Urgent health update: Consequences of war on Gaza-June 2, 2024

Israeli bombardment from the air, land, & sea continues to be reported across much of Gaza, resulting in further civilian casualties, displacement, & destruction of houses & other civilian infrastructure. Ground incursions & heavy fighting also continue to be reported, particularly in Rafah. Intensified hostilities following the issuance of evacuation orders & the Israeli military operation in Rafah have so far forced the displacement of about one million people, amid a decline in the entry of humanitarian aid. 

PUBLICATIONS

The Palestine challenge to US medical ethics, The Lancet

In case you missed this: The Unpunished: How Extremists Took Over Israel, The New York Times

VIDEO

California family physician, Dr. Haleh Sheikholeslami, spoke out about her recent experience working in Rafah

ALERT

American Jewish Medical Association, cloaked in language rejecting bias & claiming to be working for “Medicine Free From Hate,” is part of a concerted effort to define criticism of Israeli policy as inherently antisemitic and to silence voices that support the health and human rights of Palestinians. It is revealing that AJMA is developing speakers and journal articles to counter what they see as rampant antisemitism; they claim to be “working with the congressional educational committee, the one that did the Harvard, MIT, and Penn hearing.”

(Numbers are cumulative.)

GAZA

·       Killed: >36,379, including 270 aid workers, 493 health workers (15 also counted under aid workers) 70 civil defense staff & 147 journalists & media workers

·       Injured: >82,407

·       Israeli soldiers killed in Gaza: 293

·       Israeli soldiers injured in Gaza or along the Israeli border: 1848

·       Hostages: 125

·       5/26 attack on Rafah camp for displaced people killed 45 people, wounded 200, using US made bombs; Netanyahu called it a “tragic mistake,” UN Martin Griffiths called it “the latest – and possibly most cruel – abomination.” A second attack on an IDP camp occurred on 5/28 with 21 killed & 64 injured.

·       14 of 36 hospitals partially functional, in Rafah only 3 field hospitals functioning, 1 inaccessible & partially functional, with dire shortages of fuel & vital supplies, 1 additional field hospital in Deir Al Balah, 2 in Khan Younis, (WHO reports 4 of 9 field hospitals fully functional)

·       Health facilities continue to face dire shortages of fuel & medical supplies while having a rising influx of casualties. Nasser Medical Complex appealed for citizens to donate blood to address urgent need. Following intensification of hostilities & issuance of evacuation orders in Rafah & northern Gaza, between 5/6 & 26 >945,000 people displaced from Rafah & 100,000 in northern Gaza.

·       130 ambulances damaged

·       At least 214 Gazan doctors & staff have disappeared in Israeli detention

·       Medecins Sans Frontieres closed primary health center in Al Mawasi “due to extreme violence” after being forced to evacuate WHO-supported Trauma Stabilization Point in Tal As Sultan to the south; overall, MSF forced to leave 14 medical facilities. Similar closures occurred im SOS Village in Rafah & the Malnutrition Stabilization Center in Tal As Sultan

·       40% of health facilities partially functional, 29% of UNRWA health centers operational

·       13 emergency medical teams deployed

·        Israeli forces have taken control of a buffer zone along the border between Gaza & Egypt, giving Israel effective authority over the Palestinian territory's entire land border.

·       In Rafah, key health services, such as dialysis, medical imaging, surgery, internal medicine, & maternity & pediatric care, are no longer available, many highly skilled doctors & nurses displaced from the city.

·       Across Gaza, all medical teams are facing enormous challenges in meeting needs & are watching patients die as they lack either the tools, skills or supplies to do what is needed. No CT scans south of Wadi Gaza, high level burn treatment no longer available in all of Gaza

·       Pregnant & breastfeeding women living “in an unrelenting nightmare,”  (UN Population Fund-UNFPA) premature & complicated births have increased as pregnant women are stressed, scared, malnourished & exhausted. ~18,500 pregnant women have been forced to flee to Khan Younis & Deir al Balah, where access to maternal health care is minimal, while another 10,000 are estimated to have remained in Rafah amid desperate conditions. Beyond a critical shortage of maternal & reproductive health services & supplies, “many face the threat of famine & lack even the basics for survival.”  

·       46% of critical patients who submitted requests for medical evacuation have been approved, these include 38% who have been medically evacuated abroad, ~700 patients who should have been evacuated since the closure of Rafah Crossing, have not.

·       Flow of humanitarian aid supplies into Gaza, already insufficient to meet the soaring needs, has dropped by 67% since 5/7.

·       Temporary pier that the US military constructed, put in place to provide much-needed humanitarian aid, has broken apart in rough seas & is being repaired

·       1.1 million people to face catastrophic levels of food insecurity, 31 patients reportedly died of malnutrition, 71 patients admitted for severe malnutrition

·       ~31% of children < 2 in northern Gaza suffer acute malnutrition, ~10% < 2 in Rafah suffer acute malnutrition, >50,000 children require treatment for acute malnutrition

·       Health & environmental risks are on the rise due to fuel shortages, limited access to clean water, sewage overflow, accumulation of solid waste, & infrastructural damage.  60% of all water & sewage facilities destroyed, 3 water pipelines from Israel are operational including 2 at 50% capacity

·       Communicable diseases:

844,128 cases of acute respiratory infections

844,128 cases of diarrhea; 112,880 < 5 years old

93,209 cases of scabies and lice

57,424 cases of skin rashes

8,388 cases of chicken pox

77,820 cases of acute jaundice syndromes

·       Evacuation of Rafah by ~1 million Gazans, adults & children exhausted by constant displacement, hunger, & fear

·       Food aid agencies struggling to access humanitarian aid, particularly from Kerem Shalom crossing, due to active conflict, impassable roads, unexploded ordnance, fuel shortages, delays at checkpoints, & Israeli restrictions.

·       Fuel shortages remain a major concern, affecting trucks, hospitals, sewage systems, desalination operations & bakeries. Water & wastewater facilities in central & southern Gaza in last week of May received 43% of fuel requirements, northern Gaza-no functional desalination since October, overall water production 21% of pre-October levels

·       Fuel deficit & lack of safe access to 2 main landfills have additionally hampered solid waste collection services, resulting in the accumulation of trash across Gaza. UNRWA staff have been denied access to landfills by Israeli authorities & many of the agency’s sanitation centers, machinery & trucks for removing trash have been destroyed.  “As the weather gets warmer, it just creates more problems, not only with the stench but with the spread of diseases & with pests like mice, rats & mosquitoes which make diseases spread even more.”

·       ~270,000 tons of accumulated solid waste

·       Out of 17 bakeries World Food Program supports in Gaza, 11 are operating due to lack of cooking gas & other essentials as well as ongoing hostilities; these include 1 bakery in Jabalya, 4 in Gaza city, & 6 in the south. 

·       625,000 students: no access to education, ~6.650 students & 334 educational staff killed

·       85.8% of schools have some damage, ~60% of school buildings have served as Internally Displace People’s shelters of which 65% were directly hit or damaged

·       In spite of International Court of Justice ruling, Israel carried out strikes on Gaza 5/25 as fighting raged between the army & Hamas’s armed wing. Palestinian witnesses & AFP teams reported Israeli strikes in Rafah & central city of Deir al-Balah.

·       4 US army vessels involved in delivering humanitarian aid to Gaza via the pier built by the army broke free from their moorings due to high seas. 2 vessels were anchored on the Gaza shore & 2 others beached on the Israeli coast near Ashkelon; the Israeli navy was assisting with their recovery. Subsequently, the  
temporary pier constructed by the US military to transport aid into Gaza broke apart & sustained damage in heavy seas.

·       WHO recommendations:

• Immediate ceasefire.

• Expand & sustain humanitarian access into Gaza for fuel, water, food, medicines, other necessary supplies.

• Expand humanitarian corridors & ensure safe passage to allow delivery of humanitarian aid within Gaza.

• Active protection of civilians & health care, preserving the function of remaining health facilities.

• Establish & strengthen a routine process for medical evacuation for all patients in need, without distinction of any kind, ensuring timely referral of the +14,000 critical patients that need to be medevacked out of Gaza.

WEST BANK & JERUSALEM

·       Killed: 518

·       Injured: 5,000

·       Israelis in WB killed: 10, including 4 civilians

·       480 health related attacks: 16 people killed, 95 injured, 54 health facilities affected including 20 mobile clinics, 319 ambulances affected

·       Nearly 9,000 arrested

·       A ban on working land located within 200 meters of an Israeli settlement & a system of 60 earthen barriers & locked iron gates have prevented Palestinian farmers from tilling their plots to the west of Bethlehem for over 7 months

·       Since the war in Gaza began, armed Israeli settlers, often accompanied by the army, have stepped up seizures of Palestinian land, with new guard posts, roads, & metal gates. Israel increased its military presence in the West Bank out of concern that it could face widespread unrest or increased attacks on its forces & settlers. Those concerns were amplified by the rise of new militant groups, an influx of weapons smuggled in by Iran & polling that suggests an increase in support for Hamas.

·       UN said that 2023 was the deadliest year for Palestinians in the West Bank & East Jerusalem since it began keeping track in 2005. That violence rose significantly after the war in Gaza began & has continued into this year.

·       Jenin Refugee Camp, in northern West Bank, 12 Palestinians, including 4 children, were killed & 21 injured, in a 40-hour operation carried out by Israeli forces. This was one of many attacks across the WB.

ISRAEL

·       Israel’s national security adviser says continuing war on Gaza likely to last through end of the year. In an interview with Israel’s Kan public broadcaster, Tzachi Hanegbi said “we are expecting another 7 months of fighting” to destroy the military & governing capabilities of Hamas & the smaller Palestinian Islamic Jihad (PIJ) group.

·       Israeli military is in central Rafah, the Israel forces confirmed, despite international concern & anger over its military operation in Gaza’s southernmost city.

·       Israelis celebrated Rafah massacre with a Jewish holiday bonfire on Lag Ba Omer using the occasion to mock 45 Palestinian men, women & children killed in an attack on a Gaza camp

·       Protests were held across Israel, including in Tel Aviv, Haifa, Caesarea, Jerusalem & Beer Sheva, calling for the release of hostages & new elections. Scuffles between Israeli police & protesters erupted in Tel Aviv after thousands gathered. Protesters also called for the resignation of Netanyahu.

·       Internal IOF Report found 2 Gazans died after being beaten en route to an Israeli prison. The 2 detainees were being taken from Gaza to the Sde Teiman detention facility; several soldiers have been questioned, but no one has been arrested on suspicion of causing their deaths

·       Hundreds of reports, testimonies, & investigations have shed further light on Israel’s brutal torture of Palestinian detainees & prisoners held captive in Israeli military prisons. Prisoners are viciously beaten & abused multiple times a day, caged in cells “not fit for human life,” kept blindfolded with their hands bound with plastic ties, isolated from the outside world, stripped of their clothing, collectively punished through starvation, attacked by dogs, sexually assaulted, & psychologically tortured. At least thirteen Palestinians have died in prison since 10/7 as a result of torture & being denied proper medical care. Countless more have been discovered in mass graves with clear evidence of having undergone torture, executions, & other crimes against humanity. Evidence from over the past 30 years proves that Israeli physicians routinely fail to uphold their ethical obligations & operate in violation of international law. As detailed in reports by Human Rights Watch, Amnesty International, Physicians for Human Rights-Israel, and many, many others, Israeli medical involvement in torture is systematic — & in fact integral to Israel’s torture regime.

·       Each week, members of Rabbis for Human Rights have been demonstrating near Gaza, demanding a ceasefire & return of hostages. Combatants for Peace – an organization of former fighters from both sides – offers a meeting space to members & new joiners. Every Saturday, Standing Together, the largest Arab-Jewish movement in Israel, joins organizations such as Women Wage Peace & thousands of others in Tel Aviv to call for peace.

·       The number of patients at medical rehabilitation centers across Israel has risen dramatically since 10/7. 17,825 people were treated at centers in the first 3 months after 10/7 – more than 3 times the total number of patients treated in 2022.

·       There is no indication from Israel that the Rafah border crossing between Gaza & Egypt, could be opened soon, Palestinian Authority Health Minister told reporters on the sidelines of the World Health Assembly in Geneva. Israeli forces also achieved total control over the border between Gaza & Egypt, commonly referred to as the Philadelphi Corridor, according to military sources.

·       Israeli officials are accused of using phone taps, spying, & intimidation against International Criminal Court prosecutors for decades to derail possible war crimes investigations. An Israeli reporter said they received threats against them if they continued reporting the attempts by the former head of the Mossad.

·       Qatar & Saudi Arabia have condemned an Israeli parliamentary bill that seeks to label UNRWA, the main provider of aid to Palestinians in Gaza, a terrorist group

·       Israel’s finance minister, Smotrich, announced that Israel will withhold Palestinian tax revenues from the Palestinian Authority in the West Bank “until further notice”. The move came on the same day that Norway, Spain & Ireland announced that they will recognize a Palestinian state; this accounts for 60-65% of the Palestinian public budget & was seen as collective punishment.

US

·       2 more US officials have resigned over the Gaza war, saying that the Biden administration is not telling the truth about Israeli obstruction of humanitarian assistance to more than 2 million Palestinians trapped & starving.

·       The state department falsified a report earlier this month to absolve Israel of responsibility for blocking humanitarian aid flows into Gaza, overruling the advice of its own experts, according to a former senior US official who resigned this week.

·       Trump told Jewish donors he’ll deport pro-Palestinian protesters. In a closed meeting with donors, Trump promised swift action against student protesters if elected, while affirming Israel’s right to conduct its “war on terror”; in contradiction to previous statements calling to end the war.

·       A Palestinian-American nurse honored at NYU Langone Hospital for her compassion was immediately fired after referring to Gaza “genocide.”

·       Academics continue to face suspensions & firings for supporting Palestine, most recently a San Jose State University Justice Studies professor who was faculty advisor for campus SJP

·       Bombs used in the Israeli strike that killed dozens of Palestinians in a camp for displaced people near Rafah on 5/26 were made in the US, according to weapons experts & visual evidence reviewed by The New York Times.

·       Biden made a proposed for a ceasefire:

Stage One: complete ceasefire for 6 weeks. Israel would withdraw from “all populated areas of Gaza”; Hamas & other militant groups would release some hostages, including women, elderly & wounded, in exchange for the release of “hundreds” of Palestinian prisoners; Palestinian civilians can return to their homes anywhere in Gaza; at least 600 trucks of humanitarian aid would enter Gaza every day.

Stage Two: somewhat open-ended, details are supposed to be worked out during Stage One. Biden did explicitly say that if those negotiations were not complete by 6 weeks, the ceasefire would be extended until they were. Second stage would see an agreement on a permanent end to hostilities, the release of all living hostages held in Gaza, & a full Israeli withdrawal from Gaza. There seems to be no framework for that permanent cessation.

Stage Three: return of the remains of all dead hostages, start of a massive reconstruction effort in Gaza by the international community. 

Biggest points that are absent from Biden’s presentation are governance, issue of war crimes, & enforcement

·       “The Islamic Resistance Movement Hamas views positively what was included in US President Joe Biden’s speech today,” the group said in a statement. 

·       The top 4 congressional leaders formally invited Prime Minister Netanyahu to address a joint meeting of Congress

INTERNATIONAL

·       President Biden welcomed Egypt’s OK to use Kerem Shalom crossing, & will send a senior team to Cairo to try to reopen the Rafah crossing. The Palestinian Authority agreed with Egypt to temporarily send humanitarian aid to Gaza through Israel’s Kerem Shalom crossing until an agreement is reached to reopen the Rafah crossing. Egyptian sources said coordination was ongoing with Israel to begin delivering aid through the crossing.

·       Children being treated in Gaza’s hospitals are “underplaying” pain because it “seems trivial” in the context of the wider conflict, doctors said. International medics met in Doha, Qatar, to discuss plans for a new trauma pain management manual to support professionals treating children in Gaza & other conflict zones.

SOURCES

OCHAOPT, The Guardian, Haaretz, The New York Times, The Intercept, Aljazeera, CNN, WHO, Ministry of Health, The New York Times, Mondoweiss, Middle East Eye, Portside, +972, ABC News, UPI News, AP, Inside Higher Ed, NBC News, HuffPost, The Conversation, Reuters, Middle East Eye, Common Dreams, antiwar.com, BBC