Urgent health update: Consequences of war on Gaza and West Bank/East Jerusalem June 29, 2024
Israeli bombardment from the air, land, & sea, as well as ground incursions & heavy fighting, continue across much of the Gaza Strip, especially in Rafah & Gaza City, where overnight on 6/27 60-80,000 people were displaced from Gaza City & 5,000 more were driven from Rafah. ~78% of the Gaza Strip has been placed under evacuation orders by Israeli military. OHCHR: “Israel’s conduct of hostilities continues to raise concerns over serious violations of international humanitarian law” including the principles of distinction, proportionality & precaution, resulting in high numbers of casualties among civilians already enduring a “life-threatening lack of food, clean water & access to objects indispensable for their survival.”
ARTICLES & STATEMENTS
Asi, Sharif, Wispelwey, Abuelezam, Ahmed, and Samari open-access article in Health Equity: Racism as a Threat to Palestinian Health Equity (https://www.liebertpub.com/doi/10.1089/heq.2024.0027)
Recent events, along with the trajectory of events over the past 75 years, demonstrate that using a public health framework could help recognize racism as a structural and 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.
Wispelwey, Mills, Asi, Hammoudeh, Kunichoff, Ahmed, Civilian mortality and damage to medical facilities in Gaza. Editorial in BMJ Global Health https://doi.org/10.1136/bmjgh-2023-014756
A Jewish doctor was heckled with shouts of “shame” as she spoke out in defense of Palestinians in Gaza at the BMA’s annual representative meeting in Belfast.
British Medical Journal
The meagre flow of aid into Gaza is creating a deadly health crisis for Palestinians. BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q1390 Cite this as: BMJ 2024;385:q1390
British Medical Journal
The vitriolic disputes taking place around the world over the war between Israel and Hamas in Gaza result in part from disagreements about the moral perspective from which to evaluate it. One way to find common ground is to analyze the conflict from a stance that is neither pro-Israeli nor pro-Palestinian but pro-civilian. To do so we can use the standards of international humanitarian law, also called the laws of war.
New York Review
UN Human Rights Office - OPT: Statement on the killing and arbitrary detention of health workers in Gaza
The Floating Gaza Pier: A Symbol of Future Colonial Plans, Pier must not be viewed as merely a short-term humanitarian effort, but also as a symbol of the US & Israel’s continued imperial & colonial endeavors. Al-Shabaka
Health and Human Rights Crisis in the West Bank – Emergency Statement: JVP Health Advisory Council statement posted on Palestine Chronicle and Just World Educational.
PERSONAL WITNESS
Reem Hamadaqa spent 96 days in Al-Aqsa Martyrs Hospital in central Gaza recovering from an Israeli attack that killed the rest of her family. Here are the stories of women and children she met while she was there. Mondoweiss
VIDEO
Gaza health workers call on international community to protect Palestinian medical sector. Democracy Now
Numbers are cumulative
GAZA
· Killed: >37,765 Gazans (334 6/20-6/27), includes 500 health workers
· Injured: 86,429 (776 in the past week)
· Israeli soldiers killed in Gaza: 314
· Israeli soldiers injured in Gaza: 2005, may exceed 20,000, including 8,000 permanently disabled according to head of Israeli army’s wounded association
· Hostages: 120
UN aid worker’s testimony: Gazans “holding on by a thread”
· Watch this testimony on YouTube
· Yasmina Guerda, humanitarian affairs officer OCHA, briefed journalists on “stories that will haunt me for the rest of my very privileged life.”
· Main points:
“…should not speak about living conditions because no Gazans have ‘living’ conditions. What they have, if you look closely, is survival conditions. And barely. They’re holding on by a thread.”
Horrific aftermath of bombing of Nuseirat refugee camp (to release hostages) “…walls, doors & windows of our building were shaking…” Hundreds of people “maimed for life,” children who lost limbs...the next day at a nearby hospital: “They were staring into the void – too shell-shocked to produce a sound or a tear.”
Families “dig makeshift septic tanks with spoons, using toilets and pipes from destroyed buildings so they could have a little bit of privacy and hygiene near their tents.”
Mass displacement caused by Israel’s attack on Rafah starting 5/7: people lost access to malnutrition screening centers, “thousands of children who were being followed or who were being screened…all of a sudden we lost track of.”
Gazans urgently “need decision-makers to finally make a decisive gesture to put an end to the relentless way they are being knocked down after every attempt to get back up… And they need the support of the rest of the world to do that.”
Attacks
· 6/22 Israeli attack killed 24, injured 49 near the ICRC office, surrounded by hundreds of displaced civilians living in tents, Al Mawasi, Rafah. Mass casualties brought to nearby Red Cross Field Hospital. Israeli military denied any direct attack on Red Cross facility.
· Attacks in & around Gaza City, including in the Ash Shati’ Refugee Camp, killed 83 people, including Gaza’s Director of Emergency and Ambulance Services Rights Office, Hani al-Jafarawi, described as a “pillar” of Gaza’s health system. Israel’s military said the strike had killed a senior Hamas armed commander.
· Other attacks, deaths & injuries include eastern Khan Younis, Jabalya Refugee Camp, Al Bureij, Shujaiyeh, Gaza City
· WHO, Israelis have attacked 464 health care facilities, killed 727 health care workers, injured 933 health care workers, and damaged or destroyed 113 ambulances.
Child Health
· >21,000 children “lost, disappeared, detained, buried under rubble or in mass graves”
· Repeated displacement, incessant hostilities leave children: susceptible to a variety of mental health issues, including panic attacks, depression, anxiety & acute stress, with many expressing a “desire to die instead of living this horror.” 17,000 are unaccompanied or separated from family
· 6/27 19-21 children suffering from cancer, mostly leukemia, exited Gaza through the Israeli-controlled Kerem Shalom crossing to Egypt. >980 children with cancer, remain in need of evacuation.
· Israeli military said the operation had been carried out in coordination with US, Egypt & international community. In total, 68 people — sick &injured patients & their escorts — were allowed to leave.
· Nutrition Cluster partners screened 11,903 children for malnutrition in June: 8,505 kids with acute malnutrition. They are treating 6,634 children diagnosed with moderate & 1,874 with severe acute malnutrition. 4 children starved to death this week.
· Capacity of Nutrition Cluster partners in Khan Younis is insufficient to address the increased need for nutrition services following large-scale displacement to the area, heightening the risk of inadequate or no follow-up for children under acute malnutrition treatment.
· Education Cluster provided informal learning, recreational & mental health & psychosocial support services to 22,000 school-aged children, bringing the total number of children reached 262,000, prioritizing the provision of education & psychosocial support to children in shelters
Humanitarian Aid
· Israel continues to restrict delivery of essential humanitarian assistance and services across Gaza, including food & nutrition aid, medical care, protection & shelter, as well as water, sanitation, & hygiene (WASH) services. In northern Gaza, 49% facilitated, 10% denied, 30% impeded. In southern Gaza 71% facilitated, 5% denied, 13 % cancelled
· Persistent fuel shortages hinder aid operations & the functioning of water, sanitation, health & other facilities. 14% of diesel & benzene fuel that used to enter Gaza monthly has been entering since October.
· Aid pier US military built off Gaza has been removed again because of sea conditions, aid had stockpiled at the pier’s marshaling area awaiting distribution.
Hospitals
· Attacks on health workers & facilities continue including Médecins Sans Frontières physiotherapist killed with 5 others, including 3 children, & complete destruction of Al Awda Health & Community Association Rafah health center.
· OHCHR: notes systematic attacks on hospitals & other medical facilities, mass detention & enforced disappearances, including of medical staff. “Hospitals, medical personnel & ambulances must be respected & protected at all times.”
· Kuwait Field Hospital in Khan Younis: main generator stopped functioning due to the lack of fuel, facility now relies on a secondary generator to maintain operations.
· Nasser Medical Complex in Khan Younis now fully functional with 450-beds, including emergency, medical & pediatric departments, a laboratory, an ICU, a newborn unit, a Severe Acute Malnutrition (SAM) stabilization center. It can provide maternal, dialysis, radiological and rehabilitation/ physiotherapy services.
· >1,200 Gazans require hemodialysis treatment. ~half rely on 24 dialysis machines at Al Aqsa Hospital in Deir al Balah, only 17 machines available in the North Gaza & Gaza governorates.
· >70% of essential medicines are missing in hospitals & primary healthcare centers.
· Inability to bring in sufficient medical supplies & fuel has forced aid organizations to scale back services, including Palestine Red Crescent Society (36% of ambulances nonfunctional), UNRWA (providing 29% of health center services), MSF (shortage of sterile compress gauzes at Nasser and Al Aqsa hospitals has reduced frequency of dressing changes for severe burn patients, painkillers are absent & medicines for skin infections are “running dangerously low.”) Since 6/14 June, 6 MSF trucks, comprising 37 tons of medical supplies, have been awaiting entry on the Egyptian side of Kerem Shalom Crossing.
· Some of the 17 “partially functioning” hospitals maintain only minimal operations, with a combined capacity of 630 beds.
· Pregnant women are requesting early C-sections for fear of not being able to deliver safely later.
· WHO Trauma Surgeon and Emergency Officer : closure of Rafah Crossing, increase in fighting, large-scale displacement, collapse of law & order, force an “un-workable environment,” achieving “only a fraction of what we should be doing.” Focus on lifesaving & limb-saving operations, no protheses or rehabilitation teams available.
· WHO appealed for the facilitation of medical evacuations for over 10,000 patients, including trauma cases & people with cancer, heart, mental health & other conditions, through all possible crossings to receive the medical care they need.
· To mitigate the impact of the health system’s collapse & address soaring needs, PRCS & UNRWA: reactivated some services in northern Gaza, (Al Quds Hospital in Gaza City, clinics & health centers in Jabalya & northern Gaza. Critical priorities include ensuring access to safe drinking water & addressing the accumulation of solid waste.
· Hundreds of thousands of Gazans lack access to essential medical care. Among the worst affected are cancer & dialysis patients, who were already suffering from a chronic lack of the necessary medical care infrastructure. Now, the Israeli military is turning hospitals into military bases & war zones.
Public Health
· Devastating environmental impacts of the Gaza war include “rapidly growing soil, water & air pollution, risks of irreversible damage to [communities’] natural ecosystems.” Includes dust & contamination with unexploded ordnance, asbestos, industrial & medical waste, other hazardous substances.” Heavy metals, chemicals and sewage contaminate Gaza’s soil & water sources. Air quality is likely to deteriorate due to the burning of wood, plastic & waste for cooking. 5 out of 6 solid waste management facilities have been destroyed. These short- and long-term risks will persist long after hostilities end.
· Restrictions on the entry of fuel severely reduce access to WASH services & disrupt water trucking, network repairs, sewage pumping, & solid waste collection. Fuel scarcity has forced the rationing of municipal groundwater wells & the 2 water desalination plants that remain functional. Groundwater well production, previously accounting for 80% of Gaza’s water supply, has dropped to about 6%. Lack of fuel has limited each desalination plant’s capacity to about 25%. The WASH Cluster reported that safe water production from 6/10-23 was <30% of the per-war level.
· In Jabalya, 3 of 8 groundwater wells are operational, 5 are damaged. To supply the area with water via a well in Gaza City, 6 pipes from southern Gaza are needed; Israel has denied permits for their transport.
Food and Nutrition
· ~ 96% of Gaza’s population likely to face crisis or worse levels of acute food insecurity in next 3 months, including 33% projected to face emergency levels of acute food insecurity, 22% projected to face catastrophic levels of acute food insecurity. Projected famine did not occur in northern Gaza in May due to March & April increases in food deliveries. In southern Gaza, intensified attacks in Rafah, heightened access restrictions have displaced >1 million people to areas with “significantly reduced” infrastructure & services. >1/2 the population has no food to eat at home, > 20% go entire days & nights without eating. >1/2 of households forced to exchange clothes for money, 1/3 resorted to picking up trash to sell & some gathering leaves to eat
· Food security indicators for children (6–23 months) improved due to increased aid in April, yet deteriorated in May. 85% of parents reported children went without food for a whole day, while ~100% of households reported skipping meals or eating less. Absence of dietary diversity threatens women’s health & child development. Access constraints & insecure conditions forced the closure of nutrition delivery points in May & June, & delays in establishing nutrition services & the scaling up of early detection of children & women requiring nutrition support.
· World Food Program: supporting reopening of bakeries in Deir Al Balah, Gaza City, & Jabalya. Bakeries in Rafah remain closed due to ongoing hostilities.
· Food Security Cluster partners have been unable to consistently & safely transport aid from Kerem Shalom Crossing to central & southern Gaza. Ongoing fighting, criminal activity, & looting risk has forced the reduction of rations & limited coverage.
· In joint efforts with the Health and WASH clusters, Food Security Cluster community kitchens provided safe water along with safe food handling & storage instruction to prevent food-borne diseases. As of mid-June, a daily average of 650,000 hot meals have been provided to families in at least 190 kitchens across Gaza.
Other
· Nearly 39,000 students in Gaza were unable to take their high school final examinations across the Palestinian territories & in Jordan, will not be able to graduate.
· Attacked in the field, in the office, & at home, 1 in 10 reporters in Gaza have been killed in Israel’s military campaign. IDF appear to have viewed journalists working in Gaza for outlets controlled by or affiliated with Hamas to be legitimate military targets.
WEST BANK & EAST JERUSALEM
· Killed: >553 (including 135 children), includes 519 killed by Israeli forces, 10 by settlers, & 7 soldiers or settlers.
· >5,370 injured (including 830 children). > 1/3 caused by ammunition.
· Israelis killed by Palestinians: (including 7 soldiers and 5 settlers)
· Israelis injured: ~105 (including 70 soldiers)
· Demolitions in Umm al Kheir, south of Hebron, displaced 38 people, mostly children, destroyed multiple structures, >20 residential & other structures have pending demolition orders. Israeli military declared area a closed military zone, confiscated a tent to temporarily house displaced families, & arrested an activist.
· From 6/18-24 June, Israeli forces shot and killed 4 Palestinians, including a child, & injured about 60 others, during search & arrest operations, with repeated denial of medical care access. Video footage shows an injured Palestinian tied to the hood of a military jeep while passing by 2 ambulances. According to a 6/23 statement by the UN Human Rights Office, Israeli forces drove the man about 200 meters before interrogating, releasing, & allowing him access to medical treatment in an example of “continued and flagrant violations of international human rights law & international humanitarian law binding on Israel as the occupying Power.”
· 6/18-6/24, 18 attacks by West Bank settlers injured 8 Palestinians & damaged >100 trees & other property in Jericho. on the road connecting Ramallah & Jericho, Yasuf village, Salfit, Masafer Yatta, Manitqat Shi’b al Butum, on Palestinian land near Beitar Illit settlement in Hebron, & Al Jwaya herding community south of Hebron
· Since 10/7 OCHA recorded 1,018 attacks by Israeli settlers against Palestinians, of which 105 led to Palestinian fatalities injuries, 800 to damage to Palestinian property, 113 led to both casualty & damage to property. > 44,260 Palestinian-owned trees & saplings have been destroyed by Israeli settlers.
· Other communities threatened with demolition or demolished include Bedouin community of Barriyet Hizma in Jerusalem, Jericho.
· Israeli raids this week included Nablus, Jenin, Qalailya
· Between 10/7 & 6/24, Israeli authorities demolished, confiscated or forced the demolition of 1,013 Palestinian structures in East Jerusalem & Area C, 37% were inhabited homes. 2,246 people, including 991 children, were displaced. > ½ of those displaced were during military operations, particularly in Jenin & Tulkarm cities and the surrounding refugee camps; 42% were due to the lack of permits; 7% were displaced by punitive demolitions.
ISRAEL
· Killed in attacks: 8 Israelis & 4 Palestinian perpetrators
· 3 Israeli army reservists explained why they refuse to continue serving in Gaza. Yuval was required to torch 2 residential buildings; Michael realized how many civilians were likely to be killed during every bombing he observed; Tal broke down when Israel entered Rafah.
· Israeli police cracked down on protesters with violence, false arrests, & surveillance. June has marked a turning point in the dynamic between officers & demonstrators, with polls showing that many Israelis are afraid to join protests over the rising violence.
· Israel’s Public Defender’s Office condemned “widespread” excessive use of force by Israel’s police against protesters during demonstrations for a hostage deal & against the government, calling on the Justice Ministry to address the issue.
· Israel’s CDC & public health officials are reporting a “very significant” increase in Coronavirus cases in recent weeks due to new variants’ that aren’t reflected in the data because “there is almost no testing in the community.” Local increase is in line with patterns abroad. The Health Ministry agency said there are 14 hospitalized coronavirus patients in serious condition.
· On far-right Israeli TV Channel 14, Netanyahu says he will accept partial deal with Hamas, but remains committed to continuing the war. A source familiar with the talks said the prime minister’s remarks could sabotage the prospects of a deal altogether.
· Far-right Finance Minister Smotrich said that he intends to make the West Bank “an integral part of the State of Israel…first on the ground and then through legislation,” adding that his life’s mission “is to thwart the establishment of a Palestinian state.” In a leaked recording, he describes in detail a secret plan to cement Israel’s control over the West Bank “without being accused of annexation” & says that Netanyahu is fully on board.
· With the West Bank facing deepening economic woes, Israeli officials said that a far-right minister had tentatively agreed to release some frozen funds to the financially embattled Palestinian Authority in exchange for strengthening Israeli settlements in the territory by retroactively authorizing 5 illegal Israeli settlement outposts.
· The director of a medical center in northern Israel wrote to his staff they must prepare for an escalation in hostilities between Israel & Hezbollah, telling them that “The level of preparedness required of us has been high for almost 9 months, though now it appears more will be required of us.”
· Since the war began, mental health professional & author Merav Roth has been treating people for trauma. Now she fears the disaster’s consequences for society: “The desire to take revenge on everybody is very dangerous for us.”
· Israel’s Supreme Court ruled that the military must begin drafting ultra-Orthodox Jewish men, a decision that threatened to split Netanyahu’s coalition government.
US
· US Ambassador to Israel Jack Lew said US arms shipments “keep coming” to Israel, & that there is “no change” in American support of Israel. US has provided Israel with military aid worth approximately $6.5 billion since 10/7.
· Netanyahu aired new grievances over the Biden administration’s supply of munitions for the war in Gaza as his minister of defense arrived in Washington for meetings with senior US officials. Biden administration says it doesn’t understand repeated accusations from Netanyahu that weapons deliveries from the US to Israel have significantly dropped. President Biden has delayed only 1 shipment of heavy bombs.
· Israel is covertly funding a massive propaganda campaign to target the US public, including through the passage of legislation to restrict US citizens’ right to free speech when criticizing Israel & its ongoing war on Gaza. Israeli funds target US college campuses & push to redefine antisemitism in US law.
· Israeli defense minister met with top American officials in Washington about a possible new phase in the Israeli offensive & addressed the intensifying conflict with Lebanon. Netanyahu said that the intensive phase of Israel’s war against Hamas was “about to end,” although he made clear that Israel would not stop fighting in Gaza until Hamas was “eliminated.”
INTERNATIONAL
· Head of Iran’s land forces says that the “axis of resistance” will not stand idle if Hezbollah and Lebanon are attacked.
· Germany’s Foreign Ministry condemned the incident in which a wounded Palestinian was tied to the hood of an IDF vehicle in Jenin, calling for “clarification a& consequences.”
· Canada’s government has imposed sanctions on the Amana movement, one of the flagship organizations of the settlements in the West Bank, & on veteran settler Daniella Weiss, as part of a new round of sanctions on Israeli individuals & entities “for their role in facilitating, supporting or financially contributing to acts of violence ... against Palestinian civilians and their property.”.
· An International Criminal Court case about arrest warrants for Israeli leaders over their conduct of the war in Gaza may face delays. The court gave Britain permission to submit “observations” about the ICC’s jurisdiction, a technical topic that does not go to the substance of the accusations in the warrants.
SOURCES: OCHAOPT, OHCHR, Save the Children, WHO, UN, Haaretz, NYT, Reuters, Electronic Intifada, Intercept, Portside, Washington Post, The Guardian, Aljazeera, Mondoweiss, Counterpunch, Medecins Sans Frontieres