Urgent health update: Consequences of war on Gaza and West Bank/East Jerusalem [and now Lebanon]- September 28, 2024

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 Khan Younis, Deir al Balah, Gaza City & Rafah. The extension of the war to the West Bank and Lebanon is extremely alarming and dangerous. 

JOURNALS

Now that an operational platform is in place [for polio vaccine], we believe that the second round should include vaccination against measles, which has consistently been the deadliest vaccine-preventable disease in humanitarian emergencies. Lancet

Food insecurity, dietary inadequacy, and malnutrition in the Gaza Strip: a cross-sectional nutritional assessment of refugee children entering the first grade of UNRWA schools and their households before the conflict of 2023-24.  Lancet Glob Health. 2024 Sep 23:S2214-109X(24)00320-6. doi: 10.1016/S2214-109X(24)00320-6. Online ahead of print. PMID: 39326434

Safeguarding the SDG promise to end hunger and leave no one behind: the plight of children in the Gaza Strip. [SDG Sustainable Development Goal] Lancet Glob Health. 2024 Sep 23:S2214-109X(24)00367-X. doi: 10.1016/S2214-109X(24)00367-X. Online ahead of print. PMID: 39326432 No abstract available.

REPORTS

Giving Birth in Gaza: Procedures performed with kitchen scissors. Makeshift medical tents with no pain medication, clean water, or electricity. Marie Claire goes inside one of the most dangerous places in the world to be pregnant right now. marieclaire.com

GAZA 

Numbers are cumulative

·       Killed: 41,534 (261 this week) 

·       Injured: 96,092 (541 this week)

·       Israeli soldiers killed: 346 (0 this week)

·       Israeli soldiers injured: 2,297 (13 this week)

·       Hostages: 101 

These atrocities must end

On 9/23, the Inter-Agency Standing Committee on the situation in the OPT released a statement prior to the 79th UN General Assembly calling for an end to the “appalling human suffering and humanitarian catastrophe in Gaza.” The statement summarizes the incomparable damage of 11 months of conflict and calls for a sustained, immediate and unconditional ceasefire. 

“The parties’ conduct over the last year makes a mockery of their claim to adhere to international humanitarian law and the minimum standards of humanity that it demands. 

Civilians must be protected and their essential needs must be met. There must be accountability for serious violations of international humanitarian and human rights law. Humanitarian and aid organizations have been doing their utmost to provide relief in Gaza and the West Bank, often at great personal risk, and with many aid workers paying the ultimate price. …

“Our capacity to deliver is indisputable if we are granted the access we need. The 1st round of the polio vaccination campaign, reaching more than 560,000 children under the age of 10, is but one example. The 2nd round of vaccinations must be carried out safely and reach all children in Gaza.

“We urge world leaders, once again, to wield their influence to ensure respect for international humanitarian law, international human rights law and the rulings of the International Court of Justice – through diplomatic pressure and cooperation in ending impunity. … Allowing the abhorrent, downward spiral caused by this war in the Occupied Palestinian Territory to continue will have unimaginable, global consequences. These atrocities must end.”

Israeli Attacks 

• On 9/19 & 20, 13 killed and others injured in residences hit in Gaza City.

• On 9/20, 8 killed (3 children) and others injured in Deir al Balah.

• On 9/20 & 26, 11 killed (2 children), others injured, in residences hit near Khan Younis.

• On 9/20, 13 killed (3 children) and others injured when a house was hit in Rafah.

• On 9/24, 6 killed and others injured in Jabalya refugee camp.

• On 9/24, 12 killed, others injured in a house in An Nuseirat refugee camp, Deir al Balah.

• On 9/24, 1 killed and 6 others injured when a house was hit in Al Mawasi, near Rafah. 

• On 9/24 & 25, 11 killed (several children) and others injured in houses hit in Rafah.

• On 9/25, 5 killed (3 children), others injured, in a house hit in Al Bureij refugee camp, Deir al Balah.

Hospitals & Health Care

·       WHO reports that only 17 (of 36) hospitals remain open but only partly functional across Gaza, with a cumulative capacity of 1,501 in-patient, maternity and ICU beds. 10 field hospitals operate in Deir al Balah, Khan Younis and Rafah (6 fully, 4 partially), providing another 600 beds. 

• On 9/18, MSF announced a new field hospital in Deir al Balah will only provide only outpatient consults as “expansion of other services depends on Israeli authorities, who have delayed supplies entering Gaza.” 

• Of 132 primary care facilities, only 57 are functional, including 10 of 27 UNRWA health centers. Besides a critical shortage of medicines and supplies, the Health Cluster warns of a severe scarcity of blood units across Gaza. MoH continues to report a lack of fuel, spare parts, and filters to repair and maintain electric generators in hospitals, threatening ICUs, nurseries, and other services.

·       The Health Cluster reports priority efforts to strengthen Infection Prevention and Control (IPC) and Water, Sanitation and Hygiene (WASH) measures in health facilities. 14 facilities were assessed, and 4 hospitals provided with IPC and WASH supplies. Partners trained 44 Red Crescent staff on basic IPC practices and deployed 35 IPC focal points to health facilities. The severe lack of cleaning and hygiene supplies across Gaza hampers scale-up of IPC and WASH interventions.WASH and Health Cluster partners are identifying flood-prone areas and planning to mitigate the impact of flooding on public health. 9/25, the Clusters warned that many IDP sites are in or near flooding hotspots and the severe destruction of the past year increases vulnerability to flooding. 47% of health service points are at risk of flooding and could become inaccessible. Floods also increase the risk of water- and vector-borne diseases, as sewage more easily contaminates water supplies and stagnant water breeds mosquitos and other insects. Flooding will damage the remaining sanitation infrastructure and further disrupt management of medical and other waste.

·       Over 150,000 tons of waste are piled in the middle of Gaza City. As we approach winter, these waste piles will block drainage systems, leading to potential floods in an already devastated city. Many displaced residents living in makeshift shelters will face the added horror of flooding. The air is thick with the stench of burning garbage as desperate residents try to manage the waste by setting it on fire. The toxic fumes are worsening the situation, causing an increase in respiratory illnesses. The Gaza Ministry of Health has reported over 250,000 cases of skin diseases due to exposure to waste. With medical and hazardous waste accumulating alongside household trash, we are on the brink of a catastrophic health crisis.

·       Gaza Health Ministry said five of its employees were killed in an Israeli attack on a warehouse storing medical equipment in the Strip's south.

Internally Displaced Persons (IDPs)

• At least 32 IDPs were killed when 3 schools were hit 9/21- 23. Palestinian Civil Defense reported 9 children required amputations. UN Human Rights Office stated: “The Israeli military must stop attacking schools that provide the last shelter to Palestinians in Gaza as rains threaten to flood IDP tents... [As of 9/23], 10 schools have been hit, with 86 fatalities reported. We reiterate that all parties to the conflict have an obligation to respect and protect civilians... Considering the pattern of civilian harm and damage, measures taken by the Israeli military in these cases do not appear to have been sufficient to prevent disproportionate harm and damage. The children of Gaza have already lost schools as a place of education. Now, they are being killed in schools as they seek shelter. This must end.” It hasn’t: On 9/26, the MoH reported Al Falujah School in Jabalya was hit, killing 11 and injuring 22.

• Needs assessments by the UN and partners at IDP shelters in Deir al Balah and Khan Younis highlight the abysmal living conditions, which winter will only aggravate. Both sites face a critical lack of cleaning supplies, hygiene kits, sanitary pads, diapers, infant clothes and formula. There is a dire shortage of assistive devices for the elderly and people with disabilities. 

·       An UNRWA school in Al Bureij refugee camp, Deir al Balah, shelters 3,600 IDPs. 56 classrooms hold 80-100 people each, and 70 tents hold 40 people each. New tents are critically needed, as are repair supplies for damage caused by the Israeli military in 12/23. The medical point lacks personnel and medications, and lack of ambulances hampers access to hospitals. The site’s water desalination unit is nonfunctional, and water distribution by aid organizations covers only 60% of IDPs. Hot meals are distributed twice a week but are mostly rice and lack nutritional diversity. Most residents eat once a day, but not every day. The majority of IDPs sold their mobile phones to buy food, so radio presents the main information source for the shelter.

·       A makeshift camp in Abasan, Khan Younis, shelters 2,500 people, including 1,000 children of whom 100 are orphans. No educational activities occur, and separated children face heightened risks. The site is flood-prone, adjacent to a dump site, and respiratory diseases are common. Except for occasional charity-provided hot meals, there is no food or medical support.

Humanitarian Efforts and Aid Access

Humanitarian aid movements, particularly between northern and southern Gaza via Israeli military checkpoints, are frequently impeded, leading to incomplete or aborted missions. From 9/1-26, of 588 missions coordinated with Israeli authorities, 79 were between northern and southern Gaza, of which 69 (87%) were impeded or denied, depriving hundreds of thousands of people of critical relief supplies and services.

• Of 6 WHO planned missions between 9/13-18, only 1 was facilitated by Israeli authorities, 3 were significantly delayed and 2 were denied. WHO and its partners managed to deliver: 48,000 liters of fuel to Kamal Adwan and Indonesian hospitals; medical supplies to the rehabilitated ER at Al Shifa Hospital; and non-communicable disease kits to Red Crescent facilities in the north. WHO also facilitated the rotation of emergency medical team (EMT) personnel between northern and southern Gaza and the deployment of a new pediatrics EMT to Kamal Adwan Hospital. 

• Although the Indonesian Hospital is in an active evacuation zone, and the Al Awda and Kamal Adwan hospitals are 200 and 485 meters respectively from the affected area, they continue providing services. 

• On 9/19, UNRWA reopened a dental clinic in one of its health centers in Khan Younis.

• The Red Crescent opened the first fully equipped mobile operating room in southern Gaza, to be deployed when needed.

• On 9/25, the MoH announced that 88 unidentified Palestinian bodies were sent by Israeli authorities in a truck, which it initially refused to receive, citing lack of coordination or information to help identify the corpses. On 9/26, the MoH reported the bodies had been exhumed from graves by Israeli forces, and that MoH formed a committee to receive and bury the bodies in a dignified manner.

• The Palestinian Civil Defense (PCD) reports continued challenges in carrying out rescue operations and saving people trapped under rubble due to capacity constraints and insecurity. 9/25, the PCD center in Gaza City was hit with a missile (that did not explode), injuring 3. Most recently, equipment shortages prevented the PCD from retrieving 9 bodies from a collapsed 6-story building sheltering IDPs in Gaza City. According to PCD, more than 10,000 people remain under rubble across Gaza.

WEST BANK, INCLUDING EAST JERUSALEM 

Killed: 693 Palestinians, including 676 by Israeli forces, 12 by settlers, 7 unclear. 

·       This week, Israeli forces killed 11 Palestinians (2 children) and injured 90 (22 children).

Israeli military attacks

On 9/19, 7 were killed when Israeli forces, including undercover personnel, encircled a residential building in a 9-hour operation in Qabatiya, Jenin and exchanged gunfire with occupants. After evacuating families, Israeli forces bulldozed parts of it and fired off-shoulder rockets, displacing 5 families (20 people). Israeli forces bulldozed a 400-meter section of road. 9 Palestinians were wounded by live ammunition and 2 from teargas inhalation. Israeli forces were filmed pushing 4 Palestinian bodies off the building’s roof 4 hours after the gunfire ended. The bodies were withheld. The UN Human Rights Office condemned “the desecration of the bodies of Palestinians by Israeli security forces” and stated that the “Unnecessary or disrespectful treatment of human remains is not consistent with the protection of the basic human dignity of the dead and could amount to cruel, inhuman or degrading treatment of the deceased men’s families.”

• On 9/17, Israeli forces shot and killed a man attempting to cross the Barrier north of Tulkarm. He was evacuated to a hospital and pronounced dead.

• On 9/18, 2 children were killed in 2 separate locations: a 16-year-old boy shot and killed during an Israeli operation in Shu’fat refugee camp, East Jerusalem. They alleged the child was shooting fireworks at them. A 17-year-old boy was killed as he approached Ni’lin checkpoint (Ramallah). Details of why he was shot remain unknown.

• On 9/18, Israeli forces assaulted 12 Palestinians while searching 150 homes in Al Fawwar refugee camp (Hebron). Instituting a curfew confining 13,000 people to their homes, Israeli forces arrested 28 Palestinians, damaged belongings in 40 houses, and damaged 36 water tanks.

• On 9/20, Israeli forces shot and killed a man in Qalandiya refugee camp, Jerusalem, after opening fire at a group of Palestinians gathered at a local coffee shop. No clashes had been reported at the time of the incident.

• On 9/24, Israeli forces shot and killed a man during an operation in Al Fawwar refugee camp, Hebron. Another person was injured by live ammunition.

·       Israeli troops raided the offices of the satellite news network Al Jazeera in the West Bank, ordering the bureau to shut down, amid a widening campaign by Israel targeting the Qatar-funded broadcaster as it covers the Israel-Hamas war in Gaza .

• Committee to Protect Journalists reports an unprecedented number of journalists and media workers arrested by Israeli forces across the West Bank. CPJ has documented a total of 54 such arrests since 10/7; 36 remain jailed, including 14 held without charges under “administrative detention”. Among them is Palestinian journalist Mujahed al-Saadi, who was beaten along with his wife by Israeli soldiers during a violent raid on their home 9/19. He has since had no contact with his lawyer or family.

• Israeli Bulldozers Flatten Mile after Mile in the West Bank: Videos from Tulkarm and Jenin show bulldozers destroying infrastructure and businesses, as well as soldiers impeding local emergency responders

Settler Violence

This week, settlers carried out 25 attacks against Palestinians, resulting in 4 injuries (2 children), and property damage. Palestinians made 1 attack against settlers, with no injuries or damage reported. Since October 2023, OCHA recorded 1,390 attacks by Israeli settlers against Palestinians, of which 135 led to Palestinian fatalities or injuries, 1,110 led to property damage, and 150 led to both casualties and property damage. Settler violence displaced 277 households (1628 people, 794 children) since October.

• On 9/18, settlers assaulted a shepherd with sharpened sticks near his home in Khallet Athaba’, in the Israeli-designated “Firing-Zone 918” in Masafer Yatta (Hebron).

• On 9/18, settlers were filmed burning hundreds of olive trees near Al Mughayyir village (Ramallah). The fire was extinguished by Israeli forces. Palestinians have been unable to access this land since October and are now unable to assess the damage.

• On 9/20, a 1-year-old required medical treatment after being pepper-sprayed by settlers while travelling with his family on Road 465 (Ramallah). The assailants threw stones at Palestinian cars, managing to surround one and pepper sprayed through the window. Another vehicle was also damaged.

Demolitions

This week, Israeli authorities demolished 29 Palestinian-owned structures, displacing 37 (14 children) due to the lack of Israeli-issued building permits, almost impossible to obtain. Since October, Israeli authorities demolished 1,725 Palestinian structures across the West Bank, displacing 4,450 Palestinians (1,875 children). They included structures: residences (770), agricultural (365), water, sanitation and hygiene related (120), and livelihood related (250). For more on demolitions and displacement, see the OCHA demolition dashboard.

Attacks on Health Care

• On 9/18, hundreds of settlers, accompanied by Israeli forces, entered Joseph’s Tomb, in Nablus. Palestinians threw stones at the military, who responded with gunfire. Israeli forces obstructed an ambulance transporting an infant to hospital and assaulted the paramedics. WHO reports that from October 2023-July 2024, there were 527 attacks on health care in the West Bank, affecting 54 health facilities, including 20 mobile clinics and 365 ambulances. Force was used in 236 of the incidents, obstruction of access in 329, militarized searches in 89, and 74 involved detentions. The incidents concentrated in Tulkarm (116), Nablus (104), Jenin (94), and Bethlehem (52), hindering access to critical health care and jeopardizing medical personnel and patients.

Access Restrictions

• Since October 2023, Israeli authorities increasingly restrict movement in the West Bank by deploying and maintaining hundreds of obstacles and imposing closure policies that affect Palestinian permit-holders and bar them from East Jerusalem and Israel. Over 40% block direct access to major roads, disrupting movement for hundreds of thousands of Palestinians. Physical obstacles and permit requirements impede Palestinian access to essential services, including health care, and 44% of medical permit applications to access East Jerusalem and Israeli health facilities are denied or unanswered. As of March 2024, there were 793 physical obstacles, including 89 permanently staffed checkpoints, 196 road gates (122 which are usually closed), and 97 other closures (trenches, road barriers, etc.). This represents a 23% increase compared to June 2023. Their cumulative impact further fragments the West Bank and worsens conditions. Read the complete OCHA August 2024 report: Movement and Access Factsheet.

ISRAEL

·       "We blame the 64 members of the governing coalition for the terrible situation we're in… With heavy hearts and great trepidation, we're telling our soldier sons and daughters that because of the disastrous results of the government's policies, it's their right and duty to exercise their own judgment about taking part in military operations in Gaza." – Noorit Felsenthal Berger, one of the leaders of the 'Parents of Combat Soldiers Are Shouting "Enough"' group

·       Netanyahu rejected the US and France proposals for the 21 days ceasefire between Israel and Hezbollah. 

·       New York Times quotes a former Gaza division commander in the Israeli army saying that Hamas “took over cities minutes after Israeli forces withdrew,” adding that Israel “wins tactically, but Hamas wins at the end.”

LEBANON

Lebanese Ministry of Health: since 10/8:

Killed: 1,640 (including 104 children, 194 women)

Injured: 8,408

·       Since 10/8, 41 healthcare workers have been killed. 9/27, two strikes targeted medical facilities in Deir Syrian and Taybeh, resulting in the deaths of 7 healthcare workers.

·       Hezbollah leader, Hassan Nasrallah, was killed, in the massive air-raid the Israeli military launched against the Southern Beirut suburbs. That air-raid and the many others the Israelis have launched against Lebanon over the past week have killed hundreds-- or quite likely thousands-- of Lebanese people, maimed and displaced many more, and destroyed swathes of the country's vital infrastructure.  Nasrallah rose to power in 1992 when Israeli forces killed the previous leader, Abbas Al-Musawi.

·       Lebanese Ministry of Interior says that more than 70,000 Lebanese have been forced to flee their homes and towns since Israel launched its latest offensive

US

·       US government’s two foremost authorities on humanitarian assistance concluded this spring that Israel had deliberately blocked deliveries of food and medicine into Gaza.  US Agency for International Development delivered its assessment to Antony Blinken and State Department’s refugees bureau made its stance known to top diplomats in late April. Their conclusion was explosive because US law requires the government to cut off weapons shipments to countries that prevent the delivery of US-backed humanitarian aid. Blinken and the Biden administration did not accept either finding and the Blinken lied to congress on this matter.

·       Bernie Sanders introduced six resolutions blocking six sales of different weapons contained within the $20 billion weapons deal announced by the Biden administration in August. The sales include many of the types of weapons that Israel has used in its relentless campaign of extermination in Gaza over the past year. The senator said it is clear that the sales must be blocked as Israel openly violates humanitarian guidelines — making it a violation of multiple U.S. laws to continue funding its military.

·       US gave Israel $8.7 billion to support its “ongoing military efforts,” meaning the genocidal slaughter in Gaza and Israel’s dramatic escalation in Lebanon.

INTERNATIONAL

·       UN High Commissioner for Human Rights calls for probe of beeper attack, citing violations of international law. Volker Turk expressed horror at the attack, which killed at least 37 people and injured thousands, saying that 'international law prohibits the use of booby-trapped devices disguised in innocent-looking objects'

·       Netanyahu spoke at the UN General assembly, said Israel was winning and referred to the UN General Assembly as a “swamp of antisemitic bile.” 

SOURCES

OCHAOPT, Haaretz, Democracy Now, Portside, Truthout. Just World Educational, Antiwar.com, The National News, New York Times, Mondoweiss