Over more than 21 months, Israel has destroyed Gaza’s health care system. Israeli airstrikes have continuously targeted Gaza’s hospitals. Governmental policy has led to the denial of fuel, water and medical supplies. Israeli forces have not only blocked evacuation corridors but also killed and arrested over 1,800 medical personnel. These attacks have shut down trauma care, oncology, obstetrics and dialysis and dismantled public health infrastructure. As a result, Palestinians have been stripped of even the most basic forms of medical care: Routine vaccinations have all but ceased, communicable diseases have spread unchecked and preventive services have been eliminated.

The question of whether the Israeli government is committing genocide against the Palestinian people in Gaza has generated intense debate. Many have asked: If Israel were truly committing this crime, wouldn’t it look different? Wouldn’t it be faster, larger in scale or more spectacular in form?

At the Physicians for Human Rights Israel, an organization working to advance the right to health for all under Israel’s control, we have reached a hard but inescapable conclusion: Through the wholesale destruction of Gaza’s health care system, Israel is committing genocide, but on a longer timeline than direct killing would imply. (Israel has called the accusations of genocide “baseless.”)

Hundreds of thousands of Palestinians in Gaza are already wounded, starving or without care. Many will not survive their initial injuries or hunger, not because of their injuries alone but because of a lack of surgery, antibiotics or simple pain management. Others may have no war-related injuries at all. They may simply be people in need of ordinary medical care: patients with chronic illnesses, pregnant women, children needing vaccinations, cancer patients awaiting treatment. In Gaza today, the health system that would treat all of these people is simply gone.

In a report published by Physicians for Human Rights Israel this week, which we co-wrote, we present a legal basis for a different understanding of genocide. Article II(c) of the 1948 Genocide Convention, which is at the center of our report, defines genocide as “deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part.” It indicates that genocide can happen gradually, through systems and institutions, rather than only through direct killing. And it is this form, cumulative and infrastructural, that becomes clear when the destruction of Gaza’s medical system is closely examined.

The kind of genocide described in Article II(c) is not a lesser genocide; it is a genocide on a different temporal scale. If a bomb drops, it kills instantaneously. If a cease-fire is somehow achieved, fighter jets can be grounded. Research shows that while famine may inflict long-term cognitive and physical damage, especially on children, some aspects of the current food crisis in Gaza could eventually be reversed — assuming actual sustenance, not symbolic aid, is allowed in at scale through a neutral, United Nations-led mechanism that puts the vulnerable first. A destroyed health system, by contrast, continues to kill long after the last missile is fired.