Health and healthcare in Gaza are seriously undermined by long-term, politically-driven and mutually reinforcing movement restrictions and attacks on the health sector carried out with impunity.
Israel’s illegal closure of Gaza has accelerated the de-development of its healthcare system through restrictions on the movement of people and goods and through economic damage and impoverishment. Gaza’s health services are therefore unable to develop in line with the needs of its population.
The UN Office of the Special Coordinator for the Middle East Peace Process highlighted that
“while the population in Gaza has doubled since 2000, the number of functioning primary health care clinics in Gaza has decreased from 56 to 49, resulting in crowded conditions, decreased doctor-patient time and reduced quality of service.” (Source)
This closure regime also impedes the professional development of health workers, who are commonly denied travel permits by Israel to take up opportunities outside Gaza, adding to shortages of doctors and nurses in key specialists.
During 2018, the World Health Organization (WHO)recorded that only
“15% of applications to exit the Gaza Strip on behalf of health partners and the Ministry of Health were approved.” (source)
Israel’s imposition of a ‘dual-use list’ of materials it classifies as having a potential military use also denies or substantially reduces the entry of medical materials and equipment including X-ray scanners, carbon fibre components for the stabilisation and treatment of complex limb injuries, and carbon fibre and epoxy resins used in the production of artificial limbs. (source)
Health workers’ safety is hindered by restrictions on the entry of communications equipment for ambulance coordination and emergency response and protective equipment, including helmets and protective vests.
Access and Movement restrictions
This de-development of health infrastructure is a key reason for a large number of patients that must be referred out of Gaza for treatment in the West Bank, including East Jerusalem, or abroad. But medical referrals including for oncology, cardiology and neonatal intensive care are regularly obstructed by Israel through a bureaucratic permit regime the WHO has termed “neither transparent nor timely.” (source)
Around 10,000 medical appointments for patients from Gaza are missed yearly due to denials and delays by Israel.
WHO reports indicate that 54 patients died in 2017 after having to miss their scheduled medical appointments outside Gaza due to denials and delays by Israel; 46 of the patients had cancer. A decline in the issuance of permits from 92% of applications in 2012 to just 54% in 2017 runs counter to growing health needs. (source)
Case of Abeer Abu Jayyab: Abeer, aged 46, suffered from breast cancer and required a treatment course of Herceptin. This drug was unavailable in Gaza, and she had applied for a health travel permit for treatment at Augusta Victoria hospital in East Jerusalem. Her permit applications were denied on reported security grounds by the Israeli authorities, and she had to miss her scheduled appointments. Abeer died in Gaza on 8 June 2017 after cancer metastasized. (source)
Case of Hiba Swailam: Hiba was forced to return to Gaza after giving birth to pre-term triplets, who remained at Makassed Hospital in East Jerusalem. Two of the babies died in her absence; one suffered from necrotising enterocolitis, for which the best treatment is mother’s milk. Hiba had to be informed by telephone about the deaths of her children, due to the access restrictions and permit regime. (Source)
Attacks on healthcare
Gaza’s health sector has also endured repeated attacks by Israeli forces, carried out with impunity, for more than a decade.
In March 2019, the UN Independent Commission of Inquiry into the ‘Great March of Return’ protests in Gaza released a report describing the occupied Palestinian territory as
“one of the most dangerous places in the world for healthcare workers.” (source)
Also, the Commission of Inquiry found that, in the context of the protests, there were “reasonable grounds to believe that Israeli snipers shot at journalists, health workers, children and persons with disabilities, knowing they were clearly recognizable as such.” It further concluded that “the Government of Israel has consistently failed to meaningfully investigate and prosecute commanders and soldiers for crimes and violations committed against Palestinians or to provide reparation to victims.” (source)
Case of Musa Abu-Hassanin: On 14 May 2018, Musa, a 34-year Palestinian Civil Defence field paramedic, was fatally shot in the upper right shoulder while trying to evacuate wounded demonstrators east of Gaza City. The Commission of Inquiry found that Musa was 250–300 metres from the Gaza perimeter fence and was wearing a high visibility vest. Shortly before his death, Musa helped rescue a member of his team, Tarek Loubani, a Canadian-Palestinian doctor who had been shot in both legs while working at the protests. No criminal investigation has been announced by the Israeli authorities into Musa’s death.
“Musa’s my rescuer. He was a very bright guy. Incredible man. About an hour after he rescued me, he was trying to get another patient and ended up getting shot in the chest. Unfortunately, he died. It’s unfortunate because we, as a medical team, always hope for and expect some protection.”
Dr Tarek Loubani (source)
Mental health
The closure of Gaza exposes Palestinians to stress, anxiety and feelings of hopelessness. Exposure to frequent violence, including repeated large-scale military offensives, also has a harmful effect on the mental health and psychological wellbeing of the population. (source)
In 2017, the UN estimated that 25% of children in Gaza (290,000 children) needed continuous psychosocial support. (source) This estimation precedes large-scale violence and casualties sustained during the Great March of Return, and will surely have risen.
The Norwegian Refugee Council, for example, found in 2019 that 68% of schoolchildren living close to Israel’s perimeter fence show symptoms of psychosocial distress: “The violence children witness daily, including the loss of loved ones, in the context of Israel’s crippling siege, which perpetuates and exacerbates Gaza’s humanitarian crisis, has left an entire generation emotionally damaged.” (source)
Malnutrition and food insecurity
As a result of severe economic deterioration, high rates of poverty and unemployment, malnutrition is a major and growing concern in Gaza.
More than two thirds (68%) of people are moderately or severely food insecure, and one in ten children under five years old suffers stunting (being short for age, a marker of chronic malnutrition). Stunting permanently compromises social, academic, economic and health outcomes in affected children. (source)
People with disabilities
In Gaza people with disabilities are disproportionately affected by the poor socio-economic conditions that are largely caused by Israel’s illegal closure.
UN OCHA has stated that people with disabilities in Gaza
“are among the most vulnerable groups in a society already in crisis.” (source)
Limited electricity supply and frequent power cuts impede the rights of Palestinians with disabilities in Gaza, for instance preventing those with physical disabilities from using lifts to exit their homes and charging electrical wheelchairs. Those with hearing impairments also find it difficult to charge their hearing aids, limiting their ability to communicate with family and friends.
During the 2014 offensive on Gaza, Palestinians with disabilities had severe difficulty evacuating civilian buildings under attack, increasing their risk of injury and death. When preliminary warnings were given by Israel, these were not effective or advanced enough for individuals with disabilities to evacuate safely. In some circumstances, people with disabilities had to be left in their homes, as family members were unable to evacuate them
The number of Palestinians in Gaza with a disability, whether physical or/and mental, has increased as a result of Israeli military offensives as well as the imposition of the closure policy which has generated higher levels of poverty.
During Israel’s 2014 offensive on Gaza, 11,000 Palestinians were injured, 10% of whom were physically disabled.
Of the 7,000 live ammunition injuries caused by Israel’s use of force against demonstrators at the ‘Great March of Return’ in 2018–2019, 156 have resulted in limb amputations. 94 of these resulted from bone infections subsequent to the initial injury. (source)
An estimated 1,200 Palestinians still require extensive limb reconstruction treatment for injuries sustained at the protests. Only in the longer term will we be able to say how many will endure a significant loss of function.
Go to the main page of the campaign.
