A year after the 51-day war in Gaza, hundreds of Palestinians with devastating injuries from the Israeli assault still fill the waiting rooms of Médecins Sans Frontières (MSF) in need of complex reconstructive surgeries and physical rehabilitation.

With the continued blockade and siege of Gaza, it is as if the latest of round of Israeli-Palestinian bloodshed had just ended. Today, perhaps more than at any time in its 20-year history of providing medical and psychological care in Gaza and the West Bank, MSF sees how the suffering wrought by the Israeli occupation has become normalized and how an end to the occupation is the only way to ease the suffering of Palestinians.

The human toll of the latest Gaza war was appalling: more than 2,200 people were killed and more than 11,000 wounded, including almost 7,000 women and children. “Eight-year-old children in Gaza have known nothing but the blockade and war since they were born,” says Erwan Grillon, MSF’s Head of Mission for Gaza and the West Bank. “And they’ve already lived through four offensives, two of which were absolutely devastating and indiscriminately killed a shocking number of civilians. The majority of our patients who still require war-related surgeries and physiotherapy are children under 18.”

In MSF clinics, Gazans still dealing with the complications of their war injuries are now packed alongside patients, mostly young children, who have suffered severe burns from home heating and cooking accidents as result of being forced to live in makeshift or damaged homes. More than 12,000 houses were damaged or destroyed during the war, as were more than 70 hospitals or health structures.

The Israeli military blockade of Gaza continues to starve the territory of desperately needed supplies, including building materials that could help rebuild some of the neighbourhoods that were reduced to rubble by the Israeli military. Israel has put severe restrictions on cement and other building materials, which are considered “dual-use” items that could be used to create weapons, leading to few houses being repaired in the strip.

“Living conditions keep on deteriorating,” says Grillon. “In our post-operative clinic in Gaza, the majority of our patients were treated for burns from explosions caused by the use of unsafe home heating products or in household cooking accidents in homes damaged during the war. Sixty percent of them were children.”

As a consequence of the blockade, people are still living in terribly unsafe conditions and almost entirely dependent on outside aid. Unemployment is at record high—more than 40 percent overall and more than 60 percent among the young—and 80 percent of the population is at least partially dependent on humanitarian aid.

While the devastation of the war in Gaza and the ongoing blockade of the strip have garnered the most international attention, the occupation of the West Bank illustrates another form of oppression that also has widespread public health consequences. Today, due to settlements, byways, checkpoints, and military deployments, Palestinians can only inhabit less than 40 percent of the West Bank.

The Palestinian population in the West Bank is subjected to indignities, threats, and humiliations on a daily basis. MSF mental health programs are filled with patients suffering from psychological disorders as a result of being subjected to endless harassment, frequent (and unpunished) settler violence against individuals and property, night raids, administrative detention, or other acts.

“The stories our teams tell us are such that merely stating the facts should be enough to denounce them,” says Grillon. “On a daily basis we see patients, a third of whom are younger than 13, in a constant state of anxiety and terror because of night-time incursions by Israeli soldiers and settler attacks. We’ve been treating the same families presenting the same symptoms for the past ten years. Nothing has changed.”

As a direct result of the perpetuation of the occupation and the complete failure of any political process, Palestinians in both Gaza and the West Bank are trapped in a never-ending cycle of violence that must be addressed frankly and urgently. Measures taken by Israel in the name of security must be judged in terms of their humanitarian fallout. And the governments and international institutions either explicitly or tacitly supporting these policies must likewise consider the human costs of these policies, given the undeniable devastation they have wrought.

“Trying to create a false equivalence in terms of responsibility for the current situation in the West Bank and Gaza simply obscures the reality of responsibility for the violence in the Occupied Territories,” says Dr. Mego Terzian, president of MSF France. “Employing the rhetoric of self-defence to seize territory and continue a brutalizing occupation, Israel and its international backers have sought to codify a system that is wounding Palestinians day after day, smothering life and hope, and guaranteeing more of the same in the future.”