How 15 months of war has devastated Gaza

A ceasefire deal to bring an end to the 15-month long conflict between Israel and Hamas has been finalised in Qatar.

Israel has long said it would not agree to any ceasefire until it completed military operations in the territory, which were sparked by Hamas’s shock October 2023 attack which killed about 1,200 people and saw 251 more taken hostage.

Gaza has suffered vast destruction with a colossal humanitarian impact. More than 46,000 Palestinians have been killed during Israel’s military action, according to the Hamas-run health ministry, and much infrastructure across the strip has been levelled by air strikes.

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

BBC Verify has been analysing the scale of the damage caused by a conflict which has 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 record for identified victims as of 7 October 2024, 59% were women, children and the elderly, but a UN analysis in November put the figure for women and children as high as 70%.

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

Karin Huster, a coordinator with Médecins Sans Frontières (MSF), told BBC Verify that the Gaza health system faces “immense” challenges to “adequately manage all those injured patients over the long-term”.

A paper in the Lancet medical journal recently suggested the death toll could be significantly higher than the ministry’s figures.

The health ministry’s death toll does not differentiate 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 that figure.

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

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

The below map shows damage to infrastructure since the start of the war. Much of the Israeli bombing was concentrated in urban areas and some infrastructure was hit multiple times.

The United Nations Satellite Centre (UNOSAT) has calculated a higher figure – it reported that 69% of all structures had been destroyed or damaged at the start of December. The UN also concluded 68% of the road network in the strip had been damaged or destroyed.

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

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

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

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

There has also been considerable destruction to education facilities with the IDF indicating they had struck school buildings 49 times since the middle of July while targeting Hamas fighters.

We have verified footage from such strikes on 13 sites since the beginning of December. These sites had typically stopped functioning as schools, often becoming shelters, but the damage will present a challenge in returning education to normal in Gaza.

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

Rebuilding infrastructure – from homes to public facilities – will be a key challenge in the coming years. In May the UN estimated it could cost $40bn to rebuild the strip.

The United Nation’s Office for the Coordination of Humanitarian Affairs estimates that 1.9 million people have been internally displaced – some 90% of the population of Gaza. Some people have moved several times from one area to another.

BBC Verify has been monitoring evacuation orders in Gaza since the beginning of the conflict. Almost all of Gaza’s 2.3 million people 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 the areas subject to IDF evacuation notices since the start of the conflict – covering a significant majority of the strip. Recent analysis showed about 90% of north Gaza had been under evacuation notices between October and late November as Israel carried out significant operations in the north.

Even within the “humanitarian zone” that the IDF told Palestinians to move to for safety there have been dozens of strikes.

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

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

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

There has been a significant decrease in the amount of aid getting into Gaza in recent months, according to figures compiled by the UN. Before the conflict, there was an average of 500 truckloads of aid entering Gaza each working day.

That number began to fall in October 2023 and has not recovered.

Even when aid enters Gaza, it does not always get to its intended destination. Aid workers have warned about criminal gangs intercepting aid deliveries and looting supplies, as law and order broke down.

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

The ceasefire is likely to make getting aid into Gaza easier, but the next question is how to rebuild the strip. After a devastating 15 months of war, it could take Gazans over a decade to rebuild.

Additional reporting by Paul Brown and Benedict Garman.