Ophthalmic Health Service Utilization and Surgical Demand During Prolonged Armed Conflict in Gaza: A Retrospective Time-Series Study at St John Eye Hospital, 2024–2026

Vision is a fragile thing, easily broken by the chaos of war. When a society fractures, the specialized care needed to repair sight often vanishes first. Eye surgery requires more than just a skilled surgeon; it needs delicate machines to magnify the eye, sterile tools to stitch membranes thinner than a hair, and a steady flow of electricity to keep the lights on. Without these, conditions that are easily fixed in peacetime—like a cloudy lens or a detached retina—can lead to permanent blindness. In the midst of conflict, the question becomes not just how to treat the injured, but how to keep an entire system of sight alive when the roads are blocked, the supplies are gone, and the population is on the move.

This story comes from a hospital network in Gaza that refused to close its doors. Between July 2024 and July 2026, researchers looked back at the records of every single person who walked into the St John Eye Hospital facilities, from its main building in Gaza City to temporary tents in refugee camps and mobile clinics driving through the dust. They wanted to understand what happens to the need for eye care when a prolonged war tears a region apart. They were not just counting injuries; they were mapping a landscape of human need, tracking how many people came for routine checks, how many needed glasses, and how many faced the terrifying prospect of losing their sight forever. The data they gathered covers nearly 37,500 visits, a massive census of a population trying to hold onto its vision while the world around it collapses.

The numbers tell a story of resilience and overwhelming demand. Over those twenty-five months, the hospital network saw nearly 37,500 patient visits. The people seeking help were a mix of all ages, but children made up a significant portion, accounting for nearly 30 percent of all visits. This is a critical detail, because a child's eyes are still developing; if a problem like a misaligned eye or a blurry vision is not fixed quickly, the brain can learn to ignore that eye, leading to permanent blindness that no surgery can later reverse. The elderly also made up a large group, representing about one-fifth of the patients, many of whom were struggling with cataracts, a condition where the eye's natural lens turns cloudy and blocks vision.

While the war brought violence, the data showed that the majority of visits were not for traumatic injuries. Only about 2.7 percent of the encounters involved documented eye trauma, such as cuts or bruises from shrapnel. The rest of the visits were for the slow, creeping conditions that plague any population but become impossible to manage without a functioning health system. The most common reason people came was for cataracts, followed closely by the need for new glasses to correct blurry vision. There was also a high volume of patients suffering from dry eyes and inflammation, likely worsened by the dust and poor living conditions in crowded displacement camps.

The researchers watched how the flow of patients changed over time, and the pattern was stark. In the early months of the study, when the conflict was at its most intense and access was severely restricted, the hospital saw only a few hundred patients a month. But as the hospital network adapted, opening new field units and mobile clinics to reach people who could not travel to the main building, the numbers surged. By late 2025, the monthly visits had jumped to over 3,000. This spike did not mean more people were getting hurt; it meant the hospital was finally able to reach the people who had been waiting in the shadows. The capacity to treat patients grew five-fold, showing that when you bring the care to the people, the need becomes visible.

Behind these visits lay a massive backlog of surgeries that simply could not be performed. The records revealed a demand for more than 13,000 specific medical interventions. The largest group was for cataract surgery, where nearly 5,700 people needed their cloudy lenses replaced to see again. There were also hundreds of children who needed surgery to straighten their eyes, and nearly 300 patients requiring complex vitreoretinal surgery. This type of surgery is among the most difficult in medicine, used to fix detached retinas or clear blood from the back of the eye. Without it, the damage is often irreversible. The data also showed a desperate need for regular injections to treat diabetic eye disease and thousands of prescriptions for glasses.

The study makes it clear that while the hospital managed to keep working, the system is under immense strain. The researchers noted that the numbers they recorded are likely just the tip of the iceberg. Many people, especially those in the most remote or dangerous areas, could not reach the clinics at all. The true number of people needing help is almost certainly higher than what was counted. Furthermore, the study highlights that the war has created a dual crisis: the immediate trauma of injury, which gets the most attention, and the silent, accumulating backlog of routine conditions that, if left untreated, will leave a generation of children and adults without sight.

To prevent this future blindness, the authors argue that the solution requires more than just emergency aid. It demands a steady, uninterrupted flow of the specific supplies that eye surgery needs: the tiny sutures, the special lenses, the gases used to hold the eye together during repair, and the power to run the microscopes. It also requires protecting the specialized centers where these delicate operations happen and expanding mobile teams to find children who need help before their vision is lost forever. The work done by this hospital network shows that specialized care can survive even in the worst conditions, but it cannot survive alone. It needs a lifeline of supplies and safety to turn the backlog of need into a reality of restored sight.