Urgent health update: Consequences of war on Gaza and West Bank/East Jerusalem-July 13, 2024

Israeli bombardment from the air, land, & sea, as well as ground incursions & heavy fighting, continue across much of the Gaza Strip, especially in Gaza City, where tens of thousands were ordered to evacuate on 7/7-8, and more again on 7/10. ~90% of the Gazan population are now Internally Displaced by Israeli military action. 

Journal article

A call from 40 public health scientists for an end to the continuing humanitarian and environmental catastrophe in Gaza
An under-recognised aspect of the current humanitarian catastrophe in Gaza is the impact of the war on the environment and the associated risks for human health… As scientists investigating the interface of environmental pollution and human health, we must call attention to the devastating consequences for public health and the lives of future generations resulting from Israeli military action and its impact on the Gazan environment. 
Environmental Health volume 23, Article number: 59 (2024) Cite this article

Videos

Their Goal Is Total Ethnic Cleansing: Mustafa Barghouti, founder of Palestinian Medical Relief Society, on Israel’s Expulsion Order for Gaza City, Democracy Now

JVP Health Advisory Council webinar The destruction of health care in Gaza, 6/29 Recording available here

GAZA

• Killed: (by 7/11) 38,345 (152 this week)

• Injured: 88,295 injured (392 this week)

• Israeli soldiers killed in Gaza (by 7/11) 324 (1 this week)

• Israeli soldiers injured in Gaza: 2,122

• Hostages: 120 

Attacks

• 7/4-9, 27 killed (13 children) in An Nuseirat Refugee Camp, Deir al Balah. Another 16 killed and 50 injured when an UNRWA school sheltering 2,000 refugees was hit. Another 9 (4 children) killed in Al Bureij Refugee Camp, Deir al Balah.

• 7/5 and 7, 16 killed (3 children) in Jabalya.

• 7/5, 4 Palestinian police killed and 8 injured in an attack on a police vehicle near Rafah. Another 4 killed (1 child) on 7/11 in Rafah.

• 7/5, 6 killed (3 children) in a grocery store near Khan Younis.

• 7/4- 6, 6 journalists killed in Gaza City and Deir al Balah, along with family members. Journalists killed during the war: 158.

• 7/9, 27 killed and >53 injured in airstrike near Al Mutanabi school in Abasan al Kabira, near Khan Younis, a refugee shelter.

• 7/7, 4 killed while being released from Israeli detention through Kerem Shalom/Karm Abu Salem Crossing.

·       7/12  At least 120 bodies, including entire families, have been found in rubble, on streets, & in homes in 2 Gaza City neighborhoods in the last 2 days after Israeli troops withdrew from Tal al-Hawa neighborhood.

·       7/13 Israel attempted to kill a top Hamas military commander , Muhammad Deif, believed to be an architect of the10/7 attack in an airstrike in southern Gaza. > 70 people had been killed in the strike, which hit an area Israel had designated as a humanitarian zone.

·       Israeli soldiers described the near-total absence of firing regulations in the Gaza war, with troops shooting as they please, setting homes ablaze, leaving corpses on the streets — all with their commanders’ permission.

Gaza City and Displacement

·       After ordering tens of thousands of Gaza City residents to evacuate on 7/7-8, on 7/10, Israeli military airdropped leaflets ordering further evacuation south to Deir al Balah & Az Zawayda. UN Human Rights Office in the Occupied Palestinian Territory condemned the evacuation to areas where “military operations are ongoing & where civilians continue to be killed and injured.” 

·       Palestinian Civil Defense (PCD): east Gaza City is a disaster zone, 85% of buildings destroyed, uninhabitable & infrastructure massively damaged. In west Gaza City, bodies scattered in the streets & inside destroyed buildings. Withdrawing Israeli forces set houses on fire. PCD emphasized that many lives could have been saved if Israeli forces allowed them to reach the injured. >110 cadavers were recovered. 

·       Sabha Al Harazeen medical clinic was destroyed, affecting >50,000 people. Clinic included a pharmaceutical warehouse & the only public health laboratory in Gaza testing water, beverages, food, & pharmaceuticals as part of disease control & prevention. As Salam clinic also hit & destroyed, formerly providing primary health-care to thousands.

·       Those displaced from Gaza City join over 1.9 million other people displaced who face harrowing conditions in refugee camps.
Al Bureij, 3,800 IDPs share 388 tents. Only basic health-service points are available, there are dire shortages of food, drinking water, hygiene products, solar panels, & clothing.
Al Maghazi, >1,000 IDPs are crammed into an UNRWA school building, hit in late 2023. Since then, no UNRWA services could be provided. IDPs lack medical care, clothing, water and adequate food, with 7 cancer patients all unable to receive treatment.
Deir al Balah, 14,000 people live in an UNRWA school & makeshift structures in the courtyard. No food distributed since 3/1, children are “unrecognizable” due to malnourishment. Only 25 toilets are available–1 for every 560 people–& a shortage of water “due to lack of fuel to pump water from the water well” makes disease worse.

·       Displaced women highlight the particularly bleak conditions they face. Forced to cut off their hair, due to lice & lack of hygiene products, they are increasingly unable to provide for their families & children who “go to bed without eating & drinking,” as well as disabled or sick relatives. They are also facing increased sexual & gender-based violence.

Hospitals and Health Facilities

·       Evacuation of Gaza City & nearby areas affected 17 recently functional health facilities, including 6 hospitals, 2 primary healthcare centers & 9 medical points. Fearful of Israeli destruction, Al Ahli Baptist Hospital & the Patients Friends Association Hospital were evacuated; patients transferred to the Indonesian & Kamal Adwan Hospitals. The Baptist Hospital later partially reopened. Added to the European Gaza Hospital (Khan Younis, evacuated 7/2), 3 more hospitals have become non-functional, leaving only 13 out of 36 hospitals partially functional.

·       7/10: UNRWA reopened the Japanese Health Center in Khan Yunis after 6 months. On Day 1, 33 medical staff saw more than 900 patients, offering pre- and post-natal care, blood tests, treatment for non-communicable diseases & outpatient services. The only clinic in this part of Khan Younis, it is crucial for displaced families sheltering in the area & will operate double-shifts to manage the high patient load. Only 9 of 26 UNRWA health centers & 86 medical points remain operational.

·       Kamal Adwan & Indonesian hospitals absorbed patients despite a severe scarcity of fuel, beds & trauma medical supplies. Indonesian Hospital is 300% of capacity (WHO), and the hospital called on citizens to urgently donate blood. WHO also warned that fighting & access problems threaten Al Helou, As Sahaba & Al Shifa hospitals with non-functionality.

·       Chronic fuel shortages forced Kamal Adwan Hospital to suspend dialysis for 21 kidney patients & risk lives in its neonatal & intensive care units.
Kuwaiti Specialized Field Hospital received a few days supply of fuel from WHO and UNRWA on 7/5, which is attempting to meet the soaring needs at Nasser Medical Complex, the last tertiary hospital operational in southern Gaza. MSF reported its teams at Nasser were “running on emergency medical stocks” & all departments were overwhelmed by patients, far exceeding available bed capacity. Pediatrics has 56 beds, 100 patients were received on 7/3 July alone, forcing children to lie on the floor. Patients are in corridors, lying on blankets, sitting on stairs, & health workers hang IV fluids & medication bags on nails in the wall. Nasser sterilizes equipment for several field hospitals, so if no electricity, field hospitals would also cease functioning. MSF has been unable to bring any medical supplies into Gaza since April; on 7/3, trucks carrying MSF medical aid were denied entry by Israeli authorities.

·       UNFPA deployed 12 equipped midwives to medical points in Deir al Balah & Khan Younis. Heightened insecurity & the Israeli targeting of hospitals are leading pregnant women to seek birthing alternatives at outpatient facilities such as medical points.

·       Doctors who have had to perform "a constant flow of amputations" on injured children said the injuries they have witnessed were consistent with the use of "fragmentation bombs" loaded with shrapnel—which Israel has used in the past and which rights groups have said are designed to cause maximum casualties.

·       7/11 Doctors without Borders temporarily closed its last health facility in north Gaza after evacuation orders & heavy fire

Food and Nutrition

·       WHO reported  34 people died of malnutrition & dehydration since the war began, 60 cases of Severe Acute Malnutrition detected at Kamal Adwan Hospital alone in early July. Malnutrition reduces immunity for children, the elderly & others. Concurrent lack of access to adequate food, clean water, sanitation & basic health services traps people in a “vicious cycle,”

·       Since mid-January, 138,062 children aged 6-59 months have been screened for malnutrition. 7,508 children were diagnosed with Moderate Acute Malnutrition, 2,121 with Severe Acute Malnutrition (SAM). Insecurity & access restrictions have significantly limited supplies for the Supplementary Feeding Program.

·       UN experts declared famine has spread throughout Gaza.  “We declare that Israel’s intentional and targeted starvation campaign against the Palestinian people is a form of genocidal violence and has resulted in famine across all of Gaza.”

Humanitarian Aid

·       Insecurity, damaged roads, breakdown of law & order, & access limitations limit aid delivery between Kerem Shalom Crossing & Khan Younis & Deir al Balah, causing shortages of fuel & commodities, increasing spoilage of stranded supplies due to heat. Food rations in Gaza have been reduced, bakeries & community kitchens struggle to remain open. Only 7 of 18 bakeries remain operational, all in Deir al Balah. 6 bakeries working at partial capacity are now closed due to lack of fuel. Shortages of cooking gas & food supplies resulted in a 15% reduction in meals prepared by community kitchens. Displaced households rely on burning plastic & waste to cook, exacerbating health risks & environmental hazards.

·       Aid organizations in northern Gaza distribute wheat flour & canned food entering via Erez West Crossing, but prohibition of commercial truck entry for months has caused a near total lack of protein (meat and poultry) in local markets, & a minimal amount of local vegetables (at unaffordable prices). By May 2024, ~ 57% of Gaza’s cropland & a third of its greenhouses were damaged. Destruction in previously agricultural areas (Rafah, Khan Younis) has further destabilized food systems as has the limited entry of seeds, fertilizers & other agriculture inputs via all crossings.

·       After Israeli authorities cut off electricity supply & fuel reserves for Gaza’s only power plant  in October, electricity generation is dependent on the entry of fuel, severely restricted by Israel. Current average of ~99,000 liters of fuel per day is about 25% of what is needed to sustain humanitarian activities: generators for hospitals, bakeries, & water, sanitation, & hygiene (WASH) facilities.

·       Of 38 planned humanitarian assistance missions coordinated with the Israeli authorities to northern Gaza between 7/1-11: 14 (37%) were facilitated, 13 (34%) were impeded, 7 (18%) were denied, & 4 (11%) were cancelled. In southern Gaza, of 147 attempts, 118 (80%) were facilitated, 9 (6%) were impeded, 5 were denied (3%) & 15 (10%) were cancelled. Missions delivering water & fuel were especially affected.

Water and Sanitation

• Between 6/24-7/7 water production fell by 30% compared to the previous weeks. Lack of fuel & war damage limit water consumption to 2-9 liters per person daily, when humanitarian standards for minimum per capita amount of water needed in an emergency is 15 liters.

• Timelines for water pipeline repairs to the UAE desalination plant &e Mekerot pipeline to Gaza City are unclear due to ongoing hostilities. But testing of the electric feeder line to the Gaza Seawater desalination plant is expected to begin shortly. In the absence of safe water, testing kits & training in their use is being rolled out, as are chlorine pumps & chlorine tablets for groundwater wells & supply trucks.

• Lack of access to clean water, hygiene supplies, sanitation facilities drives a surge in acute respiratory infections (>923,000 cases), diarrheal illnesses, acute jaundice, skin infections, all exacerbated by poor living conditions & overcrowding. 

Gender

·       Psychological First Aid (PFA), psychosocial support, case management, referral, legal counselling, recreational activities & awareness sessions on menstrual & personal hygiene were provided to 12,000 displaced women & girls in the past month. >80,000 hygiene & menstrual hygiene kits were distributed, Protection Cluster is advocating for entry into Gaza of additional hygiene supplies for women & girls to address existing shortages. Gender-based violence partners have established 6 mobile safe spaces in Deir al Balah & Khan Younis. 

Education

·       14 additional community-led education initiatives started in Deir al Balah & Khan Younis, bringing total to 59. 8 new Temporary Learning Spaces (TLS) were set up. These efforts increase access to learning opportunities for school-aged children, who for 9 months have been deprived of formal education. 

·       Education Cluster has completed the mapping of 10,394 teachers (75% female) in 227 informal shelters, with 99% expressing readiness to resume work. The Cluster plans to scale up informal learning activities at displacement sites, as well as recreational & Mental Health & Psychosocial Support (MHPSS) for school-aged children.

·       Denial of education supplies, recent evacuation orders & increased attacks on schools pose significant challenges to the expansion of the Education response. Some existing TLSs were evacuated, and finding alternative suitable spaces in new areas of displacement is challenging. 

Other

·       Documents & testimonies reveal the Hannibal operational order, which directs use of force to prevent soldiers being taken into captivity, was employed at 3 army facilities infiltrated by Hamas, potentially endangering civilians as well.

WEST BANK & EAST JERUSALEM

·       553 Palestinians killed (131 children) and ~5,500 Palestinians injured (~850 children). 

·       14 Israelis killed, including 9 soldiers and 5 settlers, and ~105 Israelis injured, including 90 soldiers. 

·       Since October 2023, more than 1,000 Israeli settler attacks on Palestinians have displaced about 1,390 people, including 660 children, in 29 Bedouin and herding communities due to settler violence and access restrictions. 

Attacks

·       Between 7/2-8, Israeli forces killed 15 people, including 5 by airstrikes, mostly in Jenin & Tulkarm cities &ir adjacent refugee camps. 85 people (9 children) were injured across the West Bank, 83 by Israeli forces and 2 by settlers.  

·       A Palestinian family was displaced & 13 others affected by a settler attack in Hebron. 

·       On 7/9, Israeli forces shot & killed a 13-year-old boy in Ramallah, & injured 3 others (age 9-13) in Askar Refugee Camp, Nablus. 

·       On 7/9, Israeli forces besieged & raided Nur Shams Refugee Camp, Tulkarm for 15 hours. Bulldozers destroyed roads, damaging infrastructure & disrupting water, electricity, & internet services. Homes, shops & other structures were also damaged.  

·       Between 7/2-8, Israeli settlers perpetrated 22 attacks, injuring 2, damaging hundreds of Palestinian-owned trees & other property. Israeli settlers throwing stones at Palestinian-plated vehicles damaged cars in Ramallah & Nablus; Palestinians threw Molotov cocktails at Israeli-plated vehicles in Ramallah. 

·       7/2, Palestinians from Nablus discovered 210 olive trees, 7 cypresses, & 45 grapevines destroyed or damaged by settlers from Migdalim, who also took over land owned by Palestinians planted with olive trees.  

·       7/3, settlers from Eyvatar assaulted & injured a farmer in Beita village (Nablus) &  threatened him not to return to his land. 

·       7/3, armed settlers from a new outpost near Avigayil raided Khallet Athaba’ herding community (Hebron), setting fire to grazing areas, damaging vehicles & houses, assaulting 5 Palestinians, setting a house on fire, stoning a Palestinian Civil Defense (PCD) vehicle trying to extinguish the fire. Palestinians defended themselves & their properties, contacted Israeli police & forces, who then arrested a Palestinian. Massive damage occurred, including to solar panels, leaving the community with almost no electricity. A family of 4, 2 children, was displaced, & 13 families (88 people, 20 children) were affected. 

·       7/7, settlers from Talmon raided Al Mazra’a al Qibliya village (Ramallah), where they threw stones at houses, set fire to vehicles, & injured a Palestinian.  

·       3 Israeli outposts were established near the villages of Turmus’ayya & Burqa (Ramallah), the new settlers have been attacking Palestinians. In Turmus’ayya, settlers burned or cut down hundreds of olive trees, burned farmhouses, generators & solar panels, stole water tanks & other belongings. In Burqa, settlers threw stones at houses and tried to set a house & trees on fire.  

·       In 4 incidents, Israeli settlers cut down 27 pine trees belonging to the Palestinian youth centre in Kafr Ni’ma village (Ramallah), destroyed 200 almond trees while grazing their sheep on Palestinian land in Umm ad Daraj village (Hebron), ran over &  killed 6 sheep, injured 6 others in Umm Safa village (Ramallah).  

·       Since 10/7/23, Israeli settlers made 1,084 attacks, of which 107 led to Palestinian fatalities & injuries, 859 led to property damage, 118 caused both casualties & damages. ~46,500 Palestinian-owned trees & saplings were destroyed by Israeli settlers. Since October, 235 Palestinian households (1,392 people, 663 children), were displaced in 29 Bedouin & herding communities by settler violence & access restrictions. UN Human Rights Office (OHCHR) highlighted that a new wave of settler attacks “fit within long-standing trends of organized violence against Palestinians committed with impunity & with the backing of [Israeli forces... These attacks] come as Israel’s government takes overt measures that could facilitate the annexation of Palestinian land in violation of international law.”  

·       The Israeli authorities punitively demolished 5 structures that belonged to 2 Palestinians who killed an Israeli in a February shooting attack that killed 1 & injured the other, displacing 11 people, including 2  children. A residence demolished in Duma village (Nablus) belonged to a Palestinian accused of killing an Israeli boy in April 2024.  

·       Israeli authorities demolished 41 Palestinian-owned structures due to the lack of Israeli-issued building permits, including 5 in East Jerusalem & 36 in West Bank Area C. This displaced 19 households (91 people, 45 children) & affected 155 others, including 92 children. 47% of the displaced (43 people) were from Birin (Hebron) & 44% (40 people) from 6 herding communities in Jericho, Nablus, & Hebron. All the East Jerusalem structures, including 3 homes, were demolished by their owners. In Area C, 16 inhabited & 4 uninhabited homes, 13 livelihood structures, 7 latrines, & primary school were demolished. The school in Khallet Amira (Hebron) served 39 pupils & 10 kindergarteners.

·       Growing evidence that Israel has repeatedly obstructed ambulances, attacked health care facilities and providers in WB

Other

·       Israel transferred $116 million of withheld tax revenue to the Palestinian Authority, the first such transfer since April. Israel collects tax on goods that pass through Israel into the West Bank on behalf of the PA & transfers the revenue. Since 10/7 Smotrich has withheld sums earmarked for administration expenses in Gaza. Israel also deducts funds for electricity, water, costs to treat Palestinians in Israeli hospitals & “martyr’s payments” which the PA pays to families of militants and civilians killed or imprisoned by Israeli authorities.

ISRAEL

·       While ceasefire talks seemed to be moving forward, Netanyahu unexpectedly created a list of so-called “non-negotiables” that seemed aimed at derailing talks.

·       Israeli and Egyptian ceasefire negotiators are in talks about an electronic surveillance system along the border between Gaza & Egypt that could allow Israel to pull back its troops from the area if a ceasefire is agreed. The question of whether Israeli forces stay on the border is one of the issues blocking a potential ceasefire deal because both Hamas, & Egypt, a mediator in the talks, are opposed to Israel keeping its forces there.

·       Israel urged UNRWA to fire 100 workers they accuse of being affilitated with Hamas or Palestinian Islamic Jihad. UNRWA employs 13,000 workers.

·       Thousands gathered in Tel Aviv for an event, "It's Time: The Great Peace Conference." Rally organized by a confederation of some 50 organizations & individuals from Israel's left & pro-peace camp, with a message that revolved around the arena's LED screens: "It's time to reach a deal. To stop the war. To make peace."

US

·       Israeli Defense Minister Gallant met with top White House official for Middle east affairs to discuss a cease-fire & hostage release “as long as Israel’s red lines are preserved,” ie destruction of Hamas’ military & governing abilities.

·       7/12 Biden claimed that he isn’t providing Israel with the 2,000-pound bombs that Israeli forces are using to kill Palestinians in Gaza — a statement that is patently untrue. Since October, Biden has sent over 10,000 of these highly destructive bombs to be used in Israel’s assault — raising questions about whether this was another of Biden’s gaffes or simply a lie from Biden as his support among Democratic-leaning voters who are opposed to the genocide has cratered.

·       75% of Middle East scholars say Israel is carrying out genocide or war crimes “akin to genocide” in Gaza, but overwhelmingly they are afraid to express their views because of the consequences on campus. Middle East scholars see anti-Palestinian bigotry as far more of a problem on campuses than antisemitism. They say administrations are wildly out of touch with student & faculty sentiment on protests of the war.

·       A self-styled civil rights organization, the Anti-Defamation League has surveilled leftwing activists and “regularly tracks, profiles and sends threat assessments of individuals” it perceives as a problem. The group is particularly focused on redefining criticism of Israeli policy as inherently antisemitic.

·       Pentagon is dismantling $230 million temporary pier built for Gaza aid after multiple failures, technical and weather related.

INTERNATIONAL

·       Houthi forces in Yemen appear to have resumed attacks on commercial ships in the Red Sea after pausing strikes for more than a week

SOURCES
OCHA OPT, New York Times, Reuters, +972, The Guardian, UN Human Rights Office of the High Commissioner, Common Dreams, Democracy Now, Portside, Truthout, Middle East Monitor, Electronic Intifada, Mondoweiss