Wounds such as burns or leg injuries more common in Gaza than among US soldiers who fought in Iraq and Afghanistan
Civilians in Gaza have sustained injuries of a type and on a scale more usually seen among professional soldiers involved in intense combat operations, research has found.
A study published in the British Medical Journal (BMJ) found that some types of wounds – such as burns or injuries to legs – were more common among civilians in Gaza than among US soldiers fighting in recent conflicts in Iraq and Afghanistan.
“Injured civilians in Gaza are experiencing a pattern of wounds that you would expect in intense combat with military professionals. The distribution and nature [of injuries] is almost the same or worse,” said Bilal Irfan, a bioethicist who conducts research at the University of Michigan and is one of the study’s authors.
The peer-reviewed research, the first of its kind, drew on data provided between August 2024 and February 2025 by dozens of international medical professionals who have worked in Gaza during the nearly two-year-old conflict.
Irfan said the data did not include most fatal injuries. “This is data for the patients who made it to hospital and so survived. We don’t even have a full profile of the serious injuries of those who died without any medical attention,” he said.
The war was triggered by Hamas’s 7 October 2023 attacks on Israel in which militants killed 1,200 people, mostly civilians, and took 251 hostage, of whom about 50 remain in Gaza, about 20 of them thought to be alive.
The ensuing Israeli military campaign has killed more than 65,000 Palestinians, mostly civilians, and injured more than 160,000, and has reduced swathes of the territory to ruins and displaced most of the population, in many cases multiple times.
The new study will increase the pressure on Israel, which is facing deepening isolation over its conduct of the war in Gaza. Overall, almost 24,000 trauma-related injuries were reported in the study, of which 18% were burns. About two-thirds of injuries were from explosions.
Burns were particularly common and severe, in particular among children, the authors found. More than one-tenth of burn injuries were fourth-degree, meaning they penetrated all tissue layers down to the bone.
The extent of traumatic injury victims reflects “the impact of indiscriminate aerial and heavy explosive bombardment in civilian areas”, the study said.
Firearm injuries made up about 30% of war-related trauma, similar to reports from Syria’s civil war where civilians were frequently victims during a decade of violence. Just under 10% of gunshot patients were shot in the head.
The 78 experts who provided data came from 22 NGOs from Britain, the US, Canada and the EU, and included specialists in several disciplines. They were interviewed or provided data within three months of deployment in Gaza, Irfan said. The injury patterns in Gaza were then compared with studies of US combat veterans who fought in Afghanistan and Iraq.
Dr Victoria Rose, a consultant plastic surgeon working at St Thomas’ hospital and King’s College hospital in London and another of the journal article’s authors, said the findings “should ring alarm bells through the halls of government worldwide and the humanitarian community”.
Israeli military officials insist they act within international law but admit there is “a tension” between protecting civilians and the “demands of fast-moving military operations”.
They said: “We are fighting a very different war from any previous conflict anyone has fought anywhere in the world … There are strict rules of engagement but what has changed is the policy that was designed for small wars where we wanted to deter [enemies] … We are now fighting in Gaza to ensure that Hamas is not ruling Gaza.”
Data collected by the independent violence-tracking organisation Acled suggests that as many as 15 of every 16 Palestinians the Israeli military has killed since its renewed offensive in Gaza began in March may have been civilians. Last month the Guardian revealed that internal data from the Israel Defense Forces (IDF) indicated a civilian death toll of 83% between the outbreak of war in October 2023 and May of this year.
Israel has imposed tight restrictions on supplies entering Gaza throughout the war. Last month, UN-backed food security experts confirmed famine in Gaza City and surrounding areas.
The medics who contributed to the new study found that malnutrition had worsened patient outcomes, “delayed wound healing and preventable deaths from otherwise treatable conditions”.
The few remaining hospitals and clinics in central and southern Gaza are now being overwhelmed by a “tsunami” of injured and sick patients fleeing a new Israeli offensive in the north of the devastated territory, medics say.
Donald Trump said on Thursday he thought a deal to end the war in Gaza was close. “I have to meet with Israel,” he said at the White House. “I think we can get that one done. I hope we can get it done. A lot of people are dying, but we want the hostages back.”