almost unprecedented combination of malnutrition, prolonged psychological stress, physical injury and the sheer length and intensity of the current conflict that is likely to produce particularly severe and widespread long-term medical, psychological and other consequences.

Out of literally hundreds of wars in many different parts of the world over the past 100 years, only a handful (mainly in Africa) have seen a combination of intense violence and widespread famine.

 However, in terms of sheer quantity of explosives deployed, the degree of destruction, attacks on hospitals, the siege conditions (and the population’s consequent inability to flee to safety) and the unparalleled rate of constant internal displacement episodes, the Gaza war is tragically without any parallel.

Nevertheless, longitudinal studies of the long-term health of survivors of  the 1967-70 Nigerian civil war (The Biafra conflict) and other wars demonstrate, in horrifying detail, the range of long-term medical and other consequences suffered by those who lived through and ‘survived’ those terrible events.

Informed by the data from Gaza itself (and by longitudinal studies of medical consequences of past conflicts elsewhere in the world) the outlook for hundreds of thousands of Gazans is bleak.

Israel’s horrific onslaught against the people of that territory, currently being assessed by the International Court of Justice as potential genocide, will indeed blight the lives of a large percentage of the Palestinian people for decades to come –  and will massively harm their hopes for societal progress and success. If genocide is not only mass murder on a grand scale, but also an industrial-scale systematic attempt to destroy a society, a culture and an entire people’s ability to survive intact, then Israel’s onslaught against Gaza (and its ethnic cleansing and land theft in the West Bank) would be a horrific exemplar of such a genocide.

So what is the future for Gaza’s population?

The Israeli government (backed by US President Trump) is planning to occupy Gaza, expel all or most of the territory’s population that is still alive – and may then establish illegal Israeli settlements on the newly occupied land (just as they have over the decades in the West Bank).

But, in medical terms, the long-term consequences of the ongoing Israeli military onslaught will fall into five main categories:

 Physical injuries:

There are more than 30,000 Gazans with major life-changing physical injuries that will require long-term medical help and rehabilitation. Those victims suffer from a range of injuries including severed limbs (including amputations), brain damage, severe spinal cord injuries and terrible burns.

 At present, in most cases, no proper rehabilitation is possible – because the Israelis have destroyed or seriously damaged most hospitals and are preventing rehabilitation and assistive equipment (prosthetic limbs, wheelchairs, crutches, etc) being supplied to Gaza. What’s more, Israeli bombs etc have killed dozens of key physiotherapists. Approximately two-thirds of the over 30,000 major injuries consist of serious damage to, or destruction of, people’s limbs, mainly their legs. And at least 3500 of those limb cases have involved amputations. There have also been at least 3000 Gazans who have suffered severe traumatic brain injuries and/or severe spinal cord damage. Another 3000 have suffered serious burn injuries.

A very large percentage of the amputees and other victims of these very serious injuries are children who will suffer lifelong disadvantage as a consequence of what the Israelis have done to them.

 Quite apart from the most serious injuries, there are well over 100,000 (probably more like 250,000 Gazans) who have suffered more minor injuries.

Most of the above physical injury data are estimates derived from the latest overall injuries data and also, in many cases, derived from the detailed analysis of similar data collected last year (WHO report and the medRxiv report}   

Mental illness: 

Well over 250,000 of Gaza’s 2.1 million people are likely to suffer from long-term psychological and psychiatric conditions as a direct result of the appalling traumatic stress that they have been subjected to by the Israelis. And, if adequate specialist medical help is not made available, the number of long-term sufferers could end up being more than double that number.

 Long-term conditions that the Israeli onslaught has sentenced many Gazans to are likely to include depression, chronic anxiety, Post Traumatic Stress Disorder and Alzheimer’s.  (reviews of evidence from other conflicts: here and here and re increased Alzheimer’s risk here.)

Some evidence from studies of survivors of other war zones suggest that very young Gazans may also be at greater risk of developing schizophrenia in their teenage years  (relationship between stress and schizophrenia here and here.

The sort of intense prolonged stress (and malnutrition) that Gazans (including young children) are suffering are precisely the experiences which very substantially increase people’s chances of developing one or more of those conditions. For a previous studies on war impacts on children’s mental health, please see here and here. 

What’s more, the constant war-zone stress and malnutrition being endured by so many parents is, in many cases, doubtless likely to undermine and erode their ability to fully and successfully comfort and reassure their children – and that inevitable parental stress phenomenon is in turn likely to further adversely affect their children’s levels of insecurity and stress and hence their vulnerability to mental health problems.

 Crucial data on the intense psychological impacts experienced in war zones have been gathered  during surveys of soldiers who served in the Iraq War and in Afghanistan. It is that data, along with longitudinal studies of the psychological impacts on civilians in other conflicts, that give some idea as to how the current war on Gaza is likely to affect Gaza’s population in the long term:  

 Neurodevelopmental conditions:

 Additionally, stress and/or malnutrition, especially among children (including pre-natal nutrient deficiencies), will almost certainly lead to very substantial numbers of neurodevelopmental disorders in the short and long term. These are likely to include learning disabilities, cognition problems, reduced IQ, sleep disorders, reduced ability to focus and concentrate and some severe communication disorders (including serious stuttering and other speech impediments). Relevant background articles include: 

Some evidence (from studies of early childhood stress) also suggests that the Israeli onslaught may generate a greater than normal incidence of autism in the upcoming generation.

Transgenerational impacts:

 Research over recent years suggests that malnutrition and stress (especially when it affects embryos and infants) may well impact not just those individuals – but also their children. It is therefore possible that this transgenerational consequence of Israel’s war on Gaza will adversely impact Palestinians not just in the current or upcoming generation, but also in the generation after that. Embryos are particularly vulnerable to malnutrition-triggered chemical modifications (so-called epigenetic marks) to their DNA and to proteins inside their reproductive cells. Those ‘marks’ have a role in transmitting genetic information from one generation to another.           .   

What’s more, the intensity of the Israel’s relentless onslaught on the people of Gaza is generating such high levels of constant traumatic stress that the psychological  consequences (PTSD, depression etc) of that horrific experience will also affect future generations, through its long-term impact on family life, aggression levels, separation frequency and parenting. Please see here.

Cardiovascular problems:

 Intense prolonged stress, such as that experienced in war zones, increases people’s vulnerability to adverse metabolic and hormonal changes, high blood pressure, heart disease, weakened arteries and stroke. 

 It is therefore likely that several hundred thousand Gazans will experience a higher than normal incidence of cardiovascular-linked problems and that many will therefore have their lives cut short.

 The Israelis stand accused of genocide, legally defined as “acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group”.

 The legal definition (as outlined in the 1948 UN Genocide Convention, ratified by 153 countries, including Israel) further defines genocidal acts as including the killing of members of the group; and/or “causing serious bodily or mental harm to members of the group” and/or, crucially, “deliberately inflicting on the group conditions of life calculated to bring about it’s physical destruction in whole or in part”.

 What Israel is doing in Gaza and, to an extent, also in the West Bank tragically fits those legal definitions totally.

 Israel’s actions to destroy the Gazan people, through slaughter, destruction of their physical and mental health and Israel’s plans to physically expel them from their land  (together with Israeli ethnic cleansing and other actions on the West Bank) are clearly designed to try to terminate the existence of the Palestinian people as an intact and functioning entity.

 Past and recent political statements by numerous Israeli politicians has made Israel’s intentions crystal clear – and the Israeli government continues to defy the International Court of Justice’s instructions to refrain from carrying out genocidal acts. 

 Everything in this article has very substantial implications for the UK and other so-called liberal-minded democratic countries.

 Firstly, western governments’ refusals to bring meaningful pressure to bear on Israel makes the western world tragically complicit in the unfolding Gaza genocide

 Secondly, by doing that, Britain and the rest of the western world is perhaps fatally undermining the international rule of law, without which global peace in the world could ultimately or even rapidly collapse. As the Gaza, Russia/Ukraine and the Israel/Iran wars demonstrate, only international law stands between international stability – and global chaos, conflict and collapse. By choosing not to put any real pressure on Israel, the UK and other countries are wittingly or unwittingly undermining the international legal system which has kept most of the world relatively safe for most of the time since the end of World War Two, a war in which around 80 million people died.

Thirdly, the West’s complete failure to properly oppose Israel’s aggression against Gaza (and its occupation of Palestinian land) undermines our ability to oppose Russia’s terrible war against Ukraine and Russia’s occupation of 20% of that country. By being blatantly inconsistent the West is shooting itself in the foot.

 Fourthly, Israel’s war against Gaza has highlighted the folly of Brexit. The UK’s economic and political departure from the rest of its continent has made it economically and geopolitically much more vulnerable to American pressure. Indeed, Britain’s total failure to exert any real pressure on Israel is at least in part because the UK government is petrified of any economic punishment that Mr Trump might decide to inflict, if Britain were to take any meaningful action against the Israeli government.

 And last but certainly not least, the UK, as the former colonial power in Gaza (and as the supplier of key military equipment used by Israel against Gaza) should certainly be morally obliged to contribute substantially to the cost of helping to fund the long-term rehabilitation of Gazans suffering from physical and mental conditions caused by Israel’s current genocidal war. 

 At present there is little prospect of peace, let alone a long lasting one.

 The Israeli government seems determined to expel Gaza’s inhabitants and to steal the land for itself and/or for a potential bizarre US/Israeli real estate scheme:    

 Irrespective of whether the people of Gaza are able to stay in their land or whether they are forced to leave, the hundreds of thousands of mentally and physically traumatised people will need medical care, much of it long-term.

 Looking at the injury statistics and estimating even the minimum mental health implications and assessing the costs of long-term medical care and rehabilitation (for spinal cord damage and brain damage victims, amputees (some with multiple amputations) and war-zone mental health sufferers, it’s quite clear that a huge amount of money (probably well in excess of £30 billion) will be required.

 And that is quite apart from the need to help provide over 2 million people with homes, schools, hospitals and clean water and sanitation infrastructure that western bombs and funding has helped destroy.

 Britain, the former colonial power in Gaza (and a country which has provided military equipment to Israel and which has refused to effectively/persuasively even try to restrain that country) will have a moral and political obligation to help, as will the European Union, the USA (Israel’s biggest arms supplier), the Arab world and Israel itself.

 But given that the western world doesn’t seem to have the courage to take tough restraining action (at least in the form of serious sanctions) against Israel, will it and the rest of the world have the moral fibre to mitigate the long-term consequences of a conflict that the world has shamefully failed to curtail.

 Or will the injustice and the genocide simply be allowed to continue?

If you would like to find out about the historical and geopolitical background to the Gaza war, please consider listening to the author of this article’s six-part Gaza podcast series, recorded early last year.

David Keys works as a journalist, based in London, writing mainly for The Independent but also contributing to a number of other media outlets.

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