Urgent health update: Consequences of war on Gaza and West Bank/East Jerusalem [and now Lebanon] - October 5, 2024

As the 1-year anniversary of the Gaza war approaches, the Health Advisory Council of Jewish Voice for Peace released a statement demanding a ceasefire, an end to military aid to Israel, and the recognition of Palestinian self-determination. 

Israeli air, land, & sea bombardment continues across Gaza, causing further civilian casualties, displacement, & destruction of houses & other civilian infrastructure. Ground incursions and heavy fighting continue, especially in Beit Hanoun and Beit Lahiya, Deir al Balah, Gaza City, Khan Younis & Rafah. The extension of the war to the West Bank, Lebanon, Syria and Yemen is a health and human rights emergency, and an escalation that threatens world war. 

The World Bank reports that the war has driven 100% of Gaza’s population into poverty.

JOURNALS & REPORTS

Israeli attack endangers a healthcare system reliant on Hezbollah. On 10/1, Lebanon became the latest epicenter of the 2024 Middle East crisis after Israel launched a ground attack targeting the military and political group Hezbollah. The World Health Organization (WHO) says that Lebanon, a nation of 5.4 million people, has more than 3.5 million in need of aid and is already hosting 1.3 million Syrian and Palestinian refugees.
BMJ 2024; 387 doi: https://doi.org/10.1136/bmj.q2167 (Published 04 October 2024)

Untangling the Reality of Famine in Gaza
Research and analysis by Refugees International has corroborated evidence of a severe hunger crisis in Gaza and found consistent indications that famine-like conditions occurred in northern areas during the first half of 2024. Refugees International also found that the ebbs and flows in hunger conditions are closely linked to Israeli government restrictions and concessions on aid access, and to the conduct of the Israeli military. International pressure on the Israeli government in March and April, following warnings of imminent famine in parts of Gaza, prompted a series of Israeli concessions around aid and commercial access.  Refugees International

Doctors Describe the Horror of Israel’s Pager Attack in Lebanon: Surgeons and others detail gruesome injuries; many of the thousands of victims were blinded, with fingers severed. Simultaneously, some 4,000 booby-trapped pagers that had been handed out to members of Hezbollah began beeping and then exploded. In shops, in houses and on sidewalks across the country, pagers blasted their users as well as anyone in their vicinity with small clouds of shrapnel. New Lines Magazine

At the 1 year anniversary, MSF reviews health impacts of assault on Gaza. Medicins San Frontieres

GAZA 

Numbers are cumulative

·       Killed: 41,802 (268 this week) 

·       Injured: 96,844 (752 this week)

·       Israeli soldiers killed: 346 (0 this week)

·       Israeli soldiers injured: 2,297 (0 this week)

·       Hostages: 101 

Israeli Attacks

The UN Human Rights Office (OHCHR) called on “the Israeli military to immediately end the pattern of strikes in Gaza on buildings” serving as shelters for IDPs. Over the course of 3 days, the Israeli military bombed the Al Amal Institute for Orphans and 6 schools, all serving as IDP shelters. There were strikes on schools almost every other day In Sept. & Oct. OHCHR emphasized: “Irrespective of whether Palestinian armed groups were present in these facilities, the resulting high rate of civilian casualties makes it difficult to conceive that such strikes are proportionate according to the principles of international humanitarian law. These attacks have long-term impacts on the civilian population, destroying the only viable shelters remaining for the more than one million Palestinians who have been forcibly displaced into an unsafe, unilaterally declared ‘humanitarian zone’ where there is little or no access to life-saving essential humanitarian assistance.” The OHCHR also reminded Palestinian armed groups that “using the presence of civilians to shield themselves from attack constitutes a violation of IHL.”

• 9/26, 4 killed (2 children) and others injured in a house hit in Jabalya.

• 9/26, 27 & 30, 18 killed (3 children) and others injured in 3 attacks on An Nuseirat refugee camp, Deir al Balah.

• 9/27, 3 killed and 4 injured in a house hit in Al Mawasi area, Rafah.

• 9/27, 4 killed (2 children) and others injured in a house hit in An Naser area, Rafah.

• 9/29 & 10/1, 11 killed and many injured in 2 attacks on houses in and near Gaza City.

• 10/1 & 2, 22 killed (1 baby) in 2 houses hit near Khan Younis. Nine family members remain under the rubble of 1 house. In both attacks, shelling and shooting prevented ambulances from accessing and evacuating the injured.

• 10/1, 12 killed (1 child) and 26 injured in 2 IDP tents in Mawasi, near Khan Younis.

• 10/2 NYT reports Israeli forces killed at least 51 people and injured 82 at several school buildings and homes across the enclave and at an orphanage sheltering displaced civilians

• 10/3, 5 killed (2 children) and others injured in a house hit in Ash Shati’ (Beach) refugee camp.

• Oxfam concluded in a report that “more women and children have been killed in Gaza by the Israeli military over the past year than the equivalent period of any other conflict over the past two decades.” The report pointed out that during the past 12 months in Gaza, an Israeli explosive weapon has hit a home in Gaza every four hours, a tent or temporary shelter every 17 hours, schools and hospitals every four days, and aid distribution points and warehouses every 15 days.

• Prominent Palestinian journalist Wafa Aludaini was killed in an Israeli airstrike. Wafa was killed alongside her husband, her five-year-old daughter and her seven-month-old son. As Reporters Without Borders recently noted: “At the rate journalists are being killed in Gaza, there will soon be no-one left to keep you informed.”

Winterization Plan

The rainy season will further deteriorate the dire conditions in Gaza, threatening additional displacement, asset loss, health hazards, and essential services. The UN and partners have developed a Winterization Plan to address needs of 2.1 million Gazans, including 850,000 people in 49 flood-prone areas. The plan focuses on vulnerable groups: female-headed households, children, persons at risk of violence including gender-based violence, the elderly, disabled and chronically ill. It requires US$242 million to implement urgent interventions, including: enhancing shelter conditions to protect against cold and flooding; distributing warm clothing, blankets, tarpaulins, heating materials to displaced households; installing temporary drainage systems to redirect floodwaters from infrastructure, including dumps; and establishing winter-proof baby-friendly tents for breastfeeding and nutritional services. Plan implementation requires unimpeded entry of humanitarian aid, fuel availability, and safe movement between warehouses and distribution points. 

Health & Health Care

• The 2nd round of polio vaccinations are scheduled to begin mid-October and will include distribution of Vitamin A supplements, reports WHO. 

• The new strain of polio was discovered in routine wastewater tests in Gaza in July. It is believed that the strain came from the oral polio vaccine, which contains a weakened live virus, and can in rare cases be excreted by vaccinated people to develop into a new, infectious form. The Israeli military quickly began vaccinating its soldiers once the reemergence of polio in Gaza was confirmed.

• Israel did not heed calls from the UN to implement a ceasefire in order to allow a huge vaccination campaign for the 670,000 children in Gaza under the age of 10. Dhair said that Gaza health officials nevertheless aimed to vaccinate at least 90 percent of these children with an oral vaccine in two rounds, four weeks apart, to prevent the spread of the disease, but conceded this was a formidable goal in a war zone where circumstances change quickly.

• Though the World Health Organization announced that a first phase of the vaccination campaign was completed in September, plans to finish the campaign last month proved unrealistic. The health agency is now hoping to start phase two in mid-October.

• 9/19 & 23, WHO facilitated entry through the Kerem Shalom Crossing for 8 truckloads of medications and supplies. On 9/20, WHO transferred 8 pallets from the UAE Field Hospital in Rafah for distribution to other Emergency Medical Teams. 

• 9/30, 3,000 blood units donated from the West Bank were delivered to mitigate the shortage of blood units.

• The Health Cluster is mapping Mental Health and Psychosocial Support (MHPSS) providers to ensure response to the vast scale of mental health needs and trauma. 

• MSF reports young Gazans receiving treatment at their Reconstructive Surgery Hospital in Amman, Jordan experience both post-traumatic stress disorder (PTSD) and acute stress syndrome, and will require psychotherapy for years. 

• As of 9/25, WHO has recorded 516 attacks on healthcare, including  a 9/21 attack on a MoH warehouse in Rafah, killing 4 MoH employees and injuring 6. MoH also confirmed the death of 3 health workers detained by the Israeli army while on duty between 12/2023-3/2024; 5 health workers have died in detention since October.

• 9/30, 8 patients (7 children) were evacuated  to receive treatment in Romania: 4 patients with cancer, 2 with blood disease, 1 needing a kidney transplant, and 1 severely injured travelled to Bucharest with 24 family members, coordinated by the EU. Since the Rafah Crossing closure in May, only 229 patients (with 316 companions) have been evacuated through the Kerem Shalom Crossing; 12,000 patients in need of urgent treatment remain trapped in Gaza. 

·       For Gazans with disabilities, Israel shows no mercy. Feeling but not hearing the bombs, displaced without their specialized equipment, mauled by army dogs; this is how Palestinians with physical and cognitive impairments are surviving and dying amidst the Israeli onslaught.

·       Dr. Khaled Alser, the Gaza general surgeon who has been in Israeli captivity since March, is now free, his friends and family report. Supporters may remember he co-authored an article that was published in The Lancet while he was in detention.

Education

• A new study shows the war in Gaza will set back education “up to 5 years and risks creating a lost generation of permanently traumatized Palestinian youth.” The report’s most optimistic projection (assuming an immediate ceasefire and rapid rebuilding of the education system) shows students losing 2-3 years of schooling competencies. If schooling does not resume until 2026, losses could stretch to 5 years. This does not account for the additional impacts of trauma, malnutrition and forced displacement which further challenge children’s physical, cognitive and emotional wellbeing.

• The Education Cluster warns that many of the 215 temporary learning spaces (TLSs), serving 34,000 kids are at risk from upcoming winter floods. Restrictions by Israel on the entry of educational materials and prefab structures, denial of freedom of movement, and severe overcrowding in IDP sites all hinder mitigation measures.

• An Education Cluster assessment reports 87% of school buildings have been destroyed. These schools served 541,227 students with 20,222 teachers, representing 86% of the students and teaching staff. 

• Since October 2023, 10,449 students and 419 educational staff have been killed, and over 16,250 students and 2,463 teachers have been injured. The Education Cluster urgently calls for adherence to International Humanitarian Law, which protects schools during conflicts. Ongoing violations threaten efforts to address children's trauma and provide essential learning in the absence of formal education. 

Food & Nutrition

• Due to continuous supply shortages in September, 1.4 million people did not receive monthly food rations. Insecurity, damaged roads, and access limits at the Kerem Shalom Crossing (and the shutdown of aid through the Jordan Corridor) have prevented 100,000 metric tons of food commodities, equal to 2 months of food parcels for the entire population, from entering. This food must be allowed in!

• As of the 3rd week of September, 150 kitchens provide 600,000 meals/day. This will decrease in October due to Israeli choking of supplies. 14 bakeries are operational, but 6 in northern Gaza will close without resupply of yeast.

• An analysis by the Famine Early Warning Systems Network (FEWS NET) indicates aid only partially mitigates the acute food insecurity. People will continue to experience “large to extreme food consumption deficits, malnourishment, and hunger-related mortality” until “safe, consistent humanitarian access” facilitates aid delivery and distribution.

• Recent Israeli operations in Beit Lahiya destroyed >12.5 acres of eggplants, oranges, peppers and other vegetables grown by 10 farmers. Satellite imagery collected in 9/2024 shows 68% (102 sq.km.) of cropland is damaged. 

• While the olive harvest has begun, more than 1 million olive trees have been uprooted since October 2023. Only 4 of 37 olive presses are functional but their use is unlikely due to lack of fuel. 

·       Israel has destroyed hundreds of dunams of agricultural land, depriving Palestinians in the northern Gaza Strip of agricultural land and resources vital to survival, according to the Euro-Med Human Rights Monitor. “This destruction is part of a larger Israeli plan that dates back to last October,” Euro-Med said in a report published on September 26. Under this plan, Israeli forces have worked to eliminate almost 80% of the agricultural land in the Gaza Strip from use by Palestinians.”

• A report by the Palestinian NGO Network (PNGO) on the fishing industry notes that 87% of fishing boats have been damaged or destroyed since October. Gaza’s port and key fishing infrastructure is also destroyed. With Israeli restrictions, and lack of equipment and fuel, the result is thousands of fishers’ lost livelihoods and people losing nutrition.

• Since 12/2023, 318,603 children <6 were screened for malnutrition: 21,638 have acute malnutrition; 16,872 moderate acute malnutrition; and 4,766 severe acute malnutrition, and 145 of those with medical complications. 

·       ~90% of coordinated humanitarian aid movements between northern and southern Gaza have been either denied or impeded this month by Israel, according to the UN.

Water & Sanitation

• At the end of September, the Palestinian Water Authority & Coastal Municipalities Water Utility reported that average supply of safe drinking water was about ¼ of what was provided prior to October 2023. WASH Cluster partners received only 25% (4% less than early Sept.) of the fuel necessary to meet critical WASH and public health needs. Water from the main transmission line from Israel remains at 80% capacity, with several critical water facilities recently damaged and rendered inaccessible.

• Generators, submersible pumps and other well and pumping station supplies remain urgently needed, unavailable on the local market, and not cleared by Israel for entry.

• Continued shortages of soap and basic hygiene items hinder the ability to prevent communicable diseases, especially in overcrowded shelters, disproportionately affecting children, pregnant women, and those with compromised immune systems. Shampoo, detergent, and dishwashing soap are no longer available, making it impossible to maintain cleanliness, prepare food safely, or wash clothes. Healthcare facilities struggle to maintain sanitation, increasing infection risk for patients and staff. 

• The spike in prices and lack of hygiene supplies leave many women and girls without means to handle menstruation. The Gender Based Violence sub-cluster is assessing cash assistance to address this urgent need, but the unavailability of cash hinders support.

Economy

• The World Bank reports that almost 100% of Gaza’s population now lives in poverty, as the Palestinian economy is “nearing economic freefall, amidst a historic humanitarian crisis in the Gaza Strip.” Gaza’s economy shrunk by 86% in Q1/24, with GDP in the OPTs falling 35%, “marking its largest economic contraction on record.” Supply chain disruption increased basic commodity prices by 250% compared to August 2023. 

·       Muhammad Abu Samra is one of many people in his family who makes his living from farming in central Gaza. Not any more. The farmland he owns and cultivates was bombed repeatedly in the last year and is now unusable for cultivation. It’s deliberate, he said. “The occupation wants to destroy houses, farms, streets and all elements of life in Gaza, not only to make us poor but also to make us dependent on aid and to leave us, in the post-aggression phase, as beggars.” The pattern of damage in Gaza would seem to bear him out. According to satellite data analyzed by Al Jazeera, some 60 percent of Gaza’s agricultural land had been damaged or destroyed in the eight months from October 2023 to end of June.

WEST BANK, INCLUDING EAST JERUSALEM 

Killed: 695 Palestinians, including 678 by Israeli forces, 12 by settlers, 7 unclear. 

·       This week, Israeli forces killed 3 Palestinians and injured 109 (58 children).

Israeli attacks

• 9/24, Israeli forces shot and killed a man in Al Fawwar refugee camp, Hebron.

• 9/25, Israeli forces surrounded a house in Anza (Jenin), exchanged fire with occupants, then allowed women and children to evacuate. A woman was shot and killed outside a nearby house.

• 9/26, Israeli authorities notified the Palestinian District Coordination Office in Nablus that a man died in custody after succumbing to injuries sustained the same day after being shot by Israeli forces during a raid in Ein Beit al Mai refugee camp, Nablus.

• The first airstrike by an Israeli jet in the West Bank since the second intifada: An Israeli airstrike on a refugee camp in Tulkarm in the West Bank killed at least 18 people, including two children. The Israeli military claimed the airstrike killed a local Hamas leader.

Settler Violence

This week, settlers carried out 15 attacks against Palestinians, resulting in 16 injuries (5 children), and property damage. Since October 2023, OCHA recorded 1,423 attacks by Israeli settlers against Palestinians, of which 140 led to Palestinian fatalities or injuries, 1,135 led to property damage, and 148 led to both casualties and property damage. Settler violence displaced 277 households (1628 people, 794 children) since October.

• 9/24, settlers from Yitzhar settlement raided Madama, Nablus, and stoned Palestinian houses. When residents threw stones back, Israeli forces shot tear gas, injuring 10 (5 children).

• 9/24, settlers vandalized dozens of fig, grape, olive and almond trees in 2 Nablus villages, Al Lubban ash Sharqiya and Khirbet Sarra.

• 9/26, settlers assaulted 2 men and pepper-sprayed 2 women in Isteih, Jericho. Also in Jericho, settlers from a newly established outpost attacked Palestinians with sticks near Al ‘Auja and damaged their vehicle.

Demolitions

This week, Israeli authorities demolished 32 Palestinian-owned structures, displacing 10 (2 children) due to lack of Israeli-issued building permits, almost impossible to obtain. Since October, Israeli authorities demolished 1,768 Palestinian structures across the West Bank, displacing 4,555 Palestinians (1,910 children). For more on demolitions and displacement, see the OCHA demolition dashboard.

• 9/25, Israeli forces demolished 7 agricultural structures and bulldozed 190 trees, water tanks, fences, and irrigation pipes in Beit Ula, Hebron, the Israeli-designated area “Firing Zone 935,” displacing 5 households (32 people, 17 children).

• 9/26, Israeli authorities demolished a house, an external kitchen, a mobile latrine and a solar system in Hammamat al Maleh, Al Burj herding community, Tubas, Area C, for lack of building permits, displacing 1 adult and 1 child. 

• 9/30, Israeli authorities demolished 2 livelihood structures in Shu’fat, East Jerusalem, for lack of building permits, depriving 9 households (41 people) of an income source.

• 9/30, Israeli forces began excavation to construct a fence on privately-owned Palestinian land along Road 60 in Sinjil village, Ramallah, Area C. Tens of trees were uprooted, retaining walls demolished, and 5 dunums of vegetables bulldozed under.

·       Over two weeks, Palestinians watched as Israeli military bulldozers tore up mile after mile of their streets and alleys, sewage seeping into the dusty ruts left behind. The people of Tulkarm and Jenin, the two West Bank towns that were the focus of Israel’s latest military raids, said they had never before experienced such a scale of destruction.

2024 Olive Harvest Season

• The Palestinian Min. of Agriculture announced 10/10 as the start of this year’s olive harvest season. However, Israeli authorities set olive harvest access dates from 10/23-28. Initial reports suggest that, unlike 2023, Israeli authorities intend to allow access to lands behind the Barrier; access to lands near Israeli settlements remains uncertain.

• The annual olive harvest is a key Palestinian economic, social and cultural event. Last year's harvest was beset by movement restrictions and violence by Israeli forces and settlers. >96,000 dunums of olive trees remained unharvested due to access restrictions, causing an loss of >1,200 metric tons of olive oil, causing a loss of US$10M. 

• The Protection Cluster and the OHCHR, coordinating with OCHA, the Food Security Sector and partners, will support farmers with coordinated protective presence in hotspots, documentation of violence, and rights advocacy. The OPT Humanitarian Fund has allocated US$750,000 to projects to strengthen farmer resilience. 

• The OHCHR called on Israeli authorities to ensure the safety of Palestinian farmers and their access to their lands, emphasizing the need to prevent a recurrence of last year’s restrictions and violence. 

ISRAEL

·       In Israel’s prisons skin diseases are a method of punishment. Prison authorities are allowing scabies to spread by restricting Palestinian inmates’ water supply and depriving them of clean clothes and medical care.

·       A year into the genocide in Gaza and the intensifying military and settler onslaught in the West Bank, children have been the most consistently targeted group by Israel in all of historic Palestine. While paling in comparison to Gaza, children in the West Bank have also been targeted by Israeli forces and settlers with alarming regularity.

·       Wafa dreamed of attending Hebrew University. Fuad is afraid the police. Adel sometimes didn't get paid. An Israeli law leaves many Palestinians who are married to Israelis – and their children – lacking citizenship, residency, or basic rights.

LEBANON

·       Hassan Nasrallah, Secretary-General of Hezbollah and one of Israel's most formidable enemies, was killed on 9/27 in a massive Israeli airstrike on Beirut. Nasrallah rose to leadership after Israel assassinated Abbas al-Musawi in 1992. He expanded Hezbollah's military and political power, cementing its role in Lebanon's internal affairs and its ongoing conflict with Israel. Israeli defense officials estimated that about 300 people were killed in that Beirut strike, including those in nearby buildings.

·       Lebanon’s health ministry said more than 100 people have been killed by Israeli strikes on 9/29, and that more than 1,000 Lebanese have been killed and 6,000 wounded in the past two weeks, many of whom were civilians. The government said a million people – a fifth of the population – have fled their homes.

·       Israeli military has begun” limited raids” against Hezbollah in southern Lebanon, shortly after the Israeli cabinet approved the ‘next phase’ of the military operation targeting Hezbollah.

·       Fears grow over Israeli ground invasion as Israel orders residents in 25 Lebanese villages to flee home.

·       Israel carried out a strike in central Beirut, the first time it has struck beyond the city’s southern suburbs since 2006. The strike hit an upper floor of an apartment building, and a security source told Reuters that at least two people were killed. 

·       Lebanese health ministry said at least six people have been killed and seven injured in an Israeli attack on a health center in the central suburb of Bachoura. It is the second time central Beirut has been targeted since Israel began its bombing campaign a couple of weeks ago. The area is home to the Lebanese parliament and the UN’s regional headquarters.

·       Lebanon's caretaker PM Najib Mikati and UN Humanitarian Coordinator for Lebanon Imran Riza launched a $426 million appeal to help civilians affected by the escalating conflict, the UN said.

US

·       Met with mass walkouts, Netanyahu told the UN General Assembly that "Israel's war on Hamas and Hezbollah will continue unabated,” in a scene that depicted the Israeli prime minister's divisiveness and polarization surrounding his highly anticipated address to the international body.

·       Maura Finkelstein, a Jewish woman, never hid her support for Palestinian liberation in the nine years as a professor of anthropology at Muhlenberg College, a small liberal arts school in Allentown, Pennsylvania. In late May she became the first tenured professor in the U.S. to be fired for pro-Palestinian speech. Her “crime”? She had shared, on her personal Instagram account, in a temporary story slide, a post written by Palestinian poet Remi Kanazi calling for the shunning of Zionist ideology and its supporters.

·       U.S. announced $336 million in humanitarian assistance to support Palestinians in Gaza and the West Bank.

·       Pentagon said the U.S. military sent three additional aircraft squadrons to the Middle East.

·       University of Maryland cannot block students from holding an event on October 7 to mourn those killed in Gaza, a federal judge ruled , allowing students to move forward with the event.

·       Cornell University has become the first university to suspend a student for pro-Palestinian organizing this semester, putting them at risk of deportation. The suspension was in response to a student-led protest organized by the Coalition for Mutual Liberation (CML), which shut down a career fair at the Statler Hotel attended by defense contractors Boeing and L3 Harris.

·       Senator Bernie Sanders (I-VT) announced that he had introduced legislation to block a $20 billion arms sale to Israel. The Joint Resolutions of Disapproval would prevent the delivery of offensive weapons that the State Department approved in August, just days before ceasefire talks were set to resume. The package includes fighter jets and advanced air-to-air missiles.

·       Almost 100 American health care workers who have served in Gaza are demanding a U.S. arms embargo on Israel until a permanent cease-fire is reached — the latest plea for the Biden administration to end its unconditional support for Israel ahead of the anniversary of the country’s siege on the Palestinian territory. Read letter here.

INTERNATIONAL

·       Israel said it bombed power stations and a port used by Houthi forces in Yemen. The strikes were carried out in retaliation for recent Houthi missile attacks on Israel. The strikes which killed four people, was the second known time that Israel has retaliated against the rebel group’s attacks by striking in Yemen.

·       Iran said its supreme leader made the decision to fire dozens of missiles into Israel as retaliation for the Israeli invasion of Lebanon and the recent killings of leaders of Hezbollah and Hamas, two of the main groups in Iran’s axis.

SOURCES

OCHAOPT, Haaretz, Palestine Chronicle, +972, The Intercept, The Guardian, Democracy Now, New York Times, Mondoweiss, Electronic Intifada, Portside