Written by Shane McGlone
Edited by Janie Chan
“Without the immediate entry of humanitarian aid into Gaza — especially health services, medical supplies, food, clean water, fuel, and non-food items — humanitarian and health partners will be unable to respond to urgent needs of people who desperately need it. Each lost hour puts more lives at risk.” - World Health Organization (October 12, 2023)
There are few events in modern history that have met the crossroads of controversy and urgency as devastatingly as the humanitarian crisis occurring in the Gaza Strip. The longstanding conflict between Israel and Palestine dates back to 1917, according to the UN historical timeline,[1] and has reached intense media coverage in the past five months due to an attack carried out by Hamas (a Palestinian militant group)[2] on October 7th, 2023. Following the surprise attack, as described by the American Jewish Committee, Israel immediately retaliated in an ongoing military effort to “eliminate the threat that Hamas poses through an air, sea, and ground campaign against the terror group’s operations.”[3] This brief synopsis, however, brushes over the significant complexity that is the center of this discussion and would prove to be inaccurate depending on which historical account you follow. It is with intent, however, that this paper does not attempt to tackle the definitions of the conflict or outline its entire history. This holistic context, and the time we take to analyze it, pales in importance to the statistically larger struggle at hand: the lives (and deaths) of Palestinian civilians. All historical data in the following sections will be presented only in direct correlation to the healthcare crisis currently occurring in Gaza and will avoid pontification.
The Blockade
In January 2022, the World Health Organization (WHO), published data highlighting the effect of the 2007 blockade on the Gaza Strip, which was emplaced by Israel and Egypt following Hamas’ occupation of the Palestinian territory.[4] This blockade increased the challenge for Palestinians in Gaza to receive both medical care and adequate medical equipment. In their report, the WHO asserts that “severe restrictions on people’s movement and limitations on the entry and exit of supplies have negatively impacted conditions of life that determine health for Palestinians in the Gaza Strip.”[5] The organization presents the following data in support of this claim.
To access hospitals in the West Bank, which is significantly more developed than Gaza[6], Gazans must be permitted to travel by Israel. From 2008-2022, over one-third of applicants were denied.
There is a separate application for companions of patients. These companions can be parents or other family members. In the same period, 44% of patient-companion applicants were denied.
From 2018-2021, 43% of children who were approved travel were forced to seek medical care unaccompanied by their parents, as they were not allowed travel via denial of their patient-companion applications.
For cancer patients who were unsuccessful in receiving accepted applications in the years 2015-2017, there was a reported decreased likelihood of survival by a factor of 1.5 when compared to patients who were granted travel access.
In an effort to bring healthcare to Gaza, medical professionals are also able to submit permits for travel. 64% of applicants were denied in the years 2016-2022.
Healthcare equipment is often denied entry to the Gaza Strip. In 2021, requests for radiological scanning equipment met a rejection rate of 69%.
The WHO in the concluding of their report urged for a lessening of the blockade in order to allow for Palestinians in the Gaza Strip to receive medical care, equipment, and the ability to travel safely with a companion.5
The Strengthening of the Blockade
While the supplies and medical aid received by Gaza in the years 2007-2022 were limited, matters worsened significantly following the attack carried out by Hamas in 2023. On October 9th, Yaov Gallant, Defense Minister of Israel, announced, “‘I have ordered a complete siege on the Gaza Strip. There will be no electricity, no food, no fuel, everything is closed.’”[7] This announcement stated that Egypt would be allowed permit crossings for aid delivery to Southern Gaza starting October 18th. The Human Rights Watch noted, however, that this small crossing of aid did not account for the devastation brought upon by lack of fuel, electricity, and water entering Southern and Northern Gaza.[8] On top of intensifying the blockade, military efforts by Israel to snuff out Hamas and free Israeli hostages have brought about a crisis for Palestinian civilians. According to an AP News report from January 11, 2024, satellite imaging reveals that “Israel’s offensive has likely either damaged or destroyed over two-thirds of all structures in northern Gaza and a quarter of buildings in the southern area of Khan Younis.”[9] The combination of the strengthening of the blockade and increased military efforts bring us to the most recent data available for the healthcare crisis of the Gazan people.
Presentation of the Data: The Current Healthcare Crisis: “Lost Hours”
Immediate Report: WHO, October 12
Only five days after Israel’s immediate retaliation to the October 7th attack, the World Health Organization warned that the hospital system in Gaza Strip was “at a breaking point.”[10] The report notes how the cutting off of fuel supply to Gaza allows only a few hours of electricity a day, limiting the amount of time hospitals can stay functioning. With increased military activity in the region, medical centers quickly became overstretched in their treatment of the elderly, sick, and newly born in efforts to provide emergency medical attention to civilians who were injured by munition. Early on, WHO documents the following data, displaying results of the total blockade and military efforts of the Israel-Hamas conflict:
Injuries of 16 healthcare workers
Death of 11 healthcare workers
Damages to 19 health facilities
Damages to 20 ambulances
At the end of their report, WHO claims that, without humanitarian aid sufficiently entering the Gaza Strip, “each lost hour puts more lives at risk.”[10]
961 Lost Hours Later: UN Report
A press release from the United Nations released on November 16, entitled “Gaza: UN experts call on the international community to prevent genocide against the Palestinian people,” presents one of the earlier reports of data. At its release, the UN report claimed:
Over 11,000 deaths of Gazans; 41% children, 25% women
More than 27,000 injured
Alongside this data, the report also mentions that “half of the civilian infrastructure in Gaza has been destroyed, including more than 40,000 housing units, as well as hospitals, schools, mosques, bakeries, water pipes, sewage and electricity networks, in a way that threatens to make the continuation of Palestinian life in Gaza impossible.”[11]
2,233 Lost Hours Later: Syrian/Palestinian American Medical Society Report Via OCHA
On February 7, 2023, the UN’s Office for the Coordination of Humanitarian Affairs (OCHA) published a press release of data made available by the Syrian American Medical Society, as well as the Palestinian American Medical Society, with confirmation by Insecurity Insight, an organization funded by the US Agency for Internal Development. The report presents that, between October 7, 2023 and January 8th, 2024, Gaza experienced:
The damaging of 123 health facilities
The deaths of 337 healthcare workers
The arrests of 200 health workers
The damaging of 122 ambulances
The damaging of 24 out of 36 hospitals
Secondly, the report corroborates WHO’s claim that 93% of Gazans have reached “crisis-level hunger.”[12] Some other health issues on the rise in Gaza are listed:
Upper respiratory infection
Meningitis
Skin rashes
Chicken pox
A 25-fold increase of diarrhea in children[12]
3,001 Lost Hours Later: International Rescue Committee Report
On February 9, 2024, the International Rescue Committee released a report that gathers confirmed data in one of the most extensive presentations currently available on the crisis. Entitled “The Collapse of Gaza’s Health System,” the organization presents:
The displacement of 1.7 million Palestinians, including “crucial health care professionals”[13]
More than 600 reported incidents of violence or obstruction against health care
The report designates a section solely to Palestinian children, noting the following statistics and facts:
Over 12,000 children dead
Roughly 1,000 children suffer from either single or double leg amputation, often from a procedure lacking anesthesia
The adoption of a new acronym for children in the hospital system: “WCNSF” (“wounded child, no surviving family”)[13]
As time progresses forward past the WHO’s October 12 report, “lost hours” pile up as relief is withheld from the Palestinian people. These hours— defined by a lack of sufficient aid and support entering the Gaza Strip—pass by as the world, and especially the US, continue to put priority in actionless discourse. Without action, the Palestinian people continue to be the victims.
Most recently, a raid carried out by the Israeli army on Al-Shifa Hospital, the largest medical complex in Northern Gaza, has resulted in the death of 140 people, as well as the detaining of 600 individuals.[14] While Israel claims those affected by the raid were terrorists, Palestinian news outlets question the validity of the claims. Furthermore, it is currently circulating that the military effort has brought about the destruction of the Al-Shifa surgical suite. All in all, the attack represents a continued disruption of urgent medical care that Palestinian civilians desperately need, and already severely lack.
While the world remains unengaging in the humanitarian crisis, it begs the question as to who will protect the people of Palestine. Without intervention, it appears that the assumption is that the Palestinian people are to deliver their own solace, as if to find pieces of themselves within the rubble and reassemble. With a region so irreversibly damaged, with nearly all of its people starving, most of its hospitals depleted, and tens of thousands dead and millions displaced, how can one expect the solution to come from the Palestinian people themselves? Furthermore, with external depleting forces in Palestine, how is any internal healing possible?
Surviving Before Healing
As for aid entering Gaza, the current situation is grim. On March 20, 2024, The New York Times released an article titled: “Why Isn’t More Aid Getting to Gazans?” To answer the titular question, the paper points out the following issues:
Scarcity:
Before the insufficient supply of medical equipment and personnel can be dealt with, the delivery of food to Palestinian people is of utmost concern. More than a million Palestinians approach fatal levels of starvation, which is met with the entering of 140 food trucks a day. The World Food Program, an international organization affiliated with the UN, claims that 300 trucks are just enough to meet the basic necessities of nourishment for the Gazan people.
Inefficiency:
Mirroring the difficulty for resources to enter Gaza during the pre-October-7th partial blockade, for supplies to enter the Gaza Strip, they must be heavily inspected. Inspection usually begins at El Arish in Egypt. After passing this inspection, aid will receive an inspection at Rafah. After passing this inspection, aid will receive inspection at one of two crossings to Israel. After passing this inspection, aid will have to receive warehouse designation in Gaza. For aid entering Northern Gaza, aid will receive another inspection by Israeli agencies. This entire process takes about 3 weeks, if all goes smoothly. If just one item is not deemed to pass inspection, the truck carrying aid must re-enter the queue for entrance. Items such as medical kits and scissors have been denied crossing under suspicion of their weaponization.[15]
Safety:
Israeli military efforts and the destruction brought upon by them have made the terrain treacherous for the transport of aid. It is challenging, and at times impossible, to drive aid trucks across the rubble. Perhaps most devastating is that resource distribution is frequently met with violence. From December 2, 2023, to March 14, 2024, five events occurred in which civilians were killed in the process of receiving aid. As hungry Palestinians crowded around aid trucks on February 29, 2024, open gunfire from Israeli forces caused the death of more than 100. Air strikes have destroyed U.N. aid warehouses and killed relief workers. In Gaza City, aid packages delivered from the air have fallen on and killed at least 5 people.[15]
Of all the efforts noted above, none have been successful. As many note, however, success is not an option within the current structure. Resources are not only slim, but also nearly impossible to disperse. Aid agencies fear putting workers in grave danger by placing them in Gaza, and actions taken by the Israeli army place Palestinians at risk of safely obtaining food and medical supplies. Furthermore, while external agencies such as Doctors Without Borders (Medecins Sans Frontieres) try to deliver medical supplies and personnel, the danger posed to healthcare workers is a large limitation. On February 20, 2024, an Israeli tank fired at a house where Medecins Sans Frontieres staff was located. The daughter-in-law and wife of a medical colleague were killed, with many others injured.[16]
As long as bullets fly in Gaza, aid will not be able to enter. As long as aid does not enter Gaza, Palestinian civilians will continue to approach death. As Palestinian civilians continue to approach death, food-based and medical resources will continue to become more dire. As food-based and medical resources continue to become more dire, aid will be required to enter. As long as bullets fly in Gaza, aid will not be able to enter.
Be reminded that this is not an editorial that poses discourse upon the conflict between Israel and Palestine as a whole. While such a conversation is important, it also carries an intimacy and complexity that removes impetus from changes that must be made for the Gazan people. Mistakenly conflating its aim with that of this post, and attempting to draw attention to its argument, is a misconception that is deadly for the Palestinian people.
References:
[1] “History of the Question of Palestine - Question of Palestine.” United Nations, United Nations, www.un.org/unispal/history/. Accessed 2 Mar. 2024.
[2] Robinson, Kali. “What Is Hamas?” Council on Foreign Relations, Council on Foreign Relations, 2023, www.cfr.org/backgrounder/what-hamas.
[3] “Timeline: Key Events in the Israel-Arab and Israeli-Palestinian Conflict.” AJC, 26 Feb. 2024, www.ajc.org/IsraelConflictTimeline#1982.
[4] “Timeline: The Humanitarian Impact of the Gaza Blockade.” Oxfam International, 25 May 2022, www.oxfam.org/en/timeline-humanitarian-impact-gaza-blockade.
[5] “15 years of Blockade and Health in Gaza.” EMRO WHO, 2022, www.emro.who.int/images/stories/palestine/documents/15_years_of_blockade_and_health_in-gaza.pdf?ua=1.
[6] “West Bank and Gaza: Selected Issues.” IMF, 13 Sep. 2023, www.imf.org/en/Publications/CR/Issues/2023/09/12/West-Bank-and-Gaza-Selected-Issues-539154#:~:text=Year's%20of%20isolation%20and%20 continuous,poverty%20rates%20 were%20much%20 higher.
[7] Fabian, Emanuel. “Defense Minister Announces ‘Complete Siege’ of Gaza: No Power, ...” Times of Israel, 2023, www.timesofisrael.com/liveblog_entry/defense-minister-announces-com plete-siege-of-gaza-no-power-food-or-fuel/.
[8] “Israel: Unlawful Gaza Blockade Deadly for Children.” Human Rights Watch, 8 Dec. 2023, www.hrw.org/news/2023/10/18/israel-unlawful-gaza-blockade-deadly-children.
[9]Frankel, Julia. “Israel’s Military Campaign in Gaza Seen as among the Most Destructive in Recent History, Experts Say.” AP News, AP News, 11 Jan. 2024, apnews.com/article/israel-gaza-bombs-destruction-death-toll-scope-419488c511f83c85baea22458472a796.
[10]“Hospitals in the Gaza Strip at a Breaking Point, Warns Who.” World Health Organization, World Health Organization, www.emro.who.int/media/news/hospitals-in-the-gaza-strip-at-a-breaking-point-warns-who.html. Accessed 21 Mar. 2024.
[11]Gaza: UN Experts Call on International Community to Prevent Genocide ..., www.ohchr.org/en/press-releases/2023/11/gaza-un-experts-call-international-community-prevent-genocide-against. Accessed 21 Mar. 2024.
[12]“Humanitarian Crisis Unveiled: Healthcare under Attack in Gaza - Joint Statement by the Syrian American Medical Society (SAMS), and the Palestinian American Medical Society (PAMA) - Occupied Palestinian Territory.” ReliefWeb, 7 Feb. 2024, reliefweb.int/report/occupied-palestinian-territory/humanitarian-crisis-unveiled-healthcare-under-attack-gaza-joint-statement-syrian-american-medical-society-sams-and-palestinian-american-medical-society-pama.
[13]“The Collapse of Gaza’s Health System.” The IRC, www.rescue.org/article/collapse-gazas-health-system. Accessed 21 Mar. 2024.
[14]Bigg, Matthew Mpoke, and Hiba Yazbek. “Israel’s Raid on Al-Shifa Hospital Grows into One of the Longest of Gaza War.” The New York Times, The New York Times, 21 Mar. 2024, www.nytimes.com/2024/03/21/world/middleeast/israel-al-shifa-hospital-raid-gaza.html.
[15] Gupta, Gaya, et al. “Why Isn’t More Aid Getting to Gazans?” The New York Times, The New York Times, 20 Mar. 2024, www.nytimes.com/interactive/2024/03/20/world/middleeast/gaza-aid-delivery.html.
[16] “Palestine.” Doctors Without Borders - USA, www.doctorswithoutborders.org/what-we-do/where-we-work/palestine. Accessed 21 Mar. 2024.