How 15 months of war devastated Gaza

A ceasefire agreement aimed at ending the 15-month conflict between Israel and Hamas has been finalized in Qatar.

Israel has long said it would not agree to any ceasefire until it completes its military operations in the territory, sparked by Hamas’ shock attack in October 2023, which killed around 1,200 people and took 251 others hostage.

Gaza has suffered widespread destruction with colossal humanitarian impact. More than 46,000 Palestinians have been killed in Israeli military action, according to the Hamas-run Health Ministry, and much infrastructure in the Gaza Strip has been destroyed by airstrikes.

The Israeli military insists that its attacks on Gaza targeted Hamas fighters and that it tried to avoid or minimize civilian casualties. Hamas responded to Israeli operations with rocket attacks on Israel.

BBC Verify analyzed the extent of the damage caused by a conflict that devastated Gaza.

Health officials in Gaza say they have compiled the death toll – now at 46,788 – from deaths recorded in hospitals, as well as those reported by family members.

According to the ministry’s tally of victims identified as of October 7, 2024, 59% were women, children and the elderly, but a UN analysis from November estimates that this figure rises to 70% for women and children.

The Health Ministry also says 110,453 Palestinians have been injured in the conflict, and the World Health Organization (WHO) reported on January 3 that 25% of them suffered life-changing injuries.

Karin Huster, coordinator of Médecins Sans Frontières (MSF), told BBC Verify that Gaza’s health system faces “immense” challenges in “adequately caring for all these injured patients in the long term.”

An article in the medical journal Lancet recently suggested that the death toll could be significantly higher than the ministry’s figures.

The Health Ministry’s death toll does not distinguish between civilians and combatants, but the IDF claimed to have killed 17,000 Hamas fighters as of September 2024. It has not revealed how it established this figure.

The conflict has caused widespread and significant damage to infrastructure across Gaza. The verified image below shows a neighborhood in Jabalia before the conflict and last week.

Scholars Corey Scher of the CUNY Graduate Center and Jamon Van Den Hoek of Oregon State University examined the extent of damage in Gaza based on satellite images. In their latest analysis, dated January 11, they estimated that 59.8% of buildings in the Gaza Strip had been damaged or destroyed since the start of the war.

The map below shows the damage caused to infrastructure since the start of the war. Much of the Israeli bombardment has focused on urban areas and some infrastructure has been hit several times.

The United Nations Satellite Center (UNOSAT) calculated a higher figure: as of early December, 69% of all structures had been destroyed or damaged. The UN also concluded that 68% of the strip’s road network was damaged or destroyed.

There have been several examples of damage in and around key medical facilities. The UN says 50% of hospitals are closed, with the rest partially functional – meaning many of those still open lack the capacity to treat complex chronic illnesses and injuries.

Hamas has previously been accused by Israel of operating in and around hospitals, but international agencies like the WHO have criticized the lack of protection for health workers and medical facilities – the UN estimates around 1,060 workers medical personnel were killed.

Save the Children told BBC Verify that Gaza’s six public community mental health centers and its only inpatient psychiatric hospital are also no longer functioning – a major challenge given that the UN estimates that around a million children need mental health support.

Ms Huster told BBC Verify that many specialist medical services now lack qualified practitioners and bespoke medical equipment.

There has also been considerable destruction at educational facilities, with the Israeli military reporting it has struck school buildings 49 times since mid-July while targeting Hamas fighters.

We have verified images of these strikes at 13 sites since the beginning of December. These sites have generally ceased to function as schools, often becoming shelters, but the damage will pose a challenge to the return to normal education in Gaza.

The BBC has also documented how hundreds of water supply and sanitation facilities were damaged or destroyed after Israel launched its military action.

Rebuilding infrastructure – from homes to public facilities – will be a major challenge in the years to come. In May, the UN estimated that rebuilding the strip could cost $40 billion.

The United Nations Office for the Coordination of Humanitarian Affairs estimates that 1.9 million people have been internally displaced, or around 90% of Gaza’s population. Some people have moved several times from one region to another.

BBC Verify has been monitoring evacuation orders in Gaza since the start of the conflict. Almost all of Gaza’s 2.3 million residents have had to leave their homes as Israel has carried out continuous strikes across the territory and issued mass evacuation orders for large residential areas.

The map below shows areas subject to IDF evacuation notices since the start of the conflict – covering a large majority of the Strip. A recent analysis showed that around 90% of northern Gaza was under evacuation notices between October and the end of November as Israel carried out major operations in the north.

Even inside the “humanitarian zone” to which the IDF has asked Palestinians to move for security reasons, dozens of strikes have taken place.

The changing face of Al-Mawasi – in the humanitarian zone – illustrates the impact of displacement on Gaza. The image below shows the same area before the war – and in early January. Where there was once empty farmland, there are now thousands of tents and temporary structures.

UN projects that 91% of people faced high levels of acute food insecurity. The IPC – a group that works with governments, charities and agencies – concluded that famine thresholds may have been reached in northern Gaza following recent operations there.

Among the challenges is damage to agricultural land. In September, UN agencies said 67.6 percent of cultivated land had been damaged by bombing, vehicle tracks and other “conflict-related pressures.”

There has been a significant decrease in the amount of aid arriving in Gaza in recent months, according to figures compiled by the UN. Before the conflict, an average of 500 aid trucks entered Gaza each working day.

This number began to decline in October 2023 and has not recovered.

Even when aid arrives in Gaza, it does not always arrive at its intended destination. Aid workers have warned of criminal gangs intercepting aid deliveries and looting supplies as law and order collapses.

The UN has calculated that around 1.9 million people are in need of emergency shelter and essential household items.

The ceasefire will likely make it easier to get aid to Gaza, but the next question is how to rebuild the strip. After 15 months of devastating war, reconstruction could take Gazans more than a decade.

Additional reporting by Paul Brown and Benedict Garman.