Urgent health update: Consequences of war on Gaza and West Bank/East Jerusalem-July 20, 2024

Israeli bombardment from the air, land, & sea, & ground incursions & heavy fighting, continue across much of Gaza. Attacks on IDP shelters in tent camps & schools, & their supportive infrastructure, have led to a horrific increase in casualties. Poliovirus (VDPV) type 2 has been found in environmental surveillance samples collected from Khan Younis & Deir al Balah. 

JOURNAL ARTICLES & REPORTS

Racism as a Threat to Palestinian Health Equity
A public health framework could help recognize racism as a structural & social determinant of Palestinian health. Using the principles of health equity, we show how Palestinian health inequities are rooted in settler colonialism & racism, amounting to violence & oppression against Palestinian Arabs as a racialized group, regardless of religion or citizenship. Structural racism should be recognized as a driver of Palestinian health inequities. https://www.liebertpub.com/doi/10.1089/heq.2024.0027, https://doi.org/10.1089/heq.2024.0027

War and Palestinian Youth: The Psychological and Economic Impact of Repeated Attacks, Invasions, and Wars, The impact of war on Palestinian youth includes various types of profound & chronic psychological traumas, along with economic hardships. Addressing these challenges demands collective efforts to foster healing, peace, & resilience. This involves supporting the Palestinian economy and addressing basic needs for young people, while also enhancing the capabilities of mental health workers through training and support. Reform, 2024/07/18 13:03:55, here

REPORTS

Human Rights Watch: at least five armed Palestinian groups including Hamas & Palestinian Islamic Jihad took part in the 10/7 attack on Israeli border communities, all 5 are responsible for committing war crimes & crimes against humanity. The report rebuts Hamas' claims that its combatants were instructed not to harm children, women & elderly & states the killing, torture & hostage-taking of civilians was systematic, premeditated & deliberate. here

On the Record with Hamas. In a Drop Site News exclusive, Hamas officials discuss their motivations, political objectives, and the human costs of their armed uprising against Israel. Drop Site

Gaza Community Mental Health Program: Nine Months of Israel's War on Gaza: The Mental Health Impacts and the GCMHP's Response here Discussion on Middle East Eye

Historical review of how the right wing gained victory in the West Bank here

New York Times analysis how the Israeli hostage rescue on 6/8 led to one of Gaza’s deadliest days  here

JVP Health Advisory Webinar and written summary posted on Mondoweiss here

STUDY GROUPS
The USA-Palestine Mental Health Network is hosting reading/discussion groups about Incarcerated Childhood and the Politics of Unchilding by Professor Nadera Shalhoub-Kervorkian (Cambridge University Press, 2019). These groups are now available: 

·       Mondays, September 9- October 14, 2024, 8:30-10am EST

·       Wednesdays, September 11 - October 16, 2024, 7-8:30pm EST

If you are interested in participating, please indicate which group and contact Cheryl Qamar qamar@usapalmhn.org or Christine Schmidt schmidt@usapalmhn.org and indicate which cycle you’d like to join. Participants will receive more detailed information, including zoom links.

https://mailchi.mp/ecd85f117c76/book-group-announcement-july-1-15840?e=eda3fcc0f6

ARABIC STUDY GROUP
The USA-Palestine Mental Health Network will be offering a six-session reading and discussion group on “Psychoanalysis Under Occupation” that focuses on the experiences and voices of mental health workers and patients in Palestine. The authors, Lara Sheehi and Stephen Sheehi, are on the advisory council of the USA-Palestine Mental Health Network. They invite readers to challenge old trauma paradigms..

These weekly sessions are for Arabic speakers and will be on Sundays from August 18 through September 29, 2024 (there is no session on 9/8) at 7:30-9p Beirut time/12:30-2p ET

As with the English language study group described above, there is no fee, but participants are expected to read, share opinions, and learn. If you are interested in participating, please contact Cheryl Qamar and Christine Schmidt.

Numbers are cumulative

Gaza Strip 

• Killed: (by 7/18) 38,848 (503 this week)

• Injured: 89,459 injured (1,164 this week)

• Israeli soldiers killed in Gaza (by 7/19) 326 (0 this week)

• Israeli soldiers injured in Gaza: 2,134

• Hostages: 120 

  Attacks

• 7/11 & 14, 18 killed (1 child), dozens injured in Gaza City. 

• 7/11, 8 killed in IDP tents in Khan Younis. 

• 7/13, 4 killed (1 child) in An Nuseirat refugee camp, Deir al Balah. 

• 7/13, Israeli military targeted IDP tents, a food kitchen, & water point in Al Mawasi, Khan Younis, killing 90 people, including 3 Civil Defense (PCD) workers, & injuring 300. WHO reported: 134 severely injured were admitted to the overcrowded Nasser Hospital, 120 to IMC field hospital in Deir al Balah, others to the Kuwait, Al Quds & UK-Med field hospitals in Khan Younis & the ICRC field hospital in Rafah. Nasser Hospital stopped accepting new patients in the afternoon of 7/13. UNRWA described abysmal conditions at Nasser Hospital: “many patients were treated on the ground without disinfectants”; there were “not enough beds, hygiene equipment, sheeting, or scrubs.”  Israeli military reported targeting Mohammed Deif – the leader of Qassam Brigades, Hamas’ military wing and the head of the Khan Younis brigade, Rafe Salama.

• Visual evidence from Al Mawasi strike appears to show the Israeli military launched a separate strike near emergency vehicles.

• 7/13, 22 killed praying in Ash Shati' (Beach) Refugee Camp, west of Gaza City

• 7/14 & 7/16, 2 UNRWA schools in An Nuseirat sheltering IDPs were bombed, killing 38, injuring 153. 7/14-18, an additional 41 killed (10 children) & others injured in strikes in & around Al Maghazi & An Nuseirat Refugee Camps, Deir al Balah. 

• 7/14, 7 killed near Rafah. 

• 7/16, Israel bombed a market in Khan Younis, killing 17 (4 children) injuring 26. 

• 7/17, 11 killed, Israel hit entrance to a school in Gaza City. UNRWA noted 8 schools targeted in 10 days: “The war robbed the girls & boys in Gaza of their childhood [&] education. Schools must never be used for fighting or military purposes by any party to the conflict.”  

• 7/17, 4 killed, others injured near Khan Younis.  

• Maternal health

• It is increasingly difficult to access pregnancy care due to repeated displacement, insecurity & attacks on healthcare facilities, coupled with unaffordable transportation costs, lack of fuel, & destruction of ambulances.

• UNFPA: comprehensive emergency obstetric and newborn care available at only 11 hospitals & field hospitals, fuel shortages impede use of neonatal incubators & other equipment. Emergency deliveries are taking place in tents without medical support. Water & medicine scarcity increases risk for pregnant & breastfeeding women, doctors report rising numbers of preterm & low-birth weight babies, common indicators of malnutrition compounded by stress, fear & exhaustion.

• 30,000 pregnant women suffer acute hunger, >10,000 on the verge of famine, & 7,000 suffer famine. Protection & Health Cluster partners & coordinators are scaling up sexual & reproductive health services, recruiting, training & equipping displaced health workers, particularly midwives, to provide antenatal & postnatal care services & attend emergency deliveries. 

• Pre-term deliveries & maternal complications, including eclampsia, hemorrhage & sepsis, are rising as pregnant women navigate unsafe routes to hospitals amidst conflict. Rapidly discharged, they return to the health risks of the tents & shelters. Nasser Medical Complex is the only tertiary hospital providing maternal & pediatric care in Khan Younis. 

• Miscarriages in Gaza have skyrocketed 300% according to reproductive health experts & women are three times more likely to die in childbirth.

  Child Health

• Study by Atfaluna Society for Deaf Children (ASDC) on impact of war & halted education for children with & without disabilities found >70% of parents reporting displacement shelters are unsuitable for children & contribute to the spread of infection. 90% report a lack of toilets with privacy, with figures consistently higher among parents of children with disabilities. 87% of parents state that children are susceptible to physical abuse at shelters, 65% do not receive suitable medical care. >1/2 report they are unable to calm children during bombings & emergencies. Psychological impact on children is significant, creating increased anxiety, stress, & behavioral issues. 

  Hospitals

• ~1,500 hospital beds, compared to 3,500 before the war, are available in Gaza to cover the needs of more than 2 million people. Shortage is compounded by the lack of medical supplies & equipment, leading to “unnecessary deaths, infected wounds & unnecessary amputations.” - WHO. WHO’s 7/16 request to deliver supplies to Al Ahli & Patient Friendly Hospitals were denied.

• ICRC stressed repeated mass casualty events “have stretched to breaking point” the capacity of their Rafah field hospital. After the 7/13 airstrikes in Khan Younis, they treated 26 wounded patients, 8 with immediate surgeries for life- & limb-threatening injuries. Of the 850 patients seen by their Outpatient Dept. in the 2nd week of July, ½ were women and 1/3 children.

• MSF reports in the 1st half of July their teams at the Nasser Hospital in Khan Younis & Al Aqsa Hospital in Deir al Balah have responded to 4 mass casualty events. Nasser’s pediatric emergency department is overstretched & under-resourced, seeing a daily average of >300 children. Kids admitted for inpatient care must share beds. UNFPA reports “babies, children, newborns & mothers on mattresses in the corridor”. 

• Variant poliovirus (VDPV) type 2 detected in environmental surveillance samples collected from Khan Younis & Deir al Balah, warns WHO. 
  ·  Shellshocked, attacked, left to die – this is the reality for disabled people in Gaza

  Food & Nutrition

• UNOSAT preliminary analysis, based on satellite imagery, shows 63% of cropland in the Gaza Strip shows a significant decline in health & density. This is a 9% increase in damaged cropland since 5/24, due to military destruction. North Gaza, 75% of cropland is considered damaged compared to 69% in central Gaza, 56% in Deir al Balah, 58% in Khan Younis, 52% in Rafah.

  Water and Sanitation

• Infectious diseases continue to spread due to shortages of clean water, overcrowding, & abysmal sanitation & hygiene conditions. WHO reports 990,000 cases of acute respiratory infections, 574,000 of acute watery diarrhea, 107,000 of jaundice, 12,000 of bloody diarrhea, with the real numbers likely much higher. UNRWA highlights rashes & skin infections, particularly among children, also on the rise.

• WHO reports that the Global Polio Laboratory Network (GPLN) detected variant poliovirus (VDPV) type 2 in 6 environmental surveillance samples from Khan Younis & Deir al Balah. No associated paralytic cases have yet been detected. WHO is working with the MoH, UNICEF, UNRWA & partners to assess the poliovirus spread & determine appropriate response, including vaccination campaigns. According to WHO-UNICEF routine immunization data, polio vaccination coverage in the oPt was ~89% in 2023, but 9 months of war have lowered immunization rates & increased risk of vaccine-preventable diseases. Besides supporting polio eradication by vaccinating children at every opportunity, WHO noted that: “A ceasefire is essential to allow an effective response.” 

  Displacement & Emergency Response

• Population transfer from northern to southern Gaza began when Israeli military airdropped flyers ordered Gaza City residents to evacuate, displacing people to Deir al Balah. Relief assistance included drinking water, food, hygiene supplies, & some shelter materials. IDPs, relatives & “welcome” staff were attacked on 7/17 by Israeli tanks stationed near the Netzarim corridor that fired at people assembled near the checkpoint. 7/18, a military strike on the An Nuseirat Refugee Camp forced humanitarian staff to withdraw & a protection cluster to cancel operations. 

• 6/29 & 7/12, UN post-evacuation needs assessments in Gaza City to identify priority needs covered 4 schools & 2 informal sites, hosting 4,182 people. Findings include:  
  Overcrowding and lack of safety: 5-6 households share a room. Damage and explosive ordnance contamination make them unsafe.  
  Lack of shelter materials: All households face severe shelter shortages, but those arriving from Ash Shuja'iyeh & eastern Gaza City were forced to hastily flee amid active hostilities & lack mattresses, bedding, clothes, shoes & food.
  Water scarcity: Water trucks delivering desalinated drinking water arrive irregularly. Households must rely on highly saline water for drinking, which causes stomach pain. Market priced water is expensive: US$1.4 for a jerrycan. 
  Degrading sanitation conditions: Most toilets in collective sites are nonfunctional. Sewage spills into streets, toilets lack doors & water for flushing. Personal hygiene is difficult due to lack of privacy, water, & hygiene supplies, including sanitary pads. Scorching heat & solid waste accumulation attract insects & mosquitos. Waste piles are often burnt to prevent insects & disease transmission, creating toxic fumes posing additional health hazards.
  Widespread food insecurity: Insufficient food is not equally distributed. Lack of dietary diversity is caused by the destruction of the markets & exorbitant prices. There has been a 50-fold increase in the prices of green peppers, & a 45-fold increase in the price of tomatoes. IDPs report losing >15 kgs of body weight over the past 8-9 months. 
  Poor health access and nutrition: Lack of transport, ambulance service, & essential meds limit access to health care. Nutritional deficiencies, lack of privacy, stress & trauma limit breastfeeding  amid a lack of milk formula, limited malnutrition screenings & access to supplements. IDPs report increased stillbirths. Hepatitis A, gastroenteritis, dysentery, skin & eye infections have increased. Assistive devices for people with disabilities are lacking.
  Lack of materials for educational activities: Limited non-formal education has been organized by volunteers & UNRWA for some children 5-10 years old, dedicated spaces & materials are lacking. Children >10 are mainly collecting wood & hauling water. 

  Humanitarian Aid

• 7/1-15, 1,288 truckloads of mostly food aid entered Gaza, an average of 86 trucks/day, higher than the June 76/day but lower than the May 94/day. 

• 7/1-18, of 72 planned humanitarian missions coordinated with the Israeli authorities to northern Gaza: 29 facilitated, 20 impeded, 18 denied access, 5 cancelled due to logistical, operational, or security reasons. In southern Gaza, of 240 coordinated missions: 177 facilitated, 22 impeded, 17 denied, and 24 cancelled.

• Rafah crossing to Egypt has been closed since Israel captured it in early May, blocking the only route out of the territory for thousands of Palestinians who desperately need medical care. Aid workers and doctors have warned that the prolonged closure is endangering some of Gaza’s most defenseless, including children with severe burns, cancer patients and people needing heart surgery.
  
  Environment

• According to an assessment by the UN Environment Program, it would take 15 years to clear Gaza of ~40 million tons of rubble with a fleet of >100 trucks, operation would cost up to $600 million.

  West Bank, including East Jerusalem

• Killed: 554 (131 children) 3 this week (2 children)

• Injured: ~5,500 (~850 children), 37 this week (13 children) 

• 14 Israelis killed, including 9 soldiers & 5 settlers, ~105 Israelis injured, including 90 soldiers. 

• Israeli settlers carried out 23 attacks on Palestinians, causing 2 injuries & property damage.  

• Since October 2023, there have been 1,122 Israeli settler attacks on Palestinians, 105 led to Palestinian fatalities & injuries, 898 led to damage to property, 119 caused both.

• More than 600 structures have been demolished in the West Bank & East Jerusalem, since the beginning of 2024 due to the lack of building permits, displacing >750 people. 

  Attacks

• 7/16, Israeli forces shot & arrested a 20-year-old from Gaza during a raid on stores in Al Bireh; they delivered his corpse to the Red Crescent at the Beit El DCO checkpoint. Israeli media reported he stabbed & injured an Israeli soldier before he was shot, a claim refuted by local sources.  

• 7/16, 3 Israeli settlers injured by Israeli forces mistakenly shooting their vehicle near Beit El checkpoint in Ramallah. 

• 7/16, Israeli forces closed all checkpoints between Nablus & Tulkarm for 2 hours following an incident where 3 Israeli settlers were injured by glass shrapnel near Ramin village & Shavei Shomron settlement, east of Tulkarm. 

• 7/9 July, Israeli forces shot & killed a 14-year-old near Ramallah. Child was playing with 2 other kids when 3 Israeli soldiers fired live ammunition toward them. Israeli forces & settlers prevented child’s evacuation; he was left bleeding on the ground for about 15-20 minutes before an ambulance could reach him. Israeli forces shot & killed another man on 7/12 in Ramallah. 

• 7/11, Israeli forces shot & killed a 14-year-old during a search-&-arrest operation south of Jenin, & shot 5 other children.

  Property damage

• Recurrent property & animal damage, fires, stealing, tree cutting, crop damage, & attacks on Palestinians by settlers:
  from Talmon on Al Janiya village, near Ramallah
  from a new outpost near Shilo settlement, near Ramallah on Khirbet Abu Falah village
  from Tene outpost on Khirbet ar Rahwa (Hebron)
  on Ras ‘Ein Al ‘Auja (Jericho), Mantiqat Shi’b al Butum (Hebron) & Kisan (Bethlehem), & Khashem ad Daraj (Hebron)
  from Karnei Shomron on Kafr Laqif, east of Qalqiliya
  from outpost near Nablus on 4 Bedouin families and herders

  Housing

• Israeli authorities demolished 42 Palestinian-owned structures due to the lack of impossible-to-obtain building permits, including 32 structures in Area C, 9 in East Jerusalem, 1 artesian well in Tubas (Area A). As a result, 78 Palestinians (39 children) were displaced & ~60 (22 children) were otherwise affected. Since the beginning of the year, lack of Israeli-issued building permits in the West Bank & East Jerusalem led to 615 structures being demolished & 755 people displaced, compared with 452 structures demolished & 568 people displaced in this period in 2023.  

• 7/9, Israeli forces bulldozed Nur Shams Refugee Camp (Tulkarm), causing significant damage to essential infrastructure within & around the camp, including 1,600 meters of sewage & water lines, causing disruptions of water, electricity, & internet services. UN-led assessment found 24 residences were damaged severely enough to be uninhabitable, displacing 36 families (149 people), & 150 families’ homes sustained minor to moderate damage. Dozens of workplaces & stores were also damaged. 

• Since 10/7, Israeli authorities demolished 1,179 Palestinian structures across the West Bank, of which 40% were inhabited homes, displacing 2,756 people (1,113 children). 

• 7/8, the Jerusalem District Court rejected appeals of eviction cases by 11 Palestinian households in the Silwan area of East Jerusalem, threatening 66 people with displacement. 11 families are among 97 families (over 450 people, including 200 children) at risk of displacement by Ateret Cohanim settler organization in Silwan. In total, 217 Palestinian households in East Jerusalem have eviction cases filed against them in Israeli courts, the majority by settler organizations, threatening 968 people (424 children) with displacement. 

  ISRAEL

• Knesset rejected a bill to establish a state commission of inquiry into the events of 10/7

• Knesset passed resolution opposing Palestinian statehood. Declaration stated that 'a Palestinian state would pose an existential threat to the State of Israel and its citizens.' It received support from 68 Knesset members, with opposition from only 9 lawmakers, all from Arab parties

• 7/14, 4 Israeli soldiers were rammed by a car & injured near Ramle City. The Palestinian driver was shot at the scene & his family home north of Jerusalem raided, his parents & 2 brothers arrested, soldiers fired teargas canisters at Palestinians & burned a vehicle. 

• Speaking at a protest, Yair Golan, leader of the newly-merged left-wing party known as The Democrats, said "a hostage deal will dismantle Netanyahu's government…now is the time to intensify the protest."

• Netanyahu said he will not approve a decision by Defense Minister Yoav Gallant to establish a field hospital in Israel to treat children from Gaza.

•  Finance Minister Bezalel Smotrich called on Prime Minister Benjamin Netanyahu to annex the territory should the International Court of Justice declare Israeli settlements illegal.

• Ultra-Orthodox youth protested news of impending draft notices, blocking a highway & clashing with the police, leading to 9 arrests,leaving 3 officers injured

  US

• The US, like other governments & institutions, is lashing out at their most intelligent, compassionate & courageous citizens, people like nurse Hesen Jabr from Brooklyn, who are willing to stake their careers, or, in the case of the student protesters, their future careers, to tell the truth about this genocide

• HaYovel, a US tax-deductible organization, is reaching out to “Christian Zionist” volunteers to work in illegal Israeli settlements in the occupied West Bank.

• Mike Johnson threatened to arrest lawmakers who disrupt Netanyahu's Congress speech.

•  Sen. Bernie Sanders said he would introduce a joint resolution to block the proposed sale of $18 billion worth of warplanes & other weaponry to Israel.

• Historical review of how the right wing gained victory in the West Bank here

  INTERNATIONAL

• 40 rockets were launched at northern Israel from Lebanon, with some intercepted. Israeli Air Force responded by attacking targets in southern Lebanon. Hezbollah said it launched the barrage in response to the reported killing of 3 children in an Israeli attack in southern Lebanon.

• Dozens of Hezbollah rockets sparked fires in northern Israel. 7 rockets damaged homes in the northern Israeli city of Kiryat Shmona. No casualties were reported.

• International Court of Justice says Israel should evacuate settlements & pay reparations. Israel described the request for the court to weigh in as biased & “an abuse of international law & the judicial process.”

• While numerous UN reports & resolutions in the general assembly have made the same point, the ICJ ruling, by virtue of being made in reference to treaty & individual laws, represents a judgment that will be hard to ignore.
  

  SOURCES
  OCHAOPT, CNN, Haaretz, Electronic Intifada, Human Rights Watch, The Guardian, Washington Post, New York Times, Relief Web, CARE, Drop Sight, Common Dreams, Times of Israel, Tom Dispatch, Palestine Chronicle, Middle East Eye