Pediatric Emergency Nursing in Gaza: Challenges,Adaptations,and Lessons from a Conflict Zone

Abstract

Pediatric emergency medicine faces numerous challenges in regions affected by prolonged conflict, such as Gaza. Nurses in Gaza work in overcrowded emergency departments, without access to pediatric-specific supplies or medications, yet they demonstrate remarkable resilience and adaptability, developing innovative solutions to deliver lifesaving care. Therefore, pediatric nurses in conflict settings must be trained in trauma care, triage, and emergency interventions tailored to children. Effective communication, resourcefulness, stress management, and teamwork are essential, along with ongoing training in disaster preparedness and advocating for improved resources and policies to support children's healthcare needs. This article explores the systemic challenges, resourceful strategies, and key lessons from pediatric emergency nursing in Gaza.

Introduction

The Gaza Strip, a densely populated area home to over 2 million people, has faced prolonged conflict that has severely impacted its healthcare system. Nearly half of Gaza's population is under the age of 18, making children particularly vulnerable (20240201_ACAPS_thematic_report_Palestine_-_impact_of_conflict_on_children_in_the_Gaza_strip.Pdf, 2024). Even before the most recent escalation, approximately 1.1 million children were in need of humanitarian assistance, a situation that has since worsened (Muthumani, 2024). Pediatric emergency nurses in conflict zones often serve as primary caregivers, addressing acute and chronic health issues.

In Gaza, pediatric emergency nursing operates under the persistent threat of airstrikes and displacement, with minimal access to critical supplies and infrastructure (Brook, 2024). Providing care in an active conflict zone with limited access to supplies poses a severe health crisis (Waterston & Nasser, 2017). Moreover, restricted travel for medical care within the region or to neighboring countries, combined with a shortage of supplies and clinicians due to a weakened infrastructure, places additional strain on an already overburdened healthcare system for both care providers and patients (Mosleh et al., 2018; Olatunji et al., 2024).

This article examines the challenges faced in such high-risk environments, highlights innovative strategies nurses use to deliver care, and offers insight to strengthen disaster and conflict nursing globally.

Discussion

Lack of Age-Specific Diagnostic Tools

The Gaza Strip presents unique challenges, as children are among the most affected populations and require specialized resources that are often overlooked when preparing for work in conflict zones. Basic diagnostic tools, such as pediatric blood pressure cuffs, rectal thermometers, and pulse oximeters for infants and young children, were often unavailable. Emergency nurses also faced shortages of pediatric-specific supplies, including catheters, urine collection bags for urinalysis, and intravenous catheters needed to administer fluids and lifesaving medications. Additionally, the lack of portable X-ray and ultrasound machines necessitated the use of CT scans for diagnostic imaging in young children. However, many CT scanners in Gaza lack low-dose settings, exposing children to higher levels of ionizing radiation. This increases their lifetime risk of developing malignancies, further complicating long-term health outcomes (Brenner et al., 2001).

Lack of Access to Supplies

A critical challenge in providing pediatric care in Gaza is the severe shortage of medical supplies needed to treat common conditions that disproportionately affect children exposed to conflict. Reports from Doctors Without Borders highlight shortages of therapeutic food, intravenous fluids, and essential equipment needed for pediatric intensive care (Gaza: Maternal and Child Health Suffer under a Decimated System | Doctors Without Borders - USA, 2024). These supply gaps limit diagnostic capabilities, often forcing providers to rely solely on clinical assessments and their expertise.

Disruptions to medical supply chains, compounded by ongoing restrictions, have severely limited access to vital pediatric supplies, including neonatal incubators and antibiotics essential for treating sepsis in children (Moscatelli et al., 2024). The shortage of vital surgical tools further hampers the ability to provide timely and effective treatment for injured children, increasing their risk of complications and long-term disabilities (Qandil, 2024).

The World Health Organization reports that shortages of basic supplies are directly contributing to increased morbidity and mortality (Children's Lives Threatened by Rising Malnutrition in the Gaza Strip, 2024). Pediatric emergency care providers in Gaza face difficult triage decisions, prioritizing limited resources and lifesaving interventions for the most critically injured patients. As a result, many children are left without access to essential emergency care, disrupting vital services (Muthumani, 2024).

Lack of Age-Specific Medications

Anesthesia

The shortage of age-appropriate medications poses significant challenges for pediatric emergency nursing in Gaza, particularly in administering anesthesia and antibiotics. Ongoing conflict and restricted pharmaceutical supply chains often result in the unavailability of pediatric formulations such as syrups, suspensions, and weight-specific dosages (Karageorgos et al., 2023; Shenoi et al., 2020). As a result, healthcare providers are frequently required to adapt adult medications for pediatric use—a practice that increases the risk of dosing errors and adverse effects (Nasser et al., 2024). Furthermore, the absence of precise dosing and monitoring equipment needed to ensure child safety raises the risk of both under—dosing, leading to inadequate sedation, and overdosing, causing serious complications (Ahmed, 2023; Nasser et al., 2024).

Antibiotics

Antibiotics, which are among the most prescribed medications, are frequently unavailable in child-friendly formulations. This shortage often forces healthcare providers to rely on suboptimal alternatives, increasing the risk of dosing inaccuracies and treatment failures (Nasser et al., 2024). In addition, the overuse and improper administration of broad-spectrum antibiotics in such settings contributes to the growing global rise of antimicrobial resistance (Krockow et al., 2023). Therefore, implementing antimicrobial stewardship programs in Gaza remains a significant challenge due to its limited resources and infrastructure (Ahmed, 2023). Addressing these barriers requires a multifaceted approach, including increased international aid to supply age-appropriate medications and targeted training programs to help healthcare providers optimize pediatric care in emergency situations.

Consent Ethics

Obtaining consent for pediatric care in an active conflict zone presents significant challenges, especially when injuries often require urgent surgical intervention. Many children arrive at hospitals after being rescued from the rubble, frequently separated from their families. In such cases, hospital staff may have no way to contact family members—if any remain alive—due to displacement, communication blackouts, and the fragmentation of family units amid aerial bombardment and rescue efforts (Irfan et al., 2024). Conservative estimates suggest that at least 25,000 children have lost one or both parents during the ongoing conflict (More Women and Children Killed in Gaza by Israeli Military than Any Other Recent Conflict in a Single Year – Oxfam, 2025). As a result, healthcare providers are often compelled to act based on a “best interest” standard, making collective decisions regarding patient care in the absence of legal guardians, compounded by the young age, limited comprehension of the situation or proposed interventions, and physical injuries that impair communication.

Lack of Space

One of the significant challenges in providing medical care in Gaza is the severe lack of space to treat patients and support those recovering from acute illness or injury. Ongoing conflicts, including aerial strikes and ground invasions, have resulted in extensive damage to critical infrastructure, including hospitals, roads, water and sewage systems, and residential buildings (“Covered in Blisters”: Chickenpox and Other Skin Diseases Spread among Palestinian Children in Gaza amid Israeli Genocide | Defense for Children Palestine, 2024). This destruction has contributed to overcrowding, poor sanitation, and the spread of communicable diseases. In Rafah, the population has surged by 500% in just four months due to displacements (Mohammed et al., 2024). At least 30 hospitals and 150 healthcare facilities are no longer operational (Sah, 2024). Since October 7th, there have been over 440 attacks on healthcare facilities, leading to the closure of the only cancer hospital (Mohammed et al., 2024). Medical staff have reported stepping over bodies and limbs in hospital hallways, placing patients on the floor due to a shortage of beds, and performing surgeries in hallways due to the lack of functional operating rooms (Khan, 2024).

Current Insights and Interpretations

Pediatric nurses must be trained to deliver age-appropriate trauma care, with a focus on pediatric training, trauma triage, and emergency interventions tailored to children in mass casualty situations which include managing large numbers of pediatric trauma patients simultaneously. Additionally, emergency pediatric nurses should be skilled in managing acute exacerbations of chronic conditions and addressing common pediatric illnesses. They must also coordinate with pediatric specialists to ensure ongoing care for children with long-term health needs, especially during times of scarcity. Regarding infectious healthcare, they will need to be proficient in early identification, isolation protocols, and infection control measures.

Given the resource constraints in conflict settings, pediatric nurses must be resourceful in improvising care strategies to achieve the best possible outcomes for their patients. Strong communication skills are essential to build trust and cooperation with families, many of whom may have experienced significant trauma. Ongoing training in disaster preparedness, including pediatric-specific disaster management is crucial, this includes being familiar with field triage, emergency pediatric care protocols, and evacuation procedures. Simulated disaster scenarios and training, including pediatric triage and managing large numbers of injured children simultaneously, will help prepare nurses for high-pressure situations.

Furthermore, pediatric nurses will need strategies to manage stress and maintain resilience. This includes access to mental health support, peer networks, and self-care training. Building personal resilience is vital to maintaining both emotional well-being and high-quality care. Nurses must also understand the broader humanitarian context and advocate for children's rights by engaging with governmental agencies and international organizations. Raising awareness of the healthcare needs of children in Gaza and advocating for improved resources, facilities, and policies through holding different workshops and conferences to share the challenges faced and adaptations made.

Finally, effective teamwork and collaboration will be essential. Future pediatric nurses will need strong interpersonal skills to work within multidisciplinary and multiorganizational teams. This involves coordinating care with pediatricians, surgeons, and humanitarian organizations to provide better holistic care for children.

Conclusion

In conclusion, emergency pediatric nurses in Gaza provide essential, lifesaving care under extreme conditions, often facing resource shortages and overwhelming challenges. Despite these hardships, their resilience and commitment continue to ensure that critically ill children receive urgent care, and with increased resources and support, the quality of care could significantly improve, saving more lives and enhancing outcomes for children in urgent need.