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Armitage’s reflection from Gaza is powerful because it shows that health-system collapse is not only the destruction of buildings, but also the loss of records, referrals, communication with pharmacy, and the clinical memory that makes continuity of care possible¹. The photograph of the destroyed emergency department is striking, but from my perspective as a pharmacist supporting supervisors and supervising healthcare professionals undertaking master’s-level research in Gaza, the quieter danger is equally important: prescribing when previous medicines, current stock, local resistance data and follow-up are all uncertain.
That same pattern is visible across healthcare professional-led projects I have supported, including emerging work on child nutrition, family planning and spinal pain ²⁻⁴ as well as several other ongoing projects; During data collection and analysis, recurring problems have included fragmented documentation, disrupted follow-up, constrained counselling, limited access to essential services, and clinicians trying to make safe decisions without reliable system support. These projects point, in different clinical areas, to the same wider problem: health-system collapse is experienced not only as the loss of individual services, but as the erosion of continuity, communication and the practical infrastructure that makes primary care safe and usable.
The issue, then, is not simply whether Gaza needs better antimicrobial guid...
The issue, then, is not simply whether Gaza needs better antimicrobial guidelines or electronic records, although it clearly needs both. The deeper problem is how to rebuild the clinical memory that safe prescribing depends on. Humanitarian stewardship literature shows that conflict settings involve disrupted supply chains, limited diagnostics, weak surveillance and urgent competing priorities.⁵ Digital health work in Gaza, and the West Bank, similarly suggests that health-information systems should, ideally, be resilient to power cuts, intermittent connectivity and fragmented access.⁶ Without that resilience, guidelines and records risk becoming static documents rather than usable tools for safer care.
The wider question is: what is the minimum safe primary care system Gaza needs first? A full electronic record, a real-time stock list, patient-held medication records, or pharmacy-prescriber feedback loops linked to local resistance patterns? For me, the answer is not one tool, but a medicines infrastructure designed around instability. Medicines are not just supplies. In Gaza, they are part of the infrastructure of safe primary care.
References
1. Armitage R. Primary care in a destroyed health system: reflections on a deployment to Gaza. Br J Gen Pract 2026;76(766):224-225. doi:10.3399/bjgp26X744837. 2. Murtaja L, Abdeljawad H, Najim A, Rodgers J, Almukbel R, Mokbel K. Nutritional Status and Associated Factors Among Children Aged 6-24 Months at a Primary Health Care Centre in Conflict-Affected Gaza. medRxiv 2026:2026-05. Doi:10.64898/2026.05.12.26353044. 3. Nawara A, Alkasseh A, Najim A, Kallis TJ, Mokbel K. Access, utilisation and compliance with family planning methods among women in Gaza: a cross-sectional study. Research Square 2026. doi:10.21203/rs.3.rs-8605405/v1. 4. Salama M, Najim AA, Shabana M, Almukbel R, Mokbel K. Disability, Fatigue, and Mental Health in Acute versus Chronic Spinal Pain Patients in the Gaza Strip: A Comparative Cross-Sectional Study. medRxiv. 2026 May 15:2026-05. doi: 10.64898/2026.05.12.26353046. 5. Truppa C, Alonso B, Clezy K, et al. Antimicrobial stewardship in primary health care programs in humanitarian settings: the time to act is now. Antimicrob Resist Infect Control 2023;12(1):89. doi:10.1186/s13756-023-01301-4. 6. Ali S, Irfan B, Abdeljaber W, et al. Digital health in humanitarian crises: A case study of Gaza and the West Bank. Digit Health 2025;11:20552076251365010. doi:10.1177/20552076251365010.
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British Journal of General Practice
