In this paper, I argue that the political economy of charitable care, combined with the pious practices inherent to evangelical missions, calcified a Gazan healthcare infrastructure persistently beholden to international finance and administration. I apply Melanie Tanielian’s conception of “distributive charity,” which “forges a continuous relationship between the recipient and the giver,” to understand how precarity, piety and the legitimacy of medical practice intertwined at the intersection of local, regional and global interests. At the same time, I push back on the binary of “the recipient and the giver” to demonstrate how local physicians, staff members and students defined aspects of the Baptist hospital. The practices of the missionary hospital, both medical and missional, provided a space for a variety of local actors to shape the meanings of the institution and its role in Gazan healthcare. This paper relies on missionary records, UNRWA reports and hospital-affiliated memoirs to explore the contested reconstruction of the missionary hospital and the Gaza healthcare system after 1948.