Urgent health update: Consequences of war on Gaza and West Bank/East Jerusalem- August 18, 2024

Israeli air, land, & sea bombardment continues across Gaza, causing further civilian casualties, displacement, & destruction of houses & other civilian infrastructure.  Food shortages, crumbling infrastructure, a failing medical system, flowing sewage, waste buildup, & summer heat have turned the humanitarian crisis in Gaza into a serious epidemiological threat. Ground incursions & heavy fighting also continues, as does rocket fire by Palestinian armed groups toward Israel. A case of polio has now been confirmed in a baby.

REPORTS FROM THE GROUND

Gaza's landscape is dominated by tents that have become homes to the hundreds of thousands of displaced Palestinians. But building a tent & living in one with your entire family isn't easy. Mondoweiss

We served on Israel's Sde Teiman Base. Here's what we did to Gazans detained there: Hands & feet in shackles. Eyes blindfolded. No moving. No talking. Sometimes, violent beatings. Days upon days, weeks upon weeks pass like this at the Sde Teiman facility for Hamas “terrorists” & Palestinian civilians from Gaza. These interviewees know. They served there The New Arab, Haaretz

GAZA (numbers are cumulative)

·       Killed: 40,005 (296 this week). 10,627 children have been killed, 663 <1 year old. Those killed are largely civilians & represent 2% of total population, but only those bodies received & buried have been counted. There are likely more than 10,000 entombed in collapsed buildings & even more missing.

·       Injured: 92,401 (679 this week)

·       Israeli soldiers killed: 330 (1 this week)

·       Israeli soldiers injured: 2,208

·       Hostages: 115

Attacks

• 8/8 & 13, 15 killed (1 child) & others injured in Al Bureij Refugee Camp, Deir al Balah.

• 8/8, 6 killed & 2 injured in Khan Younis.

• 8/9 & 14, 16 killed (4 children) in Gaza City.

• 8/9, 4 killed (3 children) & 6 injured in Deir al Balah.

• 8/9 & 13, 17 killed (3 children) & >17 injured in An Nuseirat Refugee Camp, Deir al Balah.

• 8/10, Israeli military hit Al Tabi’een School in Gaza City during dawn prayers, killing 90 (11 children) & >70 IDPs among the hundreds of families taking refuge. 

• 8/10, 6 killed & 15 injured in Jabalya.

• 8/12 & 14, 34 killed (3 children) & >31 injured by airstrikes on a market & homes in Khan Younis.

·       Since 7/4, the UN Human Rights Office has recorded 21 strikes against schools serving as shelters, causing >274 fatalities. 7 schools/ IDP shelters were hit since 8/1. OHCHR condemned the increased frequency of Israeli strikes “on schools where hundreds of thousands of forcibly displaced Palestinians have sought shelter, conducted with apparent disregard for the high rate of civilian fatalities...Despite Israeli forces statements that all measures are taken to avoid civilian harm, the repeated strikes…suggest a failure to strictly comply with obligations required by International Humanitarian Law, including the principles of distinction, proportionality, & precautions in attack.”

·       The practice that Haaretz exposed of military units forcing civilian residents of Gaza to serve as human shields – searching tunnels & buildings before the forces enter, while wearing army uniforms & sometimes also protective vests to give them the appearance of IDF soldiers – is a war crime. 

Polio

• WHO & UNICEF highlighted urgency of launching a polio vaccination campaign in Gaza in August & September to prevent the spread of variant poliovirus type 2 (cVDPV2). 2 rounds of inoculation -- providing 2 drops of novel oral polio vaccine type 2 (nOPV2) to more than 640,000 children <10 years old -- requires at least 96% coverage. UN agencies stressed that the vaccination campaign’s success will depend on 7-day pauses in hostilities to “allow children & families to safely reach health facilities & community outreach workers to get to children who cannot access health facilities for polio vaccination... Without humanitarian pauses, the delivery of the campaign will not be possible.” Other essential factors include “cash, fuel & functional telecommunication networks.” 

• WHO plans to send 1.2 million polio vaccines to Gaza, with the first round scheduled for 8/17, pending Israeli approval. But a ceasefire & freedom of movement of health workers is necessary to allow for the administration of vaccines.

• Gaza Health Ministry said that a number of children have presented symptoms “consistent with polio” & that laboratory tests confirmed one of them — a 10-month-old child — was infected with the virus. It said the disease, which is highly contagious & can cause paralysis & death, would continue to spread unless there are “radical solutions” to Gaza’s humanitarian crisis, including an end to the fighting.

Evacuations

• 8/10-16, Israeli military issued 5 evacuation orders for Khan Younis & Deir al Balah, encompassing over 145 IDP sites, dozens of water, sanitation & hygiene facilities, & many educational facilities. Orders covered areas in the so-called “humanitarian area” with about 193,000 people, mostly IDPs. 

• As of 8/12, Israel's unilaterally declared “humanitarian area” in Al Mawasi has been reduced from 58.9 sq.km. to ~41 sq.km. (~11% of Gaza). ~84% of Gaza has been placed under evacuation orders.

• 8/17 Israeli military called for more evacuations from the “humanitarian zone” in parts of Khan Younis & Dier al Balah

• Ongoing shortage of shelter supplies, including tents & hygiene supplies, & limited access to basic services at arrival sites are exacerbating conditions facing displaced families, rendering them increasingly vulnerable as they struggle to meet basic needs. UNRWA: with the issuance of new evacuation orders, fear has once again spread among families who have nowhere to go & “people remain trapped in an endless nightmare of death & destruction on a staggering scale.”

Education & children

• Education Cluster’s satellite imagery shows 85% of school buildings (477 of 564) were directly hit (344) or damaged (133). These include 264 public schools, 156 UNRWA schools & 57 private schools. 180 schools serving as IDP shelters have been hit since October 2023. Humanitarian groups  are attempting to support children in schools as part of UNRWA’s “Back to Learning” program in Gaza City, Deir al Balah & Khan Younis, seeking to provide 28,000 children with safe play & learning spaces. Attacks against schools make this difficult. 

• UNICEF: "The unrelenting war in Gaza continues to inflict horrors on thousands of children, keeping far too many separated from their loved ones.” UNICEF estimates there are at least 17,000 unaccompanied or separated children in Gaza, but admits that the number of unaccompanied or separated children in Gaza is unknown as “it is nearly impossible to gather & verify information under the current security and humanitarian conditions.” 

Food & Nutrition

• World Food Program: urgent need for increased hot meal capacity in Gaza due to recurrent waves of displacement. Community kitchens struggle with unstable supplies & lack of food & fuel.  Multiple evacuation orders in Deir al Balah & Khan Younis, forced the relocation of 4 kitchens & closure of 19 food delivery points. In Deir al Balah, a WFP warehouse with 1,400 metric tons of food became inaccessible. 1 WFP warehouse with 3,000 metric tons of commodities is now accessible & is insufficient to meet the August requirements. 

• For the first time in 10 months, UN Food & Agricultural Organization delivered >2,400 veterinary kits (including iodine wound spray, salt blocks, multivitamins & disinfectants) & 500 tons of fodder across Gaza, with a goal to safeguard & improve livestock health, sustain livelihoods, & prevent the spread of disease. FAO: 70% of meat & dairy-producing livestock in Gaza have been slaughtered, consumed or lost to the ongoing hostilities, contributing to severe food insecurity.

• Famine Early Warning Systems Network reported an increase of commercial food cargo into Gaza, contributing to an overall increase in food entering mostly through Kerem Shalom Crossing, from ~ -61,530 metric tons in June to 86,925 metric tons in July. Of the total, only 8% was humanitarian aid, the rest were commercial trucks. Market surveys showed a high reliance on both humanitarian aid & market purchases, a slight improvement in food availability & diversity in Deir al Balah & Khan Younis coupled with a deterioration in other governorates. Persistent market challenges include high prices, lack of money, & the emergence of “thieves markets.”

Aid

• 8/1-15, of 109 coordinated humanitarian assistance missions to northern Gaza: 46 were facilitated by Israeli authorities, 37 denied access, 19 impeded, 7 cancelled. Of the 177 coordinated missions to southern Gaza: 96 were facilitated, 46 denied, 19 impeded, 16 cancelled. Combined, >1/2 of all humanitarian missions were denied, impeded, or cancelled since 8/1. This signifies a concerning rise in barriers to aid, particularly in northern Gaza, affecting hundreds of thousands of vulnerable people suffering under an increasingly restrictive environment for humanitarian operations.

• After closure of Rafah Crossing in May, aid organizations have faced increased insecurity, hostilities, impassable roads & lawlessness, all impeding their ability to access supplies entering through Kerem Shalom Crossing. There has been a 61% reduction in humanitarian aid picked up by humanitarian organizations comparing May to July with January to April (94 vs. 37 trucks/ day).

Water & Sanitation

• Destruction of Gaza's solid waste management system has created additional urgent humanitarian needs. 2 major landfills are inaccessible & non-operational, causing an uncontrolled accumulation of waste at over 140 temporary dump sites. This has heightened public health risks, as decaying waste fosters the spread of diseases. UNDP assessment found waste management infrastructure in a critical state, most vehicles & equipment destroyed. 1 of 5 medical waste collection vehicles is operational; 1 of 12 medical waste disinfection autoclaves is functioning; neither of 2 medical disinfection microwaves is in service. 20% of 251 waste collection vehicles & 18% of 7,300 waste containers are available for use. UNDP highlights the necessity of restoring access to landfills, ensuring a steady fuel supply, & securing new waste management equipment. UNDP supports 2 projects that collect ~680 tons of waste daily from Rafah, Khan Younis, & Deir al Balah, 60% of southern Gaza’s 1,100 tons of daily waste generation: ~150,000 tons waste has accumulated, warning this significantly heightens the risk of disease spreading.

• According to the WASH Cluster, the Coastal Municipalities Water Utility is currently using its contingency reserves of sodium hydrochloride for water chlorination. These reserves are expected to last for 1 month. The situation is further complicated by supply degradation from prolonged storage & rising temperatures, leading to the need for increased chlorine dosing, double the previous level (12% compared to 6%). Import of sodium hydrochloride into Gaza has so far been denied. According to UNICEF, disinfectant chemicals are considered "dual use" & are only selectively allowed into Gaza. Lack of chlorine increases risk of waterborne diseases spreading among the population. On the positive side, UNRWA announced  that a crucial water well in Khan Younis has been rebuilt & is now the largest source of clean drinking water for 100,000 displaced people.

WEST BANK, INCLUDING EAST JERUSALEM

This past week, Israeli forces in the West Bank killed 5 Palestinians & injured 54 (11 children).

Killed: 594 Palestinians, including 577 by Israeli forces, 10 by settlers, 7 unclear. 

Israelis killed: 15, including 9 soldiers, 5 settlers, were killed by Palestinians in the West Bank/ East Jerusalem. West Bank Palestinians have killed 10 Israelis in Israel.

There are >100 cases of Palestinian corpses being withheld by Israeli forces. 

Compared with preceding 10 months, Israeli military use of live ammunition has almost tripled the number of Palestinian children killed (115 compared to 39) & more than doubled the number injured (1,411 compared to 615) since October.

Attacks

• 8/6, Israeli military killed a Palestinian man near Tubas City. They claim he was on his way to attack Bakaot settlement with a firearm. When the Red Crescent medics arrived, Israeli forces seized their phones, took them to the back of the ambulance, & physically assaulted the medics as other soldiers threatened them at gunpoint to stay silent. The man’s body is being withheld by Israeli forces.

• 8/6, a Palestinian was killed by Israeli forces at the Tunnels checkpoint after he attempted to stab a group of soldiers. One member of the Israeli forces was injured. The man’s body is being held by the Israeli authorities.

• 8/6, Israeli forces killed 2 Palestinians & injured 3 during a raid in Jenin City. 8/11, 1 of the injured died in custody from his wounds.

• 8/7, Israeli forces shot 3 Palestinians (2 children) in an operation in Askar Refugee Camp (Nablus). UNRWA: Israeli forces entered the camp & opened fire at Palestinians standing in front of their homes. No confrontations were reported. 

• 8/8, Israeli forces shot 2 Palestinian children in an operation in Qalqiliya City.

• 8/10, Israeli forces shot 4 Palestinians (3 children) who were throwing stones at them during an operation near Nablus. 

• 8/11, Palestinians killed an Israeli civilian & injured a Palestinian with Israeli citizenship in a drive-by shooting on Rte. 90 in the northern Jordan Valley. Israeli forces then closed Route 90 & Route 578, as well as all checkpoints leading to the Jordan Valley & Jericho for ~3 hours while they searched for the perpetrators in nearby villages. 

• 8/12, a Palestinian man shot a settler & 2 Palestinians, killing 1, in Qalqiliya City. Attacker was later shot & killed by Israeli forces. His body and vehicle are being withheld by Israeli forces.

Settler attacks

This week, Israeli settlers carried out 25 attacks, causing 6 injuries (2 children) & property damage. Since October, OCHA recorded ~1,250 attacks by Israeli settlers against Palestinians, of which ~120 led to fatalities & injuries, ~1,000 led to property damage,  ~130 led to both.

• 8/6, settlers from Havat Ma’on attacked shepherds & attempted to seize their herd of ~400 sheep near Tuba, Hebron. When other Palestinians intervened, 2 Palestinians were injured. The settlers eventually left, & the injured were treated by PRCS.

• 8/6, a group of settlers from Evyatar outpost threw stones & set fire to Palestinian property in Yatma village, south of Nablus, damaging 3 houses, a scrap yard, a car, & trees.

• 8/7, settlers gathered at Israeli military observation towers along the barrier of Beit El settlement & threw stones at & injured a Palestinian woman driving on the road between Al Bireh & Al Jalazun Refugee Camp, Ramallah. The woman managed to drive to the entrance of Al Jalazun Refugee Camp before losing consciousness. She was taken to a hospital for treatment. 2 other vehicles were damaged in the attack.

• 8/9, a group of armed settlers from Itamar settlement assaulted & injured a man near Awarta, southeast of Nablus. A settler’s vehicle blocked the road he was driving to work, 4 masked settlers, 1 armed, exited the vehicle & attacked him. He escaped & went to the hospital. His vehicle was also damaged.

• 8/12, settlers from a new outpost near Khallet an Nahala assaulted & injured 2 15-year-old Palestinian boys near Artas, Bethlehem. They were herding sheep when attacked by Israeli settlers with knives, which the settlers put to their necks & forced them into the nearby settler outpost. They assaulted the boys, breaking their legs & urinating on them. They then handcuffed the boys & threw them from a vehicle into an open area where someone noticed them on the ground & called for an ambulance. Boys were taken to a hospital for treatment.

• 8/15 Dozens of Israeli settlers rioted in the West Bank village of Jit, shooting at Palestinian residents, torching vehicles and homes and throwing stones. One person was killed & another critically wounded by gunfire, 3 were wounded by stones, the Palestinian Health Ministry said. It was not immediately clear whether it was IOF or settler gunfire that killed & wounded the two. Unusually, Israeli military & officials condemned the attack

House demolitions

8/6-12, Israeli authorities demolished 9 Palestinian-owned structures, 1 of which was a punitive demolition & 8 were for lack of impossible to obtain Israeli-issued building permits. 8 of the structures were in Area C & East Jerusalem. 37 Palestinians (13 children) were displaced & ~789 (520 children) were affected. 

Since October, Israeli authorities demolished 1,380 Palestinian structures across the West Bank, including East Jerusalem, displacing more than 3,100 (1,375 children), >double the numbers of the previous year, when 1,252 were displaced (579 children). The demolitions since October include >500 inhabited structures, 100 uninhabited residential structures, >300 agricultural structures, >100 water & sanitation (WASH) structures, 200 livelihood structures, ~100 infrastructure & other structures. 25 demolitions & destruction of infrastructure have affected >181,000 Palestinians during Israeli military operations in Tulkarm & Jenin. 

• 8/7, Israeli Civil Administration & military confiscated 3 tents in the Birin herding community (Hebron) for lack of an Israeli-issued building permit, displacing 3 families of 15 people (6 children). The tents had been provided by the Palestinian Authority as a response to a previous demolition on 7/4 in the same area.

• 8/7, Israeli Civil Administration & military demolished an under-construction building belonging to the village council of Furush Beit Dajan, Area C, Nablus. The 2-story building was intended to house the village council offices & the council hall. The demolition took place due to a lack of an Israeli-issued permit. The council immediately appointed a lawyer to follow-up, but was unable to secure a building permit. Additionally, the head of the council was fined 5,000 NIS by Israel.

• 8/8, the Israeli Civil Administration & military demolished a residential apartment in a 3-story building with explosives in Dura, Area A, Hebron. Apartment belonged to the family of a man who stabbed & killed an Israeli on 4/1/24. The blast damaged another apartment & crops in nearby field. A family of 8 (1 child) was displaced & 2 other families of 13 people (3 children) were affected.

Other

·       West Bank may be third place in people' s minds behind Gaza & regional escalation, but it faces dire instability, & water is becoming one of the causes. Every year there is a growing water shortage in the summer – for Palestinians. This year it seems worse, with cutouts in Hebron, Jenin & even Ramallah. It's fundamentally political. In the West Bank, ~half of the water supply is purchased from Mekorot, according to Al-Attili. In summer, consumption rises everywhere; when settlements use more water, the allocations to Palestinians are cut – this summer, he estimates by 35 or 40% depending on the area.

·       Israeli Civil Administration has begun working towards the establishment of a new settlement in Gush Etzion as part of the cabinet's decision on reactionary measures against the Palestinian Authority & the unilateral recognition of a Palestinian state by several countries.

ISRAEL

·       The 5 Israeli army reservists suspected of abusing and committing sodomy against a Hamas member at the Sde Teiman detention center will be released to 10 days of house arrest, following agreements reached between the military prosecution & the defense.

·       Netanyahu has added new conditions to Israel’s demands for ceasefire negotiations, additions that his own negotiators fear have created extra obstacles to a deal. According to unpublished documents reviewed by NYT, Israel relayed a list of new stipulations in late July to American, Egyptian & Qatari mediators adding less flexible conditions to a set of principles it had made in late May.

·       `400 patients in Israel suffering from post-traumatic stress disorder as a result of Hamas' 10/7 attack are due to receive treatment that will include MDMA, as part of a multi-center research study to take place in 5 Israeli hospitals. The patients include displaced residents, soldiers and survivors of the Nova festival massacre.

US

·       While the American Association of University Professors' announcement that it had reversed its long-standing policy of opposing academic boycotts didn't specifically mention Israel, the war in Gaza was likely the reason it revisited its policy after almost 2 decades.

·       Dozens of American Jewish leaders, including some 100 rabbis, cantors & other figures, have published an open letter urging Netanyahu "to finalize the deal on the table & to bring much-needed relief to those suffering" in Israel & Gaza.

·       US approved the sale of a landmark $20 billion weapons package to Israel, including the hotly contested & long anticipated sale of F-15 fighter jets for over $18 billion.

·       In Gaza, Israel’s military has reached the end of the line, US officials say. Israel has severely set back Hamas but will never be able to completely eliminate the group, officials said.

INTERNATIONAL

·       More aggressive efforts to resume cease-fire talks by US, Egypt, & Qatar. US & regional officials hope that movement in the negotiations would blunt or stop a widely anticipated Iranian-led retaliation for the assassination of senior leaders of Hamas & Hezbollah, both backed by Iran.

·       British Foreign, Commonwealth & Development Office diplomat Mark Smith resigned from his position with a letter titled "FCDO complicity in War Crimes". He accused Israel of war crimes & genocidal intent & says there's "no justification for the UK's continued arms sales to Israel".

Sources:

OCHAOPT, Haaretz, New York Times, twitter, The New Arab, Electronic Intifada, MSN