Establishing a multidisciplinary pain clinic in Gaza: navigating humanitarian, coordination, and collaborative challenges in an active conflict area

The prolonged humanitarian crisis in Gaza has overwhelmed hospital capacity, accompanied by the collapse of health infrastructure, severe physical exhaustion and starvation among local healthcare workers, and a total blockade restricting humanitarian access. Coordinating international Emergency Medical Teams (EMTs) in an active conflict zone poses substantial logistical, ethical, and cross-cultural challenges. To document the establishment process, humanitarian coordination challenges, and collaborative strategies of a Multidisciplinary Pain Clinic (MPC) initiated by the BSMI–Universitas Brawijaya EMT in Gaza, and to evaluate its clinical benefits for war-related pain and torture-associated conditions, with a focus on quality of life and functional recovery. A mixed descriptive approach was employed, incorporating systematic participatory observation, documentation of EMT coordination with local healthcare providers, field-based ethical analysis, and structured interprofessional reflection. The MPC integrated international specialists and local medical personnel operating in field tents under extreme resource constraints and persistent security threats. The MPC successfully implemented adaptive multimodal pain management strategies despite severe logistical disruptions caused by the blockade, ethical challenges related to scarce resource allocation, cross-cultural communication barriers, and widespread trauma among local healthcare workers. Clinical benefits included improved chronic pain control, enhanced mobility, and reduced psychological distress among war survivors and victims of detention-related torture. Key enabling strategies included on-site nerve block training to support sustainable local capacity, real-time adaptation of protocols to available resources, and culturally sensitive, trustbased collaboration. This experience demonstrates that effective EMT deployment in conflict settings requires operational flexibility, ethical sensitivity, and strong partnerships with local providers. Multidisciplinary pain clinics play a critical rehabilitative and dignity-restoring role for war victims, contributing meaningfully to quality-of-life improvement amid complex humanitarian crises.