Five points that show the Gaza genocide hasn't stopped
It's just been recalibrated, says Médecins Sans Frontières
By Ozan Agbas, Médecins Sans Frontières (MSF) Emergency Manager for Palestine
Nine months since the so-called Gaza ceasefire and Palestinians are still pulling children from under the rubble; families are still burying their dead; and the space in which 2 million people are expected to survive has shrunk to less than a third of the size it was three years ago. This is not a ceasefire: it’s the same structural violence under a different name.
It is a continuation of the genocide that is calibrated to be violent enough to keep the Palestinians suffering daily, yet silent enough to avoid triggering international outrage. This is a ceasefire that still kills, confines and denies aid. It doesn’t dismantle the mechanisms of violence, but normalises the continued disregard for Palestinian lives.
Amid this uncertainty and ongoing violence, our Palestinian colleagues have continued to run field hospitals, treat injured patients, provide mental health support, distribute water and provide general healthcare to people in Gaza. This is what they’ve observed.
1. The killing continues
According to Gaza’s Ministry of Health, at least 1,185 Palestinians have been killed and 3,816 injured since the so-called ceasefire was announced on 10 October 2025. This is roughly one Palestinian killed or injured every hour and 20 minutes: for nine months straight. As of 19 June, over 265 children have been killed according to UNICEF. Israeli forces continue to carry out daily strikes across Gaza, while expanding their area of control everyday.
For MSF staff in Gaza, the line between treating patients and becoming one is terrifyingly thin.
On 16 July, an Israeli strike near an MSF clinic in Al-Mawasi sent four injured people to our teams. The following day, two apartment buildings housing our staff in Gaza City were struck without warning, trapping families inside as explosions shattered windows. In one building, rubble and bodies crashed into the lower-floor apartment of an MSF staff member.
The same day, MSF teams in Deir al-Balah, central Gaza, treated 12 people, seven of whom were children, who were injured after Israeli forces struck a funeral in Al-Nuseirat. In total, this strike killed eight people and injured 20. Among those killed was an MSF staff member’s 21-year-old son. Our colleague got the news while working in another emergency room.
These were not isolated incidents, they’re merely a snapshot of 48 hours in Gaza.
2. Confinement of Palestinians has become another weapon
The yellow line, negotiated as part of the ceasefire under the guise of safety, has instead become another mechanism of Israeli forces’ control and violence.
The yellow line is moving. It is neither clearly marked nor fixed, shifting westward whenever Israeli forces decide it should – without negotiation or warning.
Just last week, one mother told our teams that her 14-year-old son, who has Downs syndrome, was shot by Israeli snipers near the yellow line while he was playing near his home. The boy, who was treated by MSF staff, miraculously survived.
When the so-called ceasefire was announced, Israeli forces controlled roughly half of Gaza. Today, almost two million Palestinians are confined to approximately 30 per cent of the Strip.
Around 90 per cent of people have been forcibly displaced, many multiple times, and most are living in overcrowded tents or makeshift shelters. Scabies, respiratory infections, rat bites and other diseases are rife.
When strikes are not enough to force people out, overcrowding, disease and deprivation are left to do the rest: a slower method of making the remaining third of Gaza unliveable for the people trapped inside it.
3. Homes continue to be destroyed, and people are forced to flee
East of the Israeli-controlled yellow line, homes and entire neighbourhoods continue to be levelled. West of it, in the shrinking areas where Palestinians are confined, Israeli strikes continue to hit tents, shelters and the few buildings still standing.
By the time the ceasefire was signed, around 60 per cent of Gaza’s population had already been made homeless, with roughly 77 per cent of housing units damaged – most of those destroyed outright.
Today, almost a million Gazans live in tents or makeshift shelters, according to the Norwegian Refugee Council, most without reliable access to clean water, electricity, healthcare or necessities. Yet Israeli forces continue to destroy what little shelter remains and issue so-called evacuation orders that force people to flee again.
Like everyone else in Gaza, our colleagues are often given only moments to leave when these displacement orders are announced. They abandon what few belongings they possess, with nowhere safe to go. Even on nights without orders, uncertainty remains. Families go to sleep not knowing whether they will wake to another displacement order or at all.
The sudden and arbitrary orders for people to flee their homes and shelters continue to be used as a tool of psychological warfare by Israeli forces. Repeated displacement and lack of security is not a consequence of the military campaign. It has become one of its defining features, ensuring that Gazans never feel safe regardless of a ceasefire.
4. Aid has become another tool for military gain
As an occupying power, the Israeli state has an obligation under international law to ensure Palestinians in Gaza have access to aid, regardless of political negotiations, military agreements or conduct of hostilities.
Instead, aid continues to be used as an instrument of oppression. Supplies continue to be delayed by shifting restrictions at crossings and aid is folded into ceasefire negotiations as though they are political concessions.
In Gaza, medical supplies are rapidly depleting and some MSF projects are expected to run out of key items, including medicines for cardiovascular diseases, diabetes and chronic respiratory conditions. Israeli authorities are enforcing inadequate transport conditions for cold-chain medicine, prohibiting fridge trucks which are necessary to prevent delicate items like insulin or vaccines from spoiling.
Engine oil is also running critically low, which is essential to keep generators and vehicles running. Without it, hospitals, water systems and transport come to a halt, putting lives at risk, including babies in incubators who rely on generators to keep them alive. Our teams have been unable to directly bring in any supplies in Gaza since 1 January this year.
Rather than fulfilling its obligations as the occupying power, Israel has instead deregistered international humanitarian organisations, including MSF, forcing international staff to leave Palestine and blocking medical cargo from reaching people in need. In their place new proposals have emerged to confine Palestinians to tightly controlled camps, where access to shelter and aid would be contingent on being inside militarised enclosures supervised by Israeli-approved forces.
5. Psychological wounds continue to be inflicted
Across Gaza, MSF teams continue to see overwhelming levels of grief, anxiety, sleep disturbance and psychological distress in both adults and children. Rather than easing, these symptoms continue to accumulate under ongoing airstrikes, displacement and deteriorating conditions. Some patients, including mothers, tell our teams they are experiencing suicidal thoughts.
Humanitarian partners operating a toll-free hotline report a 14 per cent increase in remote counselling sessions between March and April 2026, reaching more than 9,600 sessions last month.
For Palestinians, a ceasefire would mean conditions for people to grieve, begin rebuilding their lives and recover from the violence they have endured. This has not happened in Gaza.
Iman Abu Shawish, an MSF mental health supervisor in Gaza, says repeated displacement orders are having a profound psychological impact, provoking high-stress reactions in the body, “for example muscular and abdominal pain, shaking, and fatigue”.
“It affects children [too], the way they play, their emotions, and we see cases of children building tents as a game. The games recreate evacuations; those are their flashbacks revealed through their only form of expression.”
“So even if their current living conditions are bad, living in tents, barely making ends meet, evacuation means restarting from zero. Humans crave stability, but evacuation means chaos, change, loss. For Gazans, that is the cruel reality for more than 21 months now.”
The protection of civilians does not begin when a ceasefire is signed. Civilians must be protected and aid facilitated during active hostilities as well. Nine months into this so-called ceasefire, the wounds of war are still being inflicted.