The Doctors Without Borders human rights group accused Israel Thursday of “ethnic cleansing” in the Gaza Strip, pointing to a paucity of aid and attacks on medical services during the 14-month war against the Hamas terror group in the enclave.

The report documented what it said were 41 attacks on staff of the medical group, known by its French acronym MSF, including airstrikes on health facilities and direct fire on humanitarian convoys.

MSF said it was forced to evacuate hospitals and health centers on 17 occasions throughout the war, which was sparked by Hamas’s October 7, 2023, invasion and massacre in southern Israel, in which some 1,200 people were killed and 251 were seized as hostages.

“We are seeing clear signs of ethnic cleansing as Palestinians are forcibly displaced, trapped and bombed,” said Christopher Lockyear, MSF’s secretary general.

Responding to the MSF report, a Foreign Ministry spokesperson accused the group of lying and misleading the public.

“Israel does not target medical teams or individuals uninvolved in terrorist activities,” tweeted Oren Marmorstein, insisting that Israel works with aid groups and foreign governments to deliver medical equipment and personnel into Gaza, while working to maintain medical infrastructure.

MSF teams “saw with their own eyes how Hamas systematically exploits hospitals for terrorist activities and operations—yet they chose to lie,” the foreign ministry spokesperson added. “Notably, this fabricated report fails to even mention the medical condition of the 100 hostages held by Hamas, whom international medical organizations have never been allowed to see.”

Israel has repeatedly rejected accusations of genocide and ethnic cleansing in the Gaza Strip, saying its actions are legitimate military operations against the Hamas terror group, and that it takes extensive measures to avoid civilian casualties.

MSF’s report, entitled “Gaza: Life in a Death Trap,” alleged the war in the Palestinian enclave has drastically reduced humanitarian aid, and charged that only 37 trucks per day were authorized to enter the strip in October 2024, compared with 500 per day before the Hamas assault and the start of the war.

The war has continued unabated for the last 14 months, besides a weeklong truce in November 2023 during which 105 hostages were released. Attempts to negotiate a longer, more sustainable ceasefire and the release of the remaining 100 hostages still in captivity have so far failed due to demands made by Hamas that Israel says are nonstarters.

Food aid to Gaza did drop sharply at the start of October, falling well below 100 trucks per day, which COGAT, the Israeli military body in charge of humanitarian aid to Gaza, said was due to crossing closures for the Jewish High Holidays and memorials marking the first anniversary of the October 7 massacre.

By early November, however, the security cabinet was said to have approved a series of steps aimed at boosting the humanitarian situation, after the US sent a letter to Israel on October 13, warning that it had 30 days to improve the situation or risk being out of compliance with US law.

Among the demands made by the US was for the number of trucks entering Gaza each day to be increased to 350.

While the number increased to around 250 each day — 50 to northern Gaza and 150 to the south and center — an Israeli official told the Axios news site that Israel won’t be able to meet the 350-truck benchmark.

MSF also asserted that the north of the territory, particularly Jabalia, has been undergoing an “extremely violent” offensive since early October.

On October 6, Israeli troops launched a new offensive in the north of the Strip, which it said was aimed at preventing Hamas from regrouping around Jabalia, Beit Lahia and Beit Hanoun.

The United Nations has estimated that around 100,000 people have been displaced from across northern Gaza, although Israel has rejected accusations that they were forcibly pushed out, and insists that it is encouraging civilians to temporarily leave areas in which the IDF is operating in order to reduce civilian casualties.

Over the past year, MSF medical teams have carried out more than 27,500 consultations and 7,500 surgical operations, the report stated. It noted a rapid spread of disease in a population that had been 90% displaced and living in wretched conditions.

An IDF assessment in July estimated that some 1.9 million Palestinians of the 2.3 million Gazan population are residing in the Israeli-designated “humanitarian zone,” in the al-Mawasi area on the southern Strip’s coast, western neighborhoods of Khan Younis, and central Gaza’s Deir al-Balah.

The organization also denounced the blocking of medical evacuations, saying that Israel only authorized 1.6% of requests between May and September 2024.

While the MSF report didn’t look past September, Israel and the World Health Organization evacuated 231 Gazans in November to the United Arab Emirates and Romania for medical treatment.

In total, however, the WHO has said that fewer than 5,000 people have been granted medical evacuations out of the territory since the start of the war.

“What our medical teams have witnessed on the ground throughout this conflict is consistent with the descriptions provided by an increasing number of legal experts and organizations concluding that genocide is taking place in Gaza,” said Lockyear.

The report called for an immediate ceasefire and the lifting of the siege to allow the massive delivery of humanitarian aid.

MSF also called on “states, particularly Israel’s closest allies, to end their unconditional support for Israel and fulfill their obligation to prevent genocide in Gaza.”

Earlier on Thursday, Human Rights Watch accused Israel of committing “acts of genocide” in Gaza by allegedly damaging water infrastructure and cutting off supplies to civilians. Israel, in response, charged the organization with “blood libel.”

And on December 5, Amnesty International accused Israel of deliberately harming Palestinians by mounting deadly attacks, demolishing vital infrastructure and preventing the delivery of food, medicine and other aid.

That report was swiftly denounced by Israel as based on falsehoods, and Amnesty Israel workers accused the parent organization of reaching a “predetermined conclusion.”

The Hamas-run Gaza health ministry says that more than 45,000 people in the Strip have been killed or are presumed dead in the fighting so far, although the toll cannot be verified, does not differentiate between civilians and fighters, and allegedly includes people killed by errant Palestinian rockets or by non-war-related causes. Israel says it has killed some 18,000 combatants in battle as of November 2024, and another 1,000 terrorists inside Israel on and shortly after October 7 last year.

Israel has said it seeks to minimize civilian fatalities and stresses that Hamas uses Gaza’s civilians as human shields, fighting from civilian areas including homes, hospitals, schools and mosques.

Israel’s toll in the ground offensive against Hamas and in military operations along the border with the Strip stands at 388. The toll includes a police officer killed in a hostage rescue mission and a Defense Ministry civilian contractor.