Occupation: the siege and health in Palestine

The Israeli occupation's closure policy began in the early 90s. Thousands of Palestinians were denied work in Israel and much of the Palestinian population of Gaza and the West Bank were denied permits, impeding their ability to move freely between Gaza and the West Bank. The Oslo peace process did nothing to prevent Israel from imposing collective punishment against the whole population of Gaza strip, as long as these measurements serve some "security" need.

The severe and harsh siege against the Gaza Strip started in January 2006. The physical siege was accompanied by a devastating economic embargo which was imposed as a collective punishment against the Palestinian people for their democratic choice. In the January 2006 elections, the Hamas party won the majority of seats in the Palestinian Legislative Council in a transparent and democratic election. The West--led by the US--imposed economic and political sanctions against the new Hamas government and 1.5 million people living in the Gaza Strip were put under collective punishment. This external siege was followed by severe Palestinian interclashes between the 2 major parties--Hamas and Fateh. Rhose interclashes were temporarily stopped many times and the political parties attempted to formulate a national unity government and bring about reconciliation between the 2 major parties. But the clear intervention of the US via supporting one party against another , ended with Hamas winning against Fateh and taking over the Gaza Strip in a bloody operation in June 2007. Another chapter of severe siege and closures were imposed against Gaza.

This siege and economic embargo affected the entire population. It affected each and every aspects of our lives. The isolation continues as well as the daily Israeli military operations against the Gaza Strip, which are a desperate attempt by Israel to stop the rockets attacks. But
while trying to stop these rockets attacks, Israel launched disproportional war and used excessive power against Gaza's population. The Israeli military didn't discriminate between civilians and guerrillas.

The power cut off was another type of punishment. The cut off of the fuel supplies, the complete sealing of the borders, and shortages of different commodities have become the norm in Gaza. The poverty of Gaza residents has reached unprecedented levels. 80% are living under the poverty line and they mainly dependent on international aid agencies. 35%of the population are severely impoverished.

I would like to explain for you the effect of the siege on the health of the Palestinian people in Gaza.

Electricity shortage and its effect on health
All hospitals and health facilities have no power at least 8 hours per day. Alternative electrical generators are used during these power cuts but this change in power source has caused many serious problems and many high tech, sophisticated equipment has gone out of order because of the unreliable power supply, e.g. CT machines, laboratory equipments and life saving machines etc. The Red Crescent Society's CT is one of many examples of expensive and crucial equipment that has been ruined by the change in current.

The electrical generators are not a substitute for normal power. They need fuel that is not readily available in Gaza. For example, I have 10 liters of fuel for my car that needs to last several weeks and I was able to get these 10 liters with great difficulty, after waiting in line for hours and hours.

The shortage of standard power and the use of electrical generators adds another burden to the health facilities' general expenditures. It also requires that they suspend many surgical operations in order to ensure emergency services like what happened in January 2008.

The shortage of electricity subsequently affects the water pumping systems, especially in high buildings and in the rural areas. During January 2008 half of the Gaza’s population had no access to clean drinking water. The sewage pumping system has also been affected, according to the UNRWA 22% of Gaza households don’t have proper sewage system, and sewage is released untreated into the sea. These combined problems will contribute to increasing health problems related to contaminated water amongst children who make up to 56% of Gaza population.

A limited and decreasing supply of electricity to Gaza strip has made the delivery of even basic services related to health, water and sanitation very difficult. The border restrictions on the supply of fuel and the banning on imports of health spare parts and machinery exacerbates an already overwhelmed health system. It will lead to further decline in the standard of living for the residents--especially health services standards--of the residents of the Gaza Strip.

Man-made poverty and its effects on health
Poverty has a direct impact on nutrition--especially children's nutrition--and that clearly explains clearly the prevalence of anemia amongst Palestinian children under the age of 5 which has reached as high as 63.4% of under 5 children in January 2008, compared to 57.5% in 2007.

The international aid organizations offer food staples but this is not adequate. Children need well balanced diets to grow in a healthy way. Additionally, whenever there is cash to purchase food, food prices are extremely high and some products are in shortage so families still can't get proper food items. Due to the difficulty of importing food into Gaza milk, cooking oil, and many other items are in shortage in the markets.

The psychological effect on the community
The continuous closure, economic siege, power cuts, and the ongoing military operations against Gaza's population are coupled with poverty and a complete lack of sources of entertainment. It is not strange that 64% of Palestinian kids suffer from post traumatic stress disorders. They exhibit signs such as nightmares, phobias, clinging to the mother, inability to focus, bed wetting and irritability.

The Palestinian community as a whole in the Gaza Strip is suffering from different sorts of psychological symptoms. Depression, anxiety, nightmares, insomnia, irritability and aggression amongst the families has increased remarkably.

Restrictions on movement
The population's right to health has been violated by the Israeli occupation. It is very difficult if not impossible for patients to access to medical care outside the Gaza Strip. There are hundreds of patients who need further treatment and referral to hospitals outside Gaza--especially cancer patients, neurosurgical operations, cardiovascular surgeries etc. These patients are routinely denied permits to leave Gaza for their medical emergencies. Many were even issued a referral and then prohibited from crossing the borders. The rate of referral was 67% in 2006 but it decreased to just 25% in 2008.

In some cases children were allowed to travel but the parents were denied permits to accompany their children. Since June 2007, 117 patients have died while waiting to be referred for treatment outside Gaza. Last October, 20 patients died. 5 of them were children.

Border closures are also impacting the quality of health available in Gaza. Our hospitals are lacking many essential medications and supplies such as anesthetics, x-ray films, laboratory kits, chronic diseases medications, spare parts for hospital beds, etc.

Emergency medical teams--while on duty and in uniform--were often prevented from doing their work during the military operations against Gaza Strip. Several human rights organizations, as well as eyewitnesses accounts by different hospitals staff, have documented these violations of the right to health. On many occasions ambulances were directly targeted by the Israeli army while trying to rescue the injured or were not allowed to reach the injured and the medical teams watched the injured bleed to death. There are countless lives that could have been saved. A few minutes or even a few seconds can make a difference for saving the lives of injured people.

The latest example is the Jabalia incursion when the Israeli army did not allow the ambulance to reach one of the injured children. The child, a girl aged 8, was heavily bleeding and when the ambulance was allowed to evacuate the child it was too late. This practice of the Israeli army during its military operations is a frank violation of human rights and of the fourth Geneva Convention regarding the protection of medical teams while on duty in war and peace. Since December 2000, 17 Palestinian health workers have been killed while on duty and 206 injured.

We are facing an impossible challenge. Gaza's health facilities have to cope with these extraordinary emergency needs with limited medical resources while at the same time trying hard to meet the routine health care needs of the population with scarce resources.

The siege of Gaza must end.

Mona El-Farra