Neurological trauma care in Gaza during prolonged conflict: a retrospective descriptive analysis of aggregated hospital data.

BACKGROUND

Neurosurgical care during prolonged conflict is constrained by disrupted infrastructure and limited resources. We describe the recorded cranial and spinal trauma workload, interventions, and operative discharge outcomes at two hospitals in Gaza.

METHODS

We retrospectively analyzed de-identified aggregate summaries from European Gaza Hospital and Nasser Medical Complex covering October 7, 2023, to October 31, 2025. Analyses were descriptive, using reported cohort denominators. Spinal involvement combined penetrating spinal, closed spinal, and combined cranial-spinal categories. Exact binomial 95% confidence intervals (CIs) were calculated for operative outcomes.

RESULTS

Summaries reported 7,876 patients evaluated and 1,438 operative patients (18%). Penetrating brain injury accounted for 47% (3,684/7,876). Spinal involvement accounted for 38% (2,978/7,876), including 13% with combined cranial-spinal injury (1,028/7,876). Recorded procedures included 758 decompressive craniectomies, 496 craniotomies/foreign-body removals, 385 thoracolumbar fixations, and 139 cervical fixations; groups overlapped. Operative in-hospital mortality was 15% (216/1,438; 95% CI 13.2-17.0), and recorded survival to discharge was 85% (1,222/1,438; 95% CI 83.0-86.8).

CONCLUSION

Recorded neurotrauma activity encompassed a substantial spinal component alongside cranial injury, supporting inclusion of both cranial and spinal capability in conflict neurosurgical planning. The report provides a descriptive reference for service preparation and preserves a historical record of care at two Gaza hospitals during profound health system disruption.