Continuity of Operating Room Services during the 2023-2025 War on Gaza - A Qualitative Case Study of Al-Ahli Arab Hospital

War conditions pose substantial and critical challenges to the healthcare system, especially in resource-limited settings. Based on the importance of operating rooms as critical and lifesaving health services, particularly in conflict settings characterised by mass casualties, resource shortages, infrastructure disruption, and difficulties in referral and coordination. This study aimed to explore the continuity of operating room services at Al-Ahli Arab Hospital during the 2023 to 2025 war on Gaza. It employed a qualitative approach and relied on semi-structured interviews with six selected participants associated with operating room services and related support positions. The data were analysed using thematic analysis to identify the main patterns and themes related to the continuity of surgical services during the war.
This study contributes to the literature by demonstrating that surgical continuity in conflict settings is not merely a technical medical issue but fundamentally a health economics challenge involving extreme scarcity, opportunity cost, and resource allocation under pressure. The findings reveal that while agile resilience and human endurance kept the operating room functioning, this was achieved through daily improvisation, task-shifting, and the repurposing of non-clinical spaces—raising critical questions about the sustainability of relying on heroic staff efforts as a substitute for systemic preparedness.
The results suggest that the operating room services were neither normal nor stable. In contrast, it was fragile and conditional on the ability of health teams to adapt to resource scarcity, security pressure, and operational constraints. The operating room shifted from a relatively scheduled surgical service to an emergency war-response service focused mainly on lifesaving cases. Shortages of fuel, electricity, anaesthesia medications, blood, oxygen, surgical supplies, sterilisation materials, and staff emerged as central factors shaping critical operational decisions. We conclude that the continuity of operating room services in conflict settings requires an integrated preparedness system. It should control critical resources, develop surgical triage protocols, improve referral and communication systems, support health workers, and strengthen infection prevention and control. Crucially, true service continuity cannot depend indefinitely on the adaptive capacity and suffering of health workers; it must be built on robust systemic protocols that remove the ethical burden from individual clinicians and ensure that surgical capacity is sustained through institutional preparedness rather than individual heroism.

Health Service Continuity, Operating Room, War On Gaza, Al-Ahli Arab Hospital

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