The impact of deconfliction on humanitarian access and healthcare delivery in Gaza: a qualitative study of international healthcare workers

Background Deconfliction is a central pillar of humanitarian risk mitigation in contemporary armed conflicts. Intended as a notification system through which parties to a conflict can mitigate against harm to humanitarian personnel and infrastructure, its effectiveness is dependent on respect for humanitarian protections. Since October 2023, repeated Israeli attacks on deconflicted sites and routes in Gaza, alongside increasing restrictions on humanitarian movement as notification-based coordination was replaced by a permission-based system, have raised fundamental questions about the utility and function of deconfliction. This study examines how deconfliction shaped humanitarian access, healthcare delivery, and Palestinian health infrastructure from the perspective of international healthcare workers in Gaza since 2023. Methods We conducted semi-structured interviews with 18 international healthcare providers who worked in Gaza between January 2024 and December 2025. Participants completed 31 deployments across 16 healthcare facilities. Interviews were analyzed using inductive thematic analysis. Results Two major themes emerged. First, participants described deconfliction as an unstable and ineffective means of ensuring humanitarian protection or access. They reported delays, denials, sudden revocations of movement permissions, and strikes on deconflicted sites. These conditions disrupted clinical care, delayed transfers and evacuations, limited facility access, and exposed both patients and providers to ongoing risk. Second, participants described deconfliction as a mechanism of control that shifted responsibility for protection from parties to a conflict to humanitarian actors and redirected resources and personnel away from Palestinian hospitals toward NGO (Non-Governmental Organization) facilities, eroding Palestinian healthcare autonomy. Conclusion Rather than a neutral protection mechanism, deconfliction operated as a conditional authorization regime through which Israel regulated humanitarian movement, medical supply chains, and healthcare delivery. This mechanism rendered protection contingent on compliance, allowing Israel to reframe attacks as humanitarian operational failures rather than violations of international law by military actors. Deconfliction also facilitated the substitution of Palestinian healthcare with internationally managed structures that were dependent on Israeli approval. By undermining local health system autonomy, deconfliction was instrumentalized within a broader Israeli strategy to deliberately inflict conditions to bring about the physical destruction of life in Gaza. These findings raise urgent questions about humanitarian actors obligations when operating within non-neutral systems and underscore the need to prioritize direct support for local healthcare institutions.