Patterns of orthopedic injuries presenting to emergency departments in Gaza amid the 2023–2025 conflict: A cross-sectional analysis

The Israeli military invasion of 2023-2025 has decimated Gaza's health system, constraining trauma capacity and disrupting prehospital and hospital care. We aimed to characterize emergency department (ED) orthopedic injury patterns. We conducted a multicenter, descriptive cross-sectional study across four referral hospitals in different governorates (September 1-16, 2024). A standardized interviewer-administered instrument and chart review captured demographics, mechanism, injury type/site, soft-tissue and neurovascular findings, acute interventions, disposition, perceived care quality, and time metrics (to first care, ED evaluation, surgery). Primary outcomes were admission and emergency surgery. Analyses included descriptive statistics and bivariable/multivariable logistic regression with hospital-clustered standard errors. Among 449 patients, the cohort was predominantly young, male, and displaced. Most presentations followed explosive violence. Fractures predominated, with a large share open; comminuted and segmental patterns were frequent, and neurovascular compromise was common. Many patients reached some form of care rapidly, yet few received first aid before ED arrival, indicating prehospital collapse amid unsafe transit. Median wait-time was short but highly variable between hospitals. Operative demand exceeded theatre capacity, with notable interhospital variation in time to surgery. Orthopedic trauma care in Gaza continues to be affected by widespread damage, though unevenly across the enclave. Immediate priorities include the entry of essential medical supplies and safe protection for hospitals and healthcare workers to operate.