This research insight provides an analytical and methodological synthesis of the master’s thesis: “Medical Intelligence: A four-dimensional framework applied to the Gaza Humanitarian Crisis”. It outlines a theoretical model of systemic interdependencies, demonstrating its potential for humanitarian crisis management within the landscape of contemporary hybrid threats.
Press articles, documentaries, and firsthand accounts from healthcare workers paint a clear picture of the humanitarian atrocities plaguing territories like the Gaza Strip, Sudan, and Ukraine. This health crisis has moved from being a temporary emergency to becoming a structural condition, and despite the efforts of humanitarian organizations and local authorities, it shows no signs of abating. In these contexts, various agencies work tirelessly to collect and analyse data to optimize the crisis management process and ensure vital assistance to affected populations. However, for purely operational reasons, the analysis remains clustered to avoid any overlaps that could slow down and hinder relief efforts1. Nevertheless, the priority given solely to the humanitarian dimension ends up producing an analytical fragmentation of what is, in reality, a systemic emergency.
The humanitarian crisis is, in fact, the result of multiple interconnected factors that, in addition to undermining a state’s welfare, have the potential to have a destabilizing impact on national and international security. It is therefore no longer sustainable to view national security in isolation from the resilience of the healthcare sector, because, as explained in the Healthcare and Public Health (HPH) Sector-Specific Plan of the United States2, the healthcare sector is intrinsically linked to other strategic assets of the nation. An attack on the technology or transportation sectors has direct or indirect repercussions on healthcare, which is the most sensitive of all. Specifically, in it, the threat not only affects the efficiency of a service but endangers the supreme good of human life. When life itself is threatened on a large scale, healthcare vulnerability ceases to be relevant only in terms of public health and acquires significance from the perspective of state stability as well. A state’s failure to guarantee the right to healthcare not only produces a clinical crisis, but also triggers a system of institutional delegitimization, increasing the risk of social unrest and providing fertile ground for extremist narratives and radicalization processes. A case in point is ISIS, which has integrated COVID-19 into its propaganda, calling it a “soldier of Allah”3 come to punish the West, thus inflaming social alienation and incentivizing recruitment. The stability of the healthcare system thus becomes an essential condition for a nation’s resilience, placing the management of medical emergencies within the purview of Medical Intelligence.
However, if healthcare is intrinsically linked to the nation’s other “lifeline functions”, Medical Intelligence must evolve conceptually to effectively operate in such fluid contexts and to capture the metamorphosis of its raw material: health data. This data can no longer be generically confined solely to the scope of medical records or epidemiological bulletins; today, health data takes on a much broader scope, as it is capable of extending simultaneously into the physical, digital, and social spheres. Daily life and the surrounding environment have become continuous generators of health information: from biometric data collected by wearable devices to the activity tracked by fitness apps, to communication flows with therapeutic chatbots and the digital traces left by search queries on symptoms and diseases. This shift transforms health data into a pervasive and uninterrupted stream, making it a security asset that extends far beyond the boundaries of the healthcare network. Its strategic value becomes clear when analysing phenomena that appear unrelated. We have seen, for example, how the Strava app has transformed simple fitness and location data into critical geopolitical indicators, revealing the locations of secret military bases4, or how bioterrorism uses dual-use technologies to target the diplomatic sphere and subvert the balance of power. Furthermore, in such scenarios, the inability to trace the origin of an outbreak with certainty immediately triggers a battle for the narrative, where state actors and conspiracy theories intertwine to erode trust in institutions and generate social panic.
The evidence that emerges from these examples is that health data, by its very nature, bears the traces of complex interconnections between biology, power, technology, and perception. Isolating clinical data from its context effectively means remaining bound to that classical doctrinal conception5 that relegates Medical Intelligence to a purely tactical, reactive function linked to Force Protection. This type of approach is now inefficient. For this reason, there is a need to develop a new framework based on four dimensions – epidemiological, geopolitical, technological, and narrative – capable of reflecting the hybrid nature of contemporary threats and of health data itself. Adopting a model that views these domains not as distinct areas but as nodes in a single network of vulnerabilities takes the analysis to a deeper level, revealing so-called “hidden risks” – that is, latent critical issues that remain invisible to traditional sector-based analyses precisely because they are nestled in the “gray areas” between one domain and another. From this perspective, if health is the point where tensions originating elsewhere converge, then monitoring healthcare resources alone is no longer sufficient to protect it. Instead, the priority is to map the pathways along which the hybrid threat spreads, transforming Medical Intelligence into a proactive tool capable of intercepting the ripple effects before they lead to the collapse of systems, thereby endangering national and international security.
By applying this concept to the context of the Gaza Strip, it is possible to identify structural dynamics that media narratives often tend to oversimplify, reducing the complexity of the crisis to the single variable of the geopolitical blockade. Although humanitarian agencies conduct much more detailed technical monitoring, public debate focuses almost exclusively on the borders, fuelling the idea that lifting the blockade is the definitive solution to every problem. However, such a view is superficial: the closure of the border crossings, while a key element, is only one of the factors provoking the crisis. If the blockade were lifted tomorrow, would the threat to public health and security disappear? The answer is no. Even assuming a scenario in which goods could flow freely through the border crossings – and thus there were sufficient fuel supplies to ensure the full operation of healthcare facilities – the risk would still remain critical.
Taking Al-Shifa Hospital as an example – which serves as a pivotal hub in the Gaza Strip’s healthcare network – it becomes clear that its vulnerability is not only the result of restrictive border controls that limit external supply flows (geopolitical dimension), but also stems from a complex convergence of technological and infrastructural challenges (technological dimension). On the one hand, the dilapidated state of the power grid prevents proper energy distribution6, rendering even the potential availability of sufficient resources futile. On the other hand, forced digital isolation – caused by obsolete mobile networks and pervasive telecommunications surveillance – hinders technological innovation and fosters an oppressive environment that also has a severe impact on the community’s mental health7. However, Al-Shifa’s vulnerability also stems from its spatial and symbolic location. Situated in the most densely populated area of the entire Gaza Strip, the hospital is condemned to a state of perpetual overcrowding which, in the event of an epidemic, transforms it from a place of care into a potential epicentre for the spread of infection (epidemic dimension). Furthermore, precisely because of its vital importance, the facility is the primary target of a systematic campaign of informational delegitimization, aimed at undermining its protected status to justify military action (narrative dimension)8.
This demonstrates that the crisis in Gaza is not a “sectoral” emergency – that is, one that can be resolved by injecting resources into a single sector such as energy or healthcare – but a structural crisis that persists regardless of the availability of resources. While sectoral vulnerability concerns a shortage of “hardware” (a lack of medicines, hospital beds, fuel), structural vulnerability concerns the connections between the various nodes.
In a crisis, collapse does not occur because a single element is missing, but because pressure on one dimension triggers a domino effect on the others. The healthcare system in the Gaza Strip is compromised not only by what it lacks, but by how it is interconnected: it is a system in which biology, technology, geopolitics, and narrative merge into a powerful instrument of hybrid warfare.
A retrospective assessment of this scenario highlights the inadequacy of current analytical models, as – while they capture fragments of reality – they fail to convey the integrity of the entire mosaic. A purely sectoral approach, typical of the humanitarian response, would in fact be limited to framing Gaza’s fragility as a public health emergency, focusing almost exclusively on the logistical management of relief efforts. Conversely, traditional Medical Intelligence, bound by the tactical paradigms of NATO or the U.S. Department of Defense, would end up mapping the healthcare system through a purely military lens. Based on this logic, critical infrastructure such as Al-Shifa would be considered solely as targets to be protected or neutralized for Force Protection purposes or to gain a tactical advantage on the ground.
The four-dimensional framework, on the other hand, has the potential to overcome the methodological limitation of Medical Intelligence, as it effectively combines the “Medical” and
“Intelligence” dimensions by integrating health data into a full-fledged intelligence cycle. By monitoring precursors across the four identified domains, it becomes possible to construct predictive scenarios capable of proactively tracking interdependent effects. The strength of the model lies in its ability to adapt to the very nature of globalization, where the logic of “lifeline functions” and “hidden risks” shapes the resilience of every modern society.
The goal of modern Medical Intelligence is therefore to function as a multidisciplinary bridge, bringing together clinical expertise, social sciences, and strategic analysis to identify the exact moment when a seemingly health-related threat is about to spill over into the realm of national and international security. Only through this ability to “read” systemic interdependencies is it possible to formulate responses that, in addition to managing the emergency and protecting human life, also serve to preserve global stability.
Vittoria Oddo is Master’s graduate in Public Policy – Crime and Security Analysis, Catholic University of Sacred Heart, Milan
- UNHCR, ‘Cluster Approach’, 22 August 2025, https://emergency.unhcr.org/coordination-and-communication/cluster-system/cluster-approach. ↩︎
- U.S. Department of Homeland Security, Healthcare and Public Health Sector-Specific Plan (2016), https://aspr.hhs.gov/cip/Documents/2016-hph-ssp.pdf. ↩︎
- Pamela Faber et al., Viral Extremism: COVID-19, Nontraditional Threats, and US Counterterrorism Policy, IOP-2021-U-029346-Final, CNA’s Occasional Paper Series (CNA, 2021), 11, https://www.cna.org/reports/2021/03/IOP-2021-U-029346-Final.pdf. ↩︎
- Valentina Avon, ‘Caso Strava, Anche Le Basi e i Militari Italiani All’estero Svelati Dalla App Di Fitness’, La Repubblica, 31 January 2018, https://www.repubblica.it/tecnologia/2018/01/31/news/strava_tracce_soldati_italiani_missioni_estero-187724827/. ↩︎
- The term “classical doctrine” refers to the official definitions provided by the major defense agencies. NATO defines Medical Intelligence as: “Intelligence derived from medical, bio-scientific, epidemiological, environmental and other information related to human or animal health. This intelligence, being of a specific technical nature, requires medical expertise throughout its direction and processing within the intelligence cycle”. See NATO, Allied Joint Medical Doctrine for Medical Intelligence, NATO STANDARD / Allied Joint Medical Publication AJMedP-3 (2020), https://www.coemed.org/files/stanags/02_AJMEDP/AJMedP-3_EDA_V2_E_(1)_2547.pdf; similarly, the U.S. Department of Defense states that: “Medical Intelligence is that category of intelligence resulting from collection, evaluation, analysis, and interpretation of foreign medical, bio-scientific, and environmental information that is of interest to strategic planning and to military medical planning and operations for the conservation of the fighting strength of friendly forces and the formation of assessments of foreign medical capabilities in both military and civilian sectors”. See Deputy Executive Secretary, Definitions of Intelligence, NFIB-24.1/14 (National Foreign Intelligence Board, 1977), https://www.cia.gov/readingroom/docs/CIA-RDP91M00696R000300020022-8.pdf. ↩︎
- DW, Gaza Strip: Heat Fuels Frustration over Living Conditions, 4 August 2023, https://www.dw.com/en/gaza-strip-heat-fuels-frustration-over-living-conditions/a-66439102. ↩︎
- Mona Shtaya, ‘Nowhere to Hide: The Impact of Israel’s Digital Surveillance Regime on the Palestinians’, Middle East Institute, 27 April 2022, https://www.mei.edu/publications/nowhere-hide-impact-israels-digital-surveillance-regime-palestinians. ↩︎
- Emanuel Fabian, ‘IDF Exposes “Hamas Sites” in Gaza Civilian Areas, in Bid to Explain Future Strikes’, The Times of Israel, 27 July 2022, https://www.timesofisrael.com/idf-exposes-hamas-sites-in-gaza-civilian-areas-in-bid-to-explain-future-strikes/. ↩︎