External environment analysis and crisis management at Al-Shifa Medical Complex, Gaza

mohamed alay, Nizam M El-Ashgar, Yousef I. Aljeesh, Bassam A. Tayeh

Objective: To analyse the external environment of senior management at Al-Shifa Medical Complex in Gaza using the PESTEL model, and to measure its effect on crisis management.

Design: Descriptive analytical cross-sectional study using a comprehensive survey and semi-structured interviews. A 74-item questionnaire (Cronbach’s alpha = 0.839) rated each item from 1 to 10 and classified it as a threat, opportunity, weakness or strength.

Setting: Al-Shifa Medical Complex, the largest governmental referral hospital in the Gaza Strip, Palestine, in 2019, before the 2023–2024 war.

Main outcome measures: Mean ratings of the political, economic, social, technological, environmental and legal fields and of crisis management, compared with the neutral value (5.5) using one-sample t-tests; and the effect of the six fields on crisis management using multiple linear regression.

Results: Seventy of 73 senior managers participated (95.9%). The political field had the highest mean (7.62), driven by the blockade (8.57) and the closure of crossings (8.43). The economic, social, technological and legal fields and crisis management were rated significantly above neutral, whereas environmental sustainability practices were not (5.78; p = 0.117). Job descriptions for health service providers were clearly lacking (3.93), and there was no evidence of legal protection for health workers, a special crisis budget, or an activated crisis management unit. The six fields explained 35% of the variance in crisis management (adjusted R² = 0.349; F = 7.169; p < 0.001); the legal field was the only significant predictor (β = 0.539).

Conclusions: Before the war, senior management worked within a hostile political and economic environment and relied on pre-prepared scenarios, but lacked key institutional safeguards. A clear legal and regulatory framework appears central to crisis management. These findings provide a documented baseline for rebuilding the health system in Gaza.

Digital transformation and international student choice in hospital administration education in India

Vishal Indurkhya, Bhoomadevi A, Hem Chandra

Digital health and artificial intelligence are changing the skills required of hospital administrators and the way they are trained. This structured narrative review examined digital and AI-related competencies, the preparedness of hospital administration education in India, India’s digital-health ecosystem as a learning environment, and factors influencing international students’ program and destination choices. PubMed/MEDLINE and Google Scholar were searched for publications from January 2015 to June 2025, with an update through August 2026. The review identified five key competency areas: digital and AI literacy, data-informed decision-making, use of digital technologies in hospital operations, digital leadership and workforce development, and responsible AI use. Educational preparedness depends on curriculum relevance, program quality, faculty capacity, practical learning, and continuing professional development. India’s digital-health system offers opportunities for practical exposure, although readiness and implementation remain uneven. International students’ choices are also influenced by program quality, recognition, affordability, career prospects, safety, institutional support, and sociocultural factors. The proposed framework links digital-health transformation with educational preparedness, program value, and international student choice, but requires further empirical testing.

Asia Pacific Journal of Health Management

External environment analysis and crisis management at Al-Shifa Medical Complex, Gaza

Digital transformation and international student choice in hospital administration education in India