Despite the ceasefire in Gaza, other conditions in US President Donald Trump’s 20-point peace plan are not being met. Israeli attacks on Palestinians have continued, while the required aid of around 600 trucks per day has not materialised, owing to the Israeli blockade. As a result, Gaza’s humanitarian catastrophe continues to unfold.Moreover, Israel has not complied with the International Court of Justice’s October 22 advisory opinion requiring the unhindered provision of humanitarian aid by the UN and its entities to civilians in the Gaza Strip. The famine that the World Health Organisation (WHO) confirmed in northern Gaza in August is spreading; more than a half-million people face starvation. The death toll – which has already surpassed 69,000, including at least 20,000 children – is set to rise.Such a ceasefire does not bring peace; it prolongs suffering. Worse, Trump’s 20-point plan calls for “technocratic governance” by external actors, another barrier to recovery – particularly when it comes to reconstructing Gaza’s healthcare infrastructure. Post-conflict recovery in Iraq, Bosnia, and Rwanda has shown that rebuilding health systems requires engaging and strengthening local institutions, rather than relying on outside experts.The sheer scale of institutional destruction in Gaza implies a far more formidable challenge than in other conflict-ridden territories. Consider that child mortality in Iraq more than doubled from 1984-89 to 1994-99, following damage to water and health infrastructure in the 1990-91 Gulf War, which was less ruinous in its effects. While UN sanctions compounded the damage in Iraq, WHO Director-General Tedros Adhanom Ghebreyesus has warned that Gaza faces a health “catastrophe” that will last for “generations to come”. Global engagement in Gaza must be motivated by solidarity, not charity. The Gaza Health Declaration, signed by more than 40 prominent Palestinian health professionals, recognises the “long histories of complacency, complicity, and collusion by many international humanitarian and development actors and donors”, and rightly calls for Palestinian sovereignty and agency to be at the centre of rebuilding efforts.In practice, that means placing Palestinians in leadership positions to guide the recovery of Gaza’s healthcare infrastructure at all stages, from design and planning to co-ordination and monitoring; ensuring that Palestinian organisations are the main administrators of health programmes; and refraining from establishing parallel systems that undermine national ones. It will also be important for the international community to provide flexible, long-term capital, rather than project-based funding that strips Palestinian institutions of their agency. Lastly, health sovereignty depends on political sovereignty, which will require ending Israel’s blockade and occupation.Palestinians have already proven themselves capable of leading recovery efforts. Despite more than 800 attacks on medical facilities and personnel in Gaza since the war began, which have left 94% of hospitals damaged or destroyed, the health system has demonstrated remarkable resilience. The Palestinian Medical Relief Society continues to provide mobile health clinics, nutrition centres, and community-based care in the territory, while the Gaza Health Ministry has coordinated service delivery, medical logistics, and workforce planning. Al-Shifa and Al-Ahli hospitals in Gaza City are operating at nearly 300% over capacity, with a constant influx of complex trauma injuries.The question is whether the international community will support Palestinian leadership or continue to undermine it. The WHO’s operational response and early recovery plan for Gaza offers useful starting points for addressing the population’s health needs. But success will depend on linking immediate lifesaving interventions with long-term efforts to strengthen institutions and local governance.Failure to do so would have serious consequences. In Bosnia, efforts to rebuild the health system faltered when donor-led projects eschewed local ownership. And in Iraq, the reconstruction of health infrastructure was not accompanied by measures to restore accountability, producing fragile institutions incapable of sustaining services.To avoid these pitfalls, emergency assistance in Gaza – including restoring access to fuel, water, and medical supplies – should be designed and implemented in ways that reinforce institutional credibility and stability. Only then can policymakers devise broader strategies to rebuild clinics and sanitation systems, expand vaccine coverage, and integrate psychosocial and gender-based-violence care into community health.Over time, predictable and locally governed health-service delivery will strengthen public trust in institutions, bolster the national health system’s legitimacy, and help create the conditions for peace, as occurred in Rwanda, where early health programs were tied to national systems.But unlike Rwanda’s nationally led health response following the 1994 genocide, Trump’s 20-point plan for Gaza treats social services as an add-on to a political settlement. This is a mistake. As South Africa’s post-apartheid transition shows, and research on forging resilient social contracts corroborates, legitimacy erodes when services fail to materialise. Bread lines and clinic queues are political spaces where people decide whether the government is serving or subjugating them.The real measure of Gaza’s recovery is how effectively short-term relief builds enduring national institutions that allow Palestinians to regain dignity and disengage from militias. When hunger and humiliation persist under externally imposed systems, violence is sure to follow. Ensuring that a mother can feed her child, a clinic has power, and safe drinking water flows from taps is a foundation for the day after. Peace takes hold only when the capacity to provide for basic material needs is developed from within. – Project SyndicateTurnwait Michael is a postdoctoral researcher on demography and population health in the Faculty of Humanities at the University of Johannesburg.Erin McCandless is Professor of Politics and International Relations and Director of the Qatar-South Africa Center for Peace and Intercultural Dialogue in the Faculty of Humanities at the University of Johannesburg.