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On a hazy morning in November, a group of aid workers with Médecins Sans Frontières (M.S.F.), known in English as Doctors Without Borders, crossed into Gaza for a two-month mission. Jennifer Hulse, an emergency physician from the U.K., led a medical team. “We all had as many bags as we could physically carry,” Hulse said. Inside were essential supplies such as surgical tools and engine oil for generators. Her assignment was to help the Gaza Health Ministry restore access to health care in the north, where Israeli attacks had flattened nearly every building in sight.

The team first spent several days at Gaza’s sole remaining hospital focussed on pediatrics—Al-Rantisi, in Gaza City, which was barely operational after Israeli air strikes. The roof had collapsed in places. Doctors were seeing patients in a waiting room with only a few cots. “It was very cold, even inside the buildings,” Hulse told me. When a storm blew through, she mistook thunderclaps for explosions. She learned that parents sometimes arrived with the bodies of infants who seemed to have died of hypothermia. Her team quickly put together a plan to help coördinate repairs, secure new electrical generators, implement a triage system, and organize trainings for staff. “We were just trying to get it functional again,” she said.

Next, Hulse travelled to Jabalia, in the northern reaches of the Gaza Strip, where the situation was even worse. She was driven through rutted streets in which not a single building remained intact. The area had previously been served by several health-care facilities, including a primary-care center—now destroyed—and the Indonesian Hospital, which I visited during a temporary ceasefire, in early 2025. But this past October, as part of another ceasefire agreement brokered by the Trump Administration, Israeli forces effectively divided Gaza in two, pushing the population toward the sea. Nearly all of the surviving health-care facilities in the northernmost area fell on the wrong side of the partition. “No one can reach them now,” Hulse said. To get proper medical care, she went on, an injured person would have to make it to a crossroads and flag down a donkey cart to Gaza City, which could take hours. As a stopgap, the M.S.F. team and Gaza’s health ministry had decided to open a temporary clinic in the area.

Hulse and her colleagues spent several days searching for a suitable location. At one point, she saw a group of children playing on what had once been the roof of a building. They climbed into a cardboard box and slid down the sloped surface as though they were sledding. “There was nothing, absolutely nothing,” she told me. “Even finding a flat piece of ground that wasn’t covered in rubble was difficult.” Still, within a few weeks, they picked a spot, dug latrines, installed generators and water tanks, and erected tents. The clinic was close to the partition, where Israeli soldiers often fired their weapons. The team piled sandbags around the perimeter for protection.

The temporary clinic opened after Christmas, and soon they were seeing up to four hundred patients a day. The staff did their best to treat all sorts of conditions: infections, heart attacks, diarrhea, gunshot wounds, shrapnel injuries. “It was a tiny clinic amid the rubble, and we didn’t always have the medications we needed,” Hulse said. “But people were still so grateful for it.” Meanwhile, about a kilometre away, workers began clearing debris from the old site of the primary-care center, making room for a permanent replacement.

Then, just before New Year’s, the Israeli government released a statement. It had previously instructed all international humanitarian organizations that operated in Gaza to submit detailed information to maintain their registration, including financial statements, the identities of all donors, and a full list of employees, with passport numbers, dates of birth, and, for Palestinians, the names of spouses and children. Organizations that refused would be expelled. “We were briefed on the issue,” Hulse said. “It was really hard to believe it was actually happening.” Thirty-seven organizations—including M.S.F., the International Rescue Committee, the Norwegian Refugee Council (N.R.C.), and Action Against Hunger—received notice that they had failed to comply and would no longer be allowed in Gaza, the West Bank, or East Jerusalem. They were given sixty days to cease operations and withdraw all international staff.

Hulse’s rotation was due to end in January, just before her fortieth birthday. She’d originally planned to hand off the Jabalia project to a new team. “But, after the statement came out, everybody was denied access,” she said. “We couldn’t get any new people or supplies in.” Hulse’s team decided to stay for as long as they could. They would have to race to finish the permanent clinic in time. In a single evening, she and a colleague hurriedly drew up a design. Hulse took the plan to the health ministry, which approved it. “We needed to at least get it started before we left,” she told me. She remembers thinking, I hope this works.

Israel seized control of the Gaza Strip and the West Bank during the Six-Day War, in 1967. After that, Israel’s Ministry of Labor and Social Affairs took responsibility for registering non-governmental organizations (N.G.O.s) and endorsing visas for aid workers. This system reportedly began to break down in recent years, when the ministry stopped issuing new registrations. On October 7, 2023, Hamas led a wave of attacks on Israel, killing about twelve hundred people. After that, the ministry stopped endorsing visas, preventing many humanitarian workers from entering Gaza and the West Bank. In October, 2024, Yotam Ben-Hillel, an Israeli human-rights lawyer, petitioned Israel’s Supreme Court on behalf of a coalition of international aid groups in an effort to force the Israeli government to address the situation. In December, Israel announced that it planned to overhaul the registration process and transfer it to a different agency: the Ministry of Diaspora Affairs and Combating Antisemitism. It released its requirements for registration in March, 2025.

The Coordinator of Government Activities in the Territories, a military unit that enforces Israeli policies in Gaza, defended the new restrictions on N.G.O.s as necessary to insure Israel’s security. “Israel is committed to allowing and facilitating the entry of humanitarian aid into the Gaza Strip,” COGAT told The New Yorker in a statement. It invoked a long-standing allegation that many humanitarian groups are compromised by militants. In 2021, Israel began designating Palestinian civil-society groups as terrorist organizations; United Nations human-rights experts said that the charge lacked “concrete and credible evidence.” In 2024, Israel barred UNRWA, a sprawling U.N. agency with tens of thousands of employees who served millions of Palestinians, from working in Gaza and the West Bank, asserting that fourteen hundred of the agency’s employees in Gaza were members of terrorist organizations, and that at least nineteen had participated in the attacks on October 7th. An internal U.N. investigation found evidence that nine employees “may have been involved” in the attacks, and their contracts with the agency were terminated.

That same year, an Israeli air strike near a medical clinic killed a Palestinian physiotherapist employed by M.S.F. The Israeli military said that he was an operative with Palestinian Islamic Jihad (P.I.J.), a militant group aligned with Hamas; M.S.F. released a statement condemning the targeting of a health-care worker and noting that hundreds of health-care workers, including six M.S.F. employees, had been killed in Gaza since the beginning of the conflict. P.I.J. eventually confirmed that the physiotherapist had been one of its commanders. “We would never knowingly employ people engaging in military activity,” M.S.F. said in a subsequent statement. “Any employee who engages in military activity would pose a danger to our staff and patients.”

Amichai Chikli, the right-wing Minister for Diaspora Affairs and Combating Antisemitism, has used such cases to argue that “much of the activity of so-called humanitarian organizations serves as a cover for hostile and sometimes violent actions.” When M.S.F. ultimately refused to share a list of its employees, he said, “We are aware that MSF employs individuals who are active in terrorist organizations, which is why it hides its employee lists.” (He also said that Rahma Worldwide, an organization that I volunteered for in Gaza, was going to be designated a “terrorist consortium.”)

Humanitarian organizations have sharply challenged these claims. Alan Moseley, a country director for the Danish Refugee Council (D.R.C.), another barred N.G.O., said that organizations like theirs have experience insuring that staff members remain neutral. “We work in conflict zones around the world where it’s very common to be faced with armed groups present,” Moseley told me. “Of course we don’t want Hamas fighters on our staff.” Mohammed Abu Mughaiseeb, a physician and an M.S.F. medical adviser, told me that the organization has employed thousands of people in Gaza, and that no one else has been proved to have participated in military activity. All M.S.F. staff go through a comprehensive vetting process, he added. By limiting humanitarian access to Gaza, Abu Mughaiseeb said, Israel was “punishing the population, not Hamas.”

Many N.G.O.s have raised concerns that lists of their employees could be used to target their Palestinian staffers. More than five hundred aid workers, including fifteen M.S.F. employees, have been killed in Gaza since October 7, 2023. (The Israeli military has said that it does not target medical personnel.) Filipe Ribeiro, a head of mission for the organization, told me that M.S.F. asked for safety assurances from a committee headed by the Ministry of Diaspora Affairs. “We asked repeatedly, ‘What will you do with this list? How can we be sure it won’t be used to harm our staff?’ ” he told me. “We never received an answer.” (When approached for comment, the Ministry of Diaspora Affairs said that it would not be able to meet The New Yorker’s deadline.) Shaina Low, a communication adviser for the Norwegian Refugee Council, said that a strict E.U. data-privacy law barred organizations from sharing employee information. “We’ve gotten opinions from authorities in the E.U.,” she told me. “They have said, yes, handing over these employee lists could violate the law.”

Not long after N.G.O.s received notice that they would be expelled from Gaza, the U.N. released a statement urging Israel to reconsider. “Humanitarian access is not optional, conditional or political,” it said. “It is a legal obligation under international humanitarian law.” Eighteen Israeli N.G.O.s described the new registration framework as a “weaponization of bureaucracy.” In early January, fifty-three international humanitarian groups called on Israel to halt the expulsion process, noting that N.G.O.s run or support sixty per cent of all field hospitals in Gaza and furnish the majority of shelter aid. Ribeiro told me that M.S.F. is one of the only organizations providing Gazans with orthopedic surgery, reconstructive surgery, and burn care. “It’s another catastrophe for the people of Gaza,” Mughaiseeb said. Finally, in February, Ben-Hillel filed a suit in Israel’s Supreme Court on behalf of numerous humanitarian organizations, including M.S.F., the D.R.C., and the N.R.C. He cited an opinion by the International Court of Justice asserting that, under the Geneva Conventions, Israel had an unconditional obligation to facilitate the “rapid and unimpeded” delivery of aid, security concerns notwithstanding. He also told the court that, under the Oslo Accords of 1993, the Palestinian Authority—not Israel—had jurisdiction over these N.G.O.s. The court recommended that the petition be dismissed, and that the organizations be given one month to submit the employee lists. A final decision is pending.

Although discussions of the new N.G.O. requirements have focussed on security, concerns about militants occupy only a small part of the Ministry of Diaspora Affairs’ written guidelines. Organizations can also be barred for promoting what the agency calls delegitimization campaigns against Israel; for denying the existence of Israel as a democratic state; or for employing an officeholder who has called for a boycott of Israel. I asked Gerald Steinberg, the founder of an Israeli group called NGO Monitor, what would justify barring humanitarian groups from providing services. He responded by citing the politics of N.G.O.s: “These are very powerful organizations, and their political agendas have major influence.” As an example, he cited an M.S.F. social-media campaign that characterized the war in Gaza as a genocide. “They are not the altruistic, neutral organizations that they claim to be,” he said. N.G.O. workers considered these arguments chilling. Hulse pointed out that M.S.F.’s mission includes témoignage, or testimony—bearing witness to human suffering. “In a conflict where the balance of power is so unequal, the number of civilian casualties is so huge, just talking about what is happening can make it seem as though you’re not being neutral,” she told me. Low, at the Norwegian Refugee Council, was more direct. “This is about silencing organizations that are documenting human-rights violations,” she said.

During Hulse’s last days in Gaza, she and her team hurried to complete as much of the Jabalia clinic as they could. Israel prohibits many construction materials from entering Gaza, so the structure was created by welding sheets of metal together and painting them white. “It’s basically a fancy shipping container,” Hulse said. It would have sinks, toilets, and electricity, with room for wound care, pediatrics, women’s health, and a small E.R. “It looked like a clean, bright island in the middle of the rubble,” Hulse told me.

Before the team’s departure, the staff gathered for a final walk-through. “Everyone was so excited about it,” Hulse said. The head pharmacist, a local health-ministry employee, talked enthusiastically about how she would arrange the pharmacy. Then she pointed out a crumpled structure next to the clinic; it had once been her family’s home. Hulse felt both hopeful and uncertain. “We had no idea if we would still be able to get them the medications and supplies they need,” she told me. Patients were concerned too, and some asked Hulse what would happen to the new clinic after her team left. “We didn’t really have answers for them,” she said.

The clinic finally opened in April, and it now treats up to five hundred patients daily. In a cell-phone video of the opening, the space was thronged with people. M.S.F. intends to provide support from afar, but Raed Abu Warda, a doctor who directs the clinic, told me that the expulsion of the international team has put the clinic under enormous strain. “They facilitated everything,” he told me. Hulse and her colleagues had provided a cache of medications, but the clinic no longer had any antibiotics. It didn’t even have chairs for patients.

After Hulse’s rotation in Gaza ended, she boarded a bus with about thirty other international M.S.F. staffers. As they drove toward the border crossing, everyone sat in silence. At their next stop, in Amman, the team had one day off—Hulse’s first in four months. Then they held a debrief meeting to discuss their experiences. In the middle of the session, they heard explosions. Iranian missiles, a response to Israeli and American attacks, were being intercepted overhead. It was the twenty-eighth of February, and the next war had just begun. ♦

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