The war will end, but Gazans will continue to die months and years later
Palestinians walk past mounds of garbage and open sewage in the Sheikh Radwan neighborhood, north of Gaza City, on 3 July 2024
Sheren Falah Saab writes in Haaretz on 22 July 2024:
On June 29, Sadil, a 10-month-old baby girl, was evacuated from the Gaza Strip. At birth, she was diagnosed with biliary atresia, a life-threatening disease in which the bile ducts from the liver to the gallbladder are blocked and without treatment can lead to liver damage, which may develop into cirrhosis and liver failure. Sadil needed urgent surgical intervention, but the situation in Gaza did not enable her to receive the essential treatment, and her liver failed. After a long wait she left Gaza, accompanied by her father, through the Kerem Shalom border crossing, to Egypt where she is supposed to undergo a liver transplant.
Sadil is one of 21 Gazan children that the organization Physicians for Human Rights Israel, alongside the World Health Organization, helped last month to leave for Egypt and European countries to receive life-saving treatments that are unavailable in Gaza. Not everyone was accompanied by a relative, as she was.
“If the health system in Gaza was functioning, Sadil would have been operated on during the first days of her life and it would have been possible to provide her with the appropriate treatment at earlier stages – and in doing so avoid the drawn-out and unnecessary suffering of waiting to receive medical treatment outside the Gaza Strip,” said Dr. Lina Qasem-Hassan, a family medicine specialist and chairwoman of the board of Physicians for Human Rights Israel.
In an article published in The Lancet at the beginning of the month, three public health experts warned that even if the war ended now, Gazans would continue to die from its effects: There will continue to be many indirect deaths in the coming months and years from causes such as communicable and non-communicable diseases and medical complications due to the destruction of health-care infrastructure; severe shortages of food, water, and shelter, and the overcrowding in the displaced persons camps.
The United Nations Conference on Trade and Development estimates it will require tens of billions of dollars and decades to rebuild the health system. Experts who spoke to Haaretz outlined a very bleak picture: Long after a cease-fire begins, the population of the Gaza Strip will continue to pay a steep price in lives and health of residents.
Destruction of the basic infrastructure
The health system in Gaza serves 2.2 million people who need medical solutions of all different types, including the treatment of the wounded, of pregnant women and new-born babies, patients with cancer, chronic and life-threatening diseases, as well as mental health care. UNRWA community clinics provide only basic care, while hospitals provide most medical services.
The first to be harmed are women and children, according to the WHO, and 50,000 pregnant women in the Gaza Strip are unable to receive the treatments they need during pregnancy.
According to data provided to Haaretz by the WHO, 26 out of 36 hospitals in the Gaza Strip were not functioning as of July 11 – either because of a lack of fuel, medical equipment or medicine, damage to infrastructure as a result of the war or their employees’ fear of coming to work. Since October 7, the organization has verified reports concerning 475 attacks on medical facilities, medical staff, ambulances and transport of medical supplies in the Gaza Strip in which 746 people were killed and 967 injured.
The first to be harmed are women and children, according to the WHO, and 50,000 pregnant women in the Gaza Strip are unable to receive the treatments they need during pregnancy. Seventy six percent of the pregnant women reported they suffered from anemia and 99 percent reported they were finding it difficult to obtain adequate nutrition and essential food additives. Fifty five percent of the new mothers reported their ability to breastfeed was impaired because of their medical state, and 99 percent found it hard to ensure the production of an adequate amount of milk for their infants, a situation that could harm their development.
Hassan notes that women could well suffer from diseases and problems related to reproduction, including urinary tract infections and gynecological infections. For example, she said women who need an IUD or want to replace one are unable to receive such treatment. In addition, a lack or prenatal follow-up leads to more complications, which in turn increases the risk of infant mortality.
Palestine Red Crescent Society members gather around the bodies of two fellow paramedics killed when an ambulance on a rescue mission was hit in an Israeli strike, 30 May 2024
Those dealing with chronic diseases have also been left without treatment and monitoring, which places their lives at immediate risk. There are 2,000 cancer patients in the Gaza Strip who need treatment, 1,500 people with kidney disease who rely on dialysis to survive, 45,000 people with heart disease, 60,000 with diabetes and 650,000 people suffering from high blood pressure. In addition to all these people, over 10,000 people need treatment that is impossible to provide in the Gaza Strip, according to WHO data.
The harm to medical staff, who were supposed to have protection under international law, has become a tool of warfare, said Dr. Lina Qasem-Hassan. “One of the implications of the destruction of the health system, even if the war ends and a process of rebuilding begins, is secondary mortality as a result of chronic illnesses or from complications of injuries that were not treated in time and could well become more serious,” said Hassan.
“Chronically ill patients still need monitoring and treatment of complications. Doctors are lacking infrastructure and an appropriate and sterile work environment, and as long as these are not rebuilt, the injured and sick will pay with their lives,” she added.
The harm to medical staff, who were supposed to have protection under international law, has become a tool of warfare, said Hassan. “Alongside the shortage of staff, some of whom were killed, injured or arrested, the widespread destruction of hospitals and medical infrastructure as a result of direct attacks critically damaged the ability to provide a medical response, which significantly increases the chances of mortality,” she added.
Julie Pucon, a medical coordinator with the Doctors Without Borders organization, told Haaretz the group’s members have witnessed the outbreak of diseases, including skin infections such as scabies and digestive problems, due to the lack of water and poor sanitary conditions in the camps for displaced people. “Residents move from one improvised shelter to another, and are pushed each time into a more crowded area, and are trying to survive without proper shelter,” she said. “The unhygienic living conditions directly affect health, and our medical staff sees it very frequently.”
The WHO said 67 percent of the water and sanitation infrastructure in the Gaza Strip has been destroyed or damaged, and none of the sewage treatment facilities are operating. This also has both a direct and indirect impact on health: Gazans collect water from substandard sources, in inappropriate containers, and they lack soap, sanitary facilities (for example for hand washing) and basic necessities such as toilet paper and women’s hygiene products. All of this has caused an increase in severe respiratory infections, intestinal diseases and diarrhea, skin infections and severe hepatitis.
Overcrowding, poor hygiene and heat
One of the dramatic steps Israel took during the war is the removal of hundreds of thousands of Gazans from their homes and the destruction of large parts of the Gaza Strip. An article published in Haaretz in February presented satellite photos that reflected unprecedented destruction. The WHO told Haaretz that some 1.9 million Gazans – 90 percent of the people in the Gaza Strip – are defined as displaced persons, and many of them were displaced more than once. Entire families live in tents made out of plastic sheets, and have limited access to food and basic services, which has made them more vulnerable and exposed to disease.
The health problems do not stop here. The summer significantly increases the risk of disease outbreaks in the Gaza Strip, according to the WHO. During periods of hot weather, the chances of food spoiling are much higher, resulting in infections, food poisoning and diseases passed on through spoiled food. The risk of infections in the water also increases, especially when the sanitation system is not functioning and this could lead to diarrhea and intestinal problems.
The heat also increases the number of mosquitoes and flies, which can spread disease, and raises the chances of suffering from dehydration, heat stroke and other health problems – particularly if there is no clean drinking water. Along with all these things, sewage flows in streets and piles of garbage are accumulating and rotting in the heat next to the displaced persons camps. In addition, to the disgusting stench that spreads everywhere, the garbage attract rats, which also spread disease.
The substandard living conditions are expected to have especially serious effects on the children in Gaza, according to the WHO. The organization warns that long-term effects in the form of malnutrition and repeated infections, along with a lack of sanitary and hygienic services, will greatly slow down the development of children. The situation in the Gaza Strip is harming the health and welfare of an entire future generation.
Working without medical supplies
A severe shortage of medical supplies and drugs exist in Gaza, said the WHO. Doctors Without Borders teams working in the Nasser Hospital in Khan Yunis have to deal with this shortage on a daily basis, said Pucon. “In general, most of the shortage is in medicines and general medical supplies. We don’t have precise data concerning exactly what is missing, but it’s possible to say that everything is lacking. It not only makes it hard to provide medical treatment, but also affects the quality of treatment provided,” she added.
The medical staff lacks gloves, materials for bandaging, crutches for those injured and basic medicines, such as paracetamol and ibuprofen. “Sometimes we can’t provide pain relievers for the full number of days the patient needs it. Because of the shortage of ibuprofen we only have paracetamol, and we have only a limited inventory of that. It harms the quality of the treatment,” she said.
The shortages also affect follow-up treatment. “Because we are expecting a shortage of materials for bandaging, for example gauze, we need to space out the number of times the patient returns to have the bandage checked,” said Pucon. “If replacing the bandage is usually done once every two or three days, now the interval is three to four days.”
Dr. Abdel Rahman al-Tayeb of the al-Aqsa Martyrs Hospital in Deir al-Balah told the UN that there is a shortage of diagnostic equipment from CT machines to equipment needed for blood tests. This affects the quality of the medical diagnosis and in the long term it harms the patients’ health.
Working under such conditions also affects the psychological state of the doctors themselves, said Hassan. “People are dying on the hospital floor because there are no beds, the medical staff is standing helpless with the injured who are arriving after every bombing and there is a shortage of everything. The doctors in the Gaza Strip are forced to decide who to treat first, who deserves to die and who deserves to live.
“It’s a very difficult decision, such as during the coronavirus pandemic, when there was a shortage of ventilators in Italy and they had to decide who to hook up. The doctors are exhausted, working continuously, cut off from their families, receiving messages about the death of relatives and continuing to work because they are devoted to their patients, and the ethical dilemmas stay with them all the time. The patients’ families are begging for help. It’s a traumatic situation whose psychological consequences are very severe, and will accompany the doctors for their entire life,” said Hassan.
Tania Hary, the executive director of Gisha, an Israeli human rights organization that works on behalf of the freedom of movement of Palestinians, said “the continuing attack intensifies the hardship of the population in the Gaza Strip immeasurably and its long-term damage continues to accumulate.
The entire population is exposed to the traumatic experiences of the war, and its physical and psychological consequences will affect the residents of Gaza for their entire lives. At the moment, their survival depends on immediate, continuous and full access to humanitarian aid. Even after a cease-fire is reached and it is possible to begin the physical and environmental rehabilitation, it will take decades, and require enormous sums and tremendous efforts on the part of Israel and the international community,” she said.
The IDF declined to comment on this report.
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