A major fallout of the assault on Gaza by the Israeli Defence Forces (IDF) has been the worsening health situation of the people there and the near collapse of the already deteriorating health services. On December 29, within two days of Israels massive air strike on Gaza, the World Health Organisation (WHO) called for an immediate end to hostilities and urged Israel to remove all blockades to ensure the immediate provision of much-needed food, water, fuel, medicines, critical life-saving and trauma-care supplies and other humanitarian aid.
The intense shelling in the first two days left 330 people dead and 900 injured, of whom 115 were in critical condition, with 25 admitted in intensive care units (ICUs). In those two days, Israeli fighter planes, helicopters and drones bombed over 240 targets, the majority of them reportedly within the first hour. According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Operation Cast Lead, as Israel calls it, caused one of the highest single-day death tolls recorded in the occupied Palestinian territory since 1967.
The blockade since June 2007 and the Israeli attacks during February-March 2008 had greatly weakened the health care system in the Gaza Strip, including the functioning of hospitals and the access to health services, affecting even basic supplies. The health workers strike that began on August 30 and continued until the December 27 Israeli attacks only compounded the worsening situation.
As hospitals in Gaza lack equipment and expertise, many patients are referred to hospitals in Israel, Jordan and Egypt for specialised care. However, the proportion of patients who could not cross over because permits were inordinately delayed or denied by the Israeli authorities increased substantially between 2006 and 2008. Since Hamas assumed authority in Gaza, the number of patients forbidden to leave it for security reasons has increased steadily. The current hostilities have only aggravated these problems.
The inability of the hospitals to cope with a problem of this magnitude, if the situation remains unchanged, said the WHO statement, will result in a surge of preventable deaths from complications due to trauma. As a top priority, the shortages of essential and life-saving medicines need to be abated without delay. The current escalation of violence only compounds the health situation and unnecessarily exacerbates the fragile status of the civilians caught up in this conflict.
On December 29, Health Minister Bassem Naeem stated that hospitals in Gaza had run out of 105 essential medicines. There was also zero stock of 225 consumables and 93 items required for blood banks and laboratories.
Even though U.N. agencies and the International Committee of the Red Cross (ICRC) have been able to organise medical supplies in the past few days, the main challenge, according to the OCHA, is the shortage of medical equipment and spares. According to the WHO, at least 1,000 medical machines are out of order. The Ministry of Health (MoH) of the Palestine Authority (P.A.), headquartered in Ramallah in the West Bank, in fact reported even a shortage of trucks to deliver medical supplies to the hospitals and a lack of proper storage capacity.
The WHO appeal warned of a rise in deaths and human suffering if the IDF attacks continued, with the civilian population bearing the brunt. With Israeli forces occupying thickly populated areas, which have become battle grounds, civilian populations have been put at grave risk.
There is no safe space in the Gaza Strip no safe haven, no bomb shelters, and the borders are closed, making this one of the rare conflicts where civilians have no place to flee, notes the OCHA report of January 7.
Since ground operations began, the death toll has risen sharply. On January 6 alone, the bombing of a school run by the U.N. Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA) in Jabalia killed 43 persons and injured 100. The Israelis claimed that the school was being used to fire mortars at the Israeli army, which the UNRWA rejected outright.
According to the MoH, as of January 7, as many as 683 Palestinians, about 15 per cent of them children, have been killed and at least 3,085, over 50 per cent of them women and children, injured. Of particular concern is the growing number of children killed and injured. Children account for nearly 56 per cent of the population in Gaza, and they remain dangerously exposed to the fighting around them, says the OCHA. The actual number of innocent victims would be greater as many are probably trapped, injured or dead under the rubble of buildings. According to the WHO, people were rushing to bury the dead without notifying the health authorities. Besides, many of the injured are not able to gain access to hospitals as Gaza has been virtually divided into two because of occupation by the IDF. Thus internal movements, even to transport medicines, remain dangerous. Only on the afternoon of January 7, the OCHA was able to coordinate, for the first time, a three-hour humanitarian ceasefire to allow the civilian population to gain access to medical services.
Even medical personnel are unable to report to work. On January 5, the ICRC attempted in vain to coordinate safe passage for a bus with 58 hospital staff. At the time of writing, the Palestinian Red Cross Society has waited for 48 hours for Israeli approval to reach those killed or wounded. Similarly, an ICRC team of war surgeons waited for over two days before it was granted access to Gaza to address the lack of surgical staff.
According to the MoH, six medical personnel have been killed and 30 injured, while 11 ambulances and three yet-to-be-used mobile clinics (donated by Spain) have been damaged in the attacks. Most of the windows of two paediatric hospitals have been broken in continuous shelling. As a result, all in-patients had to be kept in one ward of one of the hospitals. Only plastic sheets have been placed over windows of the affected wards, causing immense hardship to patients in the cold weather. There are fears of more attacks on hospitals after Israel alleged that Hamas may be using hospitals as hideouts. The director of El Wafa Rehabilitation Hospital, Gazas only rehabilitation hospital, received orders from the IDF to evacuate all staff and patients, but he refused, and everyone continues to be in the hospital.
In its report on January 6, the WHO stated: International Humanitarian Law requires all medical personnel and facilities to be protected at all times, even during armed conflict. Attacks on them are grave violations of International Humanitarian and Human Rights Laws.
Gaza has 27 hospitals. Thirteen of them are managed by the MoH and together have about 1,500 beds. Private hospitals and those run by non-governmental organisations have about 500 beds. Doctors are on 12-hour shifts, with some of them doing even 24-hour shifts. The MoH also manages 565 primary health care centres (PHCs), 24 of which are assigned to handle emergency services. Many of them remain closed periodically because of intense military activities. The MoH has also deployed many of the PHC staff to work in hospitals to meet the shortage of hands. In addition, the UNRWA manages 18 PHC centres, of which only 13 are functioning now.
The Shifa Hospital in Gaza City in the north is the main referral centre for specialised intervention, but the bisection of Gaza has made it impossible for patients from other parts of Gaza to reach Shifa. External referrals are coordinated exclusively through the Rafah crossing whenever it is open.
The division of Gaza has further complicated this process. On January 4, for example, 45 ambulances waited on the Egyptian side as damage to bridges and roads prevented both ambulances and patients from reaching Rafah. Also, the MoH has stopped all referrals to Israeli hospitals. As of January 7, a total of 133 patients have been evacuated through the Rafah crossing.
Since hospitals are being overwhelmed by the large influx of patients, they have adopted a strategy of discharging non-emergency patients quickly so as to free up beds for new casualties. But this, points out the OCHA, could seriously affect patients who need follow-up. According to the OCHA, the ICUs throughout Gaza are overloaded and there is an urgent need to evacuate the patients out of Gaza.
Mental and psychiatric problems are widespread among the traumatised people. While mental health centres remain open, the Gaza community mental health programme has suspended its activities. The programmes main building suffered serious damage in one of the attacks on December 27.
A factor that is most seriously hampering medical services is the extensive damage to infrastructure in Gaza, particularly the supply of electricity, fuel and water. Nearly 75 per cent of Gaza has no electricity. The only power plant (it meets 51 per cent of the demand), which was in any case functioning only intermittently since November 2007 after Israel suspended delivery of industrial fuel for its operations, had to shut down on December 30, resulting in power outages that last 16 hours on average daily. In addition, 15 transformers have been damaged in the air strikes. There are no transformers available in Gaza; five transformers purchased are sitting outside Gaza and need coordination to be brought in.
Moreover, owing to damage to supply lines, even power purchased from Israel and Egypt is unavailable, and military attacks prevent these lines from being repaired.
All hospitals in Gaza have been without electricity since January 3. These were in any case depending on generators during the long power cuts. But the hospitals have warned that the generators are close to collapse and that they have fuel for only a few more days.
At the Shifa Hospital alone, this would have immediate consequences for 70 ICU patients, including 30 in neonatal care. Twelve operating rooms would be affected immediately, besides the shutting down of oxygen extractors, refrigerators for blood units and machines for emergency services. Also, all hospitals would be without heating and lighting. Lack of electricity has rendered only three of the PHCs functional.
Gazas water and sewage system is on the verge of collapse without power and fuel. Nearly 70 per cent of the population does not have access to running water. People who do run the risk of getting contaminated supply from the leakage of waste water. Sanitation services (including waste disposal) have not been working because of the continued hostilities. After five of Gazas 37 waste-water pumping stations shut down, sewage is flooding the farm lands of Beit Lahiya in northern Gaza and emptying into the sea. The remaining stations reportedly have fuel only for a few days. Following damage to the main pipeline between Beit Hanoun and the Ben Lahiya waste-water treatment plant, sewage is pouring into the streets of Beit Hanoun. According to the OCHA, the sewage situation has become highly dangerous, posing the risk of water-borne diseases spreading.
While the U.N. and other international agencies are struggling to control the situation, their power to intervene remains severely limited. Unless Israels aggression is brought to an immediate halt, Palestinians will be left to face the worst ever health crisis in their history.
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