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Update on the Current Gaza Situation……

June 3, 2010

Gaza Strip

The War on Gaza: December 27th, 2008 – January 18th, 2009

The Gaza Strip has been the setting for a protracted political and humanitarian crisis for several years by different Israeli policies against Palestinians including continuous aggression, collective punishments, economic embargo, and violations to human rights, as well as a tight blockade and war. Saturday morning, the 27th of December 2008, Israel started a massive military offensive in the Gaza Strip, with air strikes, and naval bombardment followed by a ground offensive, and using of internationally prohibited weapons leaving behind death, destruction and intense suffering for a whole population in Gaza.

The 3 weeks of the devastatingly harsh and relentless Israeli military offensive on Gaza Strip killed 1,440 people, of whom 431 were children and 114 were women, according to the OCHA reports. This number does not include those who have died due to lack of access to regular health care (including obstetric care and treatment for chronic diseases). The number of injuries still stands at 5,380, of whom 1,872 are children and 800 are women, according to the MoH reports. 16 health staff members were killed and 25 injured while on-duty too. Injuries were often multiple traumas with head injuries, thorax abdominal wounds and loss of parts of extremities that left more than 600 people with permanent disability.

Children in particular suffered the most. Terrified and displaced, they were unable to deal with their new realities. Many children have lost their homes, schools and have to deal with the loss a loved one, whether a family member or a classmate. The magnitude of the disaster was unbearable. Many may know the numbers of those affected but only a few can relate to the stories of these children.

The war caused massive damage to Palestinian infrastructure; Whole neighbourhoods were turned into rubble. Schools, kindergartens, hospitals, fire stations and ambulances on duty were damaged by shelling. Also more than 4000 homes were destroyed or badly damaged. Thousands of citrus, olive and palm groves, wells and greenhouses, including those far inside the Gaza Strip, were uprooted.

People were seeking safe places but couldn’t find any, and they kept moving from one place to other, an estimated 80,000-90,000 Gazans were displaced, seeking refuge in shelters, camp or at the homes of families and friends. The aftermath also witnessed a humanitarian crisis with thousands of Gazans left homeless in temporary shelters.

An Endless Blockade

For the past three and a half years, Gaza has been under a tight blockade imposed by Israel which has affected all aspects of daily living and development. It affected all sectors of society including industrial, agricultural, economical, health and social. It also increased levels of poverty and unemployment which have become unbearable. Before Hamas came to power in Gaza, over 14,000 trucks of goods entered Gaza daily. By April 2009, that number was reduced to 2,000.

While the war on Gaza has intensified the suffering of people and destroyed the infrastructure, the endless blockade of Gaza continues to sustain this suffering and prevents effective intervention.

Since January 2010, Gazan residents have had to deal with electricity cuts from 8-12 hours per day (as opposed to 6-8 hours per day prior to January) because of lack of funds and ability to purchase sufficient industrial fuel for the power plant. This makes an even larger impact on daily life in Gaza–especially with respect to health care, sanitation and water services, and education.

UNRWA reported that items such as candles, books, crayons, shoes, sheets, blankets, coffee and shampoo are refused entry. Given that allowing these items entry would pose no security threat to Israel, the only logical conclusion is that refusing such items amounts to punishing the population.

The blockade has had a huge effect on the economy of Gaza. Before Operation Cast Lead (Israel’s last offensive on the territory in December 2009-January 2010), the World Bank estimated that only 2% of industrial establishments were still functioning. It’s safe to say that number is even less now. One of the hardest hit sectors is agriculture–because most goods are not allowed to leave the strip to be sold outside, most of the produce has to be destroyed or sold at a loss on the local markets. Unemployment is over 50%.

Damage to Health Care Infrastructure

The health sector has been on the brink of collapsing, unable to cope with the soaring numbers of casualties and fatalities. The war caused serious damage to health services infrastructure where 15 of 27 Gaza’s hospital, 43 of 110 primary health care (PHC) clinics, and 29 of 148 ambulances were partially or completely damaged during the war.

Access to health care was severely restricted and hampered by security constraints. Several PHC centres of different health providers were closed during part of or all of the period of the war. It is estimated that, during the military operation, 40% of the chronically ill interrupted their treatment. These concerns were exacerbated by the virtual halt of referrals of ordinary patients outside Gaza as life-threatening injuries had a higher priority in an overwhelmed system. Elective surgery and non-urgent routine medical interventions were delayed or interrupted during the crisis. Maternal and child health services at PHC levels were disrupted.

 Psychological Trauma in the Palestinian Territories

Trauma from Operation Cast Lead and the high level of violence that is constant in the Gaza Strip (and West Bank to a lesser extent) has caused a high level of psychological disorders in Palestinians living there—with an especially high toll on the children, who make up over half the population of the territory. According to Medecins Sans Frontieres (MSF)/Doctors Without Borders, even short-term psychological support can ease the burden of violence-induced psychiatric disorders—especially in children.

MSF conducted a study on data collected from 1,369 patients  (773 in the Gaza Strip and 596 in Nablus—a West Bank city with a high level of violence from the Israeli military) who received psychological support between January 2005 and December 2008.  23.2 % of these patients had PTSD, 17.3 % had an anxiety disorder (other than PTSD) and 15.3% had depression.

PTSD was more common in children under the age of 15, while depression was the main symptom found in adults. Among children under 16, factors significantly associated with PTSD included being witness to murder or physical abuse, receiving threats, and property destruction or loss. 65% of patient took part in individual, short-term psychotherapy, with 30.6% requiring psychotropic medication along with counselling.

Following psychotherapy, 82.8% of children and 75.3% of adults had improved symptoms. Among patients that showed no improvement or aggravated symptoms at the last session, the main persistent symptoms were sadness and aggressive behaviour. The study concluded that “These observations suggest that short-term psychotherapy could be an effective treatment for specific psychiatric disorders occurring in vulnerable populations, including children living in conflict zones, such as the Gaza Strip and the West Bank.” (Study was published in the International Journal of Mental Health Systems)

Operation Cast Lead: “War is Hell on the Brain”

According to a Ministry of Education assessment, at least 922 registered schoolchildren were injured during Operation Cast Lead, around 732 of them will live with long-term disabilities as a consequence of the war. Many children lost classmates, friends, and/or siblings and remain very much psychologically scarred.

The scale of violence during Cast Lead exposed Gazan children to unprecedented levels of stress, many witnessed horrific scenes of violence and there was no place that they could feel safe—their parents could do nothing to protect them, many of their homes and schools were destroyed indiscriminately. Children in Gaza exhibit behaviour problems such as increased levels of violence, depression, sleeping disorders, falling mute, fear and anxiety, changes in attachment to family and community, inability to concentrate, learning difficulties, and loss of recently acquired skills. An estimated 14,000-28,000 children need psychological support as a result of the war.

 Fatima B (Case 28)

“My daughter Fatima is in a very bad psychological state. Every night she dreams of Israeli aircraft attacking her; one night they kill her, another night they injure her. She wakes up in the middle of the night screaming and sweating. She needs her nerves to be examined because of her head injury that led to a mild tremor in her limbs. This tremor has affected her studies. She had beautiful handwriting before the incident…which resulted in her shaking and her handwriting is no longer clear and understandable. She refuses to go to school. I advised her to go and sit for the final exams in May. She passed all the subjects but her average marks dropped.

Fatima forces me to put a scarf over her head whenever she goes to school because of the big bald patches in her hair after she underwent surgery…she refuses to leave the house in the evening because she is afraid of darkness. These days whenever she hears Israeli aircraft, she becomes scared and rushes back to the house  and then to her room. In the daylight, her face injuries are very apparent. She has marks on her face; dark brown spots. Whenever she walks under the sun, the brown marks turn black. I do not know how to treat her and get her back the way she was before.” –Azhar Al Banna

Effect on Women and Childbirth

Since the end of Operation Cast Lead, the Hamas Health Ministry says there is a higher percentage of children being born with birth defects. According to Dr. Muweiyah Massenein, head of the ministry’s ambulance and emergency department, “we have found cases among newborn babies involving heart defects and brain abnormalities.” Hassenein states that the higher number of birth defects is a result of “Israel’s use of internationally prohibited weapons against the civilians of Gaza.”

Among white phosphorous, depleted uranium and other illegal weapons used on the Gazan civilian population during the war, many researchers and doctors working in Gaza say that Israel used the Dense Inert Metal Explosive (DIME) weapon as well, which is known to cause biological effects on foetuses—such as the ones that are being discovered now.

Medical experts had earlier predicted that the illegal weapons used by the IDF in the densely populated Gaza Strip would cause long-lasting effects and plague the future generation physically and psychologically.

Economy

In Gaza, jobs in the private sector are basically nonexistent, so even though there are goods available to buy, the people do not have money. 80% of the people in Gaza are dependent on outside food aid, either from UNWRA or the World Food Program (WFP).

Irish FM Michael Martin described the Gazan economy as devastated and “only operating at some 10-15 percent of capacity.”

Over one thousand companies have gone out of business since the last Israeli offensive on the territory, Operation Cast Lead (27 December, 2008- 18 January, 2009). Unemployment has risen to over 50%.

The World Health Organization (WHO) calls the situation in Gaza currently a “protracted political and socio-economic crisis.”

Healthcare

WHO reports that since Cast Lead, “recent events have resulted in a severe deterioration of the already precarious living conditions of the people in Gaza and have further eroded a weakened health system.”

The situation can be characterized by delays in border-crossing permits for specialized hospital treatment, shortage of medical supplies, improperly trained medical staff as a result of isolation, and damage to health services infrastructure as the main causes of the precarious health situation.

Electricity cuts due to the Israeli incursions and blockade affect the hospitals’ ability to maintain service provision. To further aggravate the situation, the inadequate amount of fuel allowed into Gaza through the Israeli blockade removes even the option of depending on backup generators to power the hospitals.

Continuous power is required for the preservation of vaccine cold chain items, food for patients and emergency operations. Operating theaters will be forced to reduce or shut down altogether due to the lack of electricity and medical supplies. Israeli border closures also mean greater shortages of basic drugs, disposable equipment, and diagnostic materials.

Many specialized treatments, for example complex heart surgery and certain types of cancer treatments, are not available in Gaza and patients are referred to outside hospitals for treatment. But many of the exit permits are denied or delayed arbitrarily by the Israeli authorities and as a result the person misses their appointments and treatment. Many have died while waiting for referral.

1103 applications for patients to cross the Erez border crossing were submitted to the Israeli authorities in December 2009. 21% were denied or delayed, causing them to miss their hospital appointments and restart the referral process from the beginning. Over 27 patients have died while awaiting referral since the beginning of 2009.

The Death of Fidaa Talal Hijjy

Fidaa Talal Hijjy, 19 years old, was diagnosed with Hodgkin’s disease in 2007, and was treated at Shifa Hospital in Gaza. Her health deteriorated and she was told she needed a bone marrow transplant, a procedure that is not available in Gaza. Her doctors referred her to Tel HaShomer Hospital in Israel on 20 August 2009 and she obtained a hospital appointment for 23 September 2009 for a transplant.

The District Liaison Office submitted an application for Fidaa to cross Erez on the date of her appointment but the Israeli Authorities did not respond to her application and she lost her appointment with Tel HaShomer Hospital. She secured a new appointment for 20 October 2009 and a new application was submitted to cross Erez. She had no response from the Israeli Authorities. Her health condition deteriorated further. She was given a new appointment at Shneider Hospital in Israel for 9 November 2009 and submitted an urgent application to cross Erez. No response was received.

Fidaa died on 11 November 2009. The Israeli Authorities approved her request on 12 November 2009, three days after her hospital appointment and one day after her death.

This is just one example, of many.

Supplies of drugs and disposable have generally been allowed through the Israeli blockade, although in inadequate quantities. There are also large shortages because of shortfalls in deliveries. Most drugs and disposables supplies are sitting at less than 30% of being fully stocked.

Delays of up to 2-3 months occur on the importation of medical equipment like x-ray machines and electronic devices. Clinical staff are frequently lacking the medical equipment they need. Medical devices are often broken, missing spare parts (which are not allowed through the Israeli blockade) or out of date.

Water and Sanitation

Recently, the salinity and nitrate levels in Gazan water supplies have been increasing due to over-extraction of ground water. Intrusion of salt water is a major concern for the safety of drinking water—especially for children. The underground wall that Egypt is building to stop the tunnel industry is also a concern—because it could cause sea water to enter the underground water supply of Gaza.

The sanitation infrastructure of Gaza was largely destroyed during Cast Lead, and has yet to be fully repaired because the Israeli blockade will not allow in replacement materials and spare parts. This has led to large sewage “lagoons” that sometimes overflow into residential neighborhoods and also into the Mediterranean Sea—causing not only a health crisis, but an environmental one as well.

For More Information About the Humanitarian Situation in Gaza:

OXFAM: “The Gaza Strip: A Humanitarian Implosion”

Current OCHA Reports on Gaza

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