Urgent health update: Consequences of war on Gaza and West Bank/East Jerusalem-July 27, 2024

Israeli bombardment from air, land & sea, & ground incursions & heavy fighting continue across much of Gaza, & has been particularly intensive with attacks on refugee camps in Deir al Balah, leading to the displacement of >190,000 from Khan Younis & Deir al Balah. Despite the increasing need, humanitarian aid entering Gaza has decreased 56% since April. 

JOURNALS & REPORTS

Counting the dead in Gaza: difficult but essential, Lancet Reflections on report in CommonDreams and CAIR

Racism as a Threat to Palestinian Health Equity, Health Equity

While We Were at War: The Government’s Annexation Revolution of the West Bank Since October 7 Peace Now

Displacement Is the Point: Contextualizing Israel’s Decades of Violence & Destruction in Gaza & the West Bank, Israel’s actions across both Gaza & the West Bank seem to point to one conclusion—population expulsion and territorial expansion. The Tahrir Institute

A new Gaza Community Mental Health Program report paints a stark picture of the severe mental health crisis unfolding in Gaza due to the ongoing Israeli genocide. GCMHP

PODCASTS & INTERVIEWS

Dr. Majed Jaber, emergency physician in Gaza who worked at the Emirati maternity hospital before Israel invaded Rafah in May, then worked at the European Gaza Hospital in Khan Younis until the Israeli army ordered the area to evacuate in early July. He talks about the rapid spread of epidemics across Gaza, especially in shelters, where facilities & tent encampments are overcrowded & lack basic sanitation, infrastructure medical services. here

Diana Buttu & Richard Falk discuss broad significance of ICJ ruling on Israeli occupation here. 
Further commentary by Kenneth Roth here

Israeli public health leaders sound alarm over polio in Gaza Democracy Now

Israeli human rights lawyer Michael Sfard discussed ICJ decision Middle East Eye

Israeli military is destroying hospitals and targeting medical staff in Gaza, doctors and nurses say. NBC

INTERNATIONAL COURT OF JUSTICE

7/19, ICJ issued decision on the Policies & Practices of Israel in the Occupied Palestinian Territory (OPT), including East Jerusalem. Requested by the UN General Assembly, they determined: Israel’s continued presence in the OPT is unlawful & must end as rapidly as possible; Israel must cease immediately all new settlement activities; Israel’s legislation & measures to maintain a near-complete separation in the West Bank & East Jerusalem between the settler & Palestinian communities constitutes a breach of the Convention on the Elimination of Racial Discrimination. 

All States & international organizations are obligated to not recognize the occupation, UN must consider actions to end it as rapidly as possible.
ICJ’s Press Release is here, a summary of the decision is here.  

Analysis in Counterpunch

Numbers are cumulative

GAZA

• Killed (by 7/25): 39,175 (327 this week) There is a desperate struggle by families & civil defense teams to find missing children, buried under rubble, lost in the chaos, decomposed beyond recognition

• Injured: 90,403 injured (944 this week)

• Israeli soldiers killed in Gaza (by 7/25): 328 (2 this week)

• Israeli soldiers injured in Gaza: 2,161

• Hostages: 115 (5 corpses were recovered this week) 
  

  7/26: UN Secretary-General António Guterres stated “humanitarian situation in Gaza is a total disaster” due to: 1) “chaotic” military campaign causing the highest level of killing & destruction since he came into office in 2017, where people are repeatedly told to move from one place to another “in search of a safety that doesn’t exist in any place.” 2) a level of humanitarian aid “totally out of proportion with the needs” & obstacles “in relation to [the entry of] security equipment [and] the so-called ‘dual use’ items” necessary for humanitarian operations. 
  
  7/26: Deputy UN Special Coordinator for the Middle East Peace Process, Muhannad Hadi, briefed the UN Security Council: “The human impact of this conflict cannot be overstated. The impact will haunt us, all of us, not for years, but for generations to come. We need a ceasefire, the ability to deliver aid to the Palestinians in line with humanitarian principles, & the immediate & unconditional release of hostages. All parties must fulfill their obligations under international humanitarian law. This includes protecting civilians, ensuring their basic needs are met, allowing them to leave for safer areas & allowing them to return, as soon as circumstances allow.”
  
  Attacks

• 7/18-20 & 23, 39 killed (>6 children) & >22 injured in & around Al Bureij & An Nuseirat Refugee Camps, Deir al Balah.

• 7/20, 14 killed & others injured in and around Gaza City.

• 7/20 a journalist & 4 family members (2 children) were killed & others injured in Jabalya Refugee Camp.

• 7/20 & 22, 16 killed & others injured in & around an IDP shelter in Khan Younis. 

• 7/24, 6 killed & others injured in Beit Lahiya Project, North Gaza.

  Evacuations & Displacement

• 7/22-25, Israeli military ordered an evacuation of some 182,000 people from Khan Younis to a shrunken by 15% so-called “humanitarian zone” in Al Mawasi, Khan Younis & displacing another 12,600 from Al Bureij Refugee Camp to already overcrowded Al Maghazi & An Nuseirat Refugee Camps in Deir al Balah. Many have to sleep in the streets, exhausted, lacking tarps for shelter, hot meals, drinking water, diapers, mobile latrines & dignity kits. Khan Younis was then bombed, killing & wounding hundreds.

• ~83% of Gaza Strip has been placed under evacuation orders or designated as “no-go zones” by the Israeli military. ~300 people, including those with reduced mobility & their caregivers, remain stranded amidst hostilities, UN personnel & Palestinian Civil Defense (PCD) are denial access to them by Israeli military.

• 7/24, PRCS stated that 7 of 27 shelters have gone out of service due to repeated evacuation orders & attacks. In Khan Younis alone:
  -- 6 education projects shut down, affecting 1,500 children in 10 Temporary Learning Spaces & 20,000 children benefiting from mental health & recreational activities.
  -- 10 schools serving as IDP shelters shut, affecting 8,232 people.
  -- 12 food distribution points, 8 cooked meal providers, 2 nutrition programs (supporting >2,800 children & pregnant women) closed.
  -- Child protection & Gender-Based Violence responses halted, leaving thousands at risk.
  -- 10 critical water & sanitation facilities (water desalination plants, water reservoirs & sewage pumping stations) have shut down. 

  Hospitals & Health Care

Evacuation orders & relentless hostilities have devastated Gaza’s health system, denying people (particularly those with chronic diseases) access to essential services. While >1,500 patients need kidney dialysis, 60 hemodialysis machines are available, compared with 182 prior to the conflict. Patients get 2 2-hour dialysis sessions/ week, instead of the required 3 4-hour sessions/ week. Sexual & reproductive health services continue to shrink. Only 8 of 16 partially functioning hospitals & 4 field hospitals provide maternal care, with >500,000 women of reproductive age lacking access to pre- and post-natal care, family planning & STI treatment. Mass casualty events further stretch limited trauma & emergency response capacity.

• 7/22-3, Nasser Medical Complex received 73 fatalities & 270 injured from Khan Younis. Already overwhelmed, they issued urgent call for blood donations, but many volunteers were found medically unfit due to wasting & malnutrition. The hospital warned of dire conditions with patients lying on the floor & a lack of medical supplies to treat them. 40 patients were taken to Al Aqsa Hospital in Deir al Balah (also at capacity), others to the IMC & UK-Med field hospitals, (WHO).

• Medical evacuations out of Gaza remain suspended since the closure of Rafah Crossing. WHO urges the establishment of safe evacuation corridors to enable critically ill & injured patients to access lifesaving care.

• Assessment was carried out on how to restore ER & key services (trauma triage, emergency treatment of communicable & non-communicable diseases) at Al Shifa Hospital in Gaza City, destroyed in March. WHO explained that only 1 X-ray machine remains functional, while all other equipment, such as ventilation & anesthesia machines, were destroyed. May, 22 dialysis machines came online, supporting 60 patients, well short of the 450 patients they supported before the Israeli destruction, but hospital lacks necessary staffing, devices, supplies, & medications. Work to rehabilitate the structure, restore electricity, water & sanitation services are needed to install new equipment. Assessments of Al Helou & Patients Friends Association hospitals, affected by Gaza City evacuation orders, were cancelled due to Israeli checkpoint delays. 

• Lack of security & designation of only Kerem Shalom Crossing for the movement of humanitarian staff has limited the number of aid workers & additional Emergency Medical Teams (EMTs) able to rotate in & out of Gaza to support the exhausted local health force. None of Gaza’s 36 hospitals is fully functional; 16 remain partially functional, but some provide only minimal services, & insecurity & road damage make 12 only partially accessible. Severe shortages of medical supplies, hospital beds, & fuel for electricity cripple the health system. UNRWA reports 60% of medicines unavailable due to Israeli constraints on importation & distribution. 

• 7/25, PRCS reported Israeli forces fired at an ambulance evacuating an injured person in Khan Younis. 7/23, UNRWA’s Phillippe Lazarini reported a clearly marked UNICEF vehicle which had coordinated with Israeli authorities was fired upon by Israeli military at a designated holding point near the Wadi Gaza checkpoint. UNICEF ED Catherine Russell noted that while they are doing everything possible to respond to the “beyond catastrophic” humanitarian situation, attacks on personnel continue to obstruct their efforts; she called for an “immediate improved security environment,” unimpeded flow of aid, & regular & safe access for humanitarian workers.   

• 7/24, 15 children & 1 adult, with 25 caregivers, evacuated from Gaza to Egypt via the Rafah crossing prior to its 7 May closure, were transferred to Spain to receive medical care. >12,000 patients remain unable to exit Gaza to get urgently needed care. Only 4,913  patients (35% of those requesting medical evacuation) have been allowed to leave since October, the majority to Egypt, Qatar & UAE.

·        Dr. Maysa Abu Sitta is trying to provide psychological support for children in the al-Amal neighborhood in Khan Younis who have lost a parent during the Israeli genocide. She has established a makeshift camp for children, “Hope Will Remain,” in her still-standing home & adjacent tents for the forcibly displaced in the area.

·       WHO: >100,000 of Gaza’s displaced people are suspected to have contracted hepatitis A, while polio, a disease that has been eradicated in much of the world, is now present there. Young unvaccinated children are at highest risk.  Polio was eradicated in Gaza in the 1980s.

Humanitarian aid 

• Project Hope reported that on 7/16 their team narrowly escaped an Israeli airstrike inside the “humanitarian zone” in Khan Younis. “We witnessed blood & casualties in the streets, leading to intense fear among all of us. We cried from the shock of the scene, but thankfully we all managed to return home... However, the trauma still lingers in our hearts – this is supposed to be a safe zone.” 

• Entry & distribution of humanitarian aid continues to be impeded. 7/1-24, 1,797 truckloads of mostly food aid entered Gaza, an average of 75/day (excluding fuel). Humanitarian shipments entering Gaza have decreased from an average of 169 trucks/day in April, 94/day in May, 77/day in June, and so far 75/day in July—a decrease of 56% since April. Northern Gaza has been especially constrained: Between 7/1-24, of 106 missions coordinated with the Israeli authorities, 10 (9%) cancelled for logistical, operational or security reasons. Of the remaining 96, 43 facilitated by the Israeli authorities, 30 impeded (after their initial acceptance), 23 denied. In central & southern Gaza, of 307 missions, 29 cancelled; of remaining 278 missions, 212 facilitated by the Israeli authorities, 35 impeded, 31 denied.  

Public Health – Water & Sanitation

• Dire water, hygiene & sanitation conditions & limited functionality of health facilities has created a high risk of poliovirus type 2 spreading across Gaza, potentially also beyond. 45% of all primary health centers (PHCs), responsible for the bulk of child immunizations, are now operational. WHO’s Dr. Saparbekov reported that the Global Polio Eradication Initiative (GPEI) is conducting an epidemiological investigation & risk assessment to recommend how best to respond to an outbreak. WHO: there is a high risk of the polio virus spreading across the Gaza Strip & beyond its borders due to the dire health & sanitation situation.

• Fuel shortages continue to jeopardize health, water, & food production facilities. Between 7/1-21, only about ¼ of the needed 400,000 liters/day entered Gaza.

• 7/20, Al Muntar water pipeline from Israel to northern Gaza resumed operations. Out of service since 7/1, Gaza City now reports water flow has increased from 15% to 40%. UNICEF & the Coastal Municipalities Water Utility installed a solar mobile desalination plant in Deir al Balah to provide drinking water to ~3,200 households. WASH Cluster reports lack of electricity, infrastructure damage, & shortages of fuel, spare parts & chlorine hamper water production, purification, & sewage pumping. Average water supply in Gaza is ~¼ of supply prior to the war.

• A report by the international NGO PAX highlights the public health risks from the destruction of the waste management system & blocked access to landfills by Israeli forces. Satellite imagery identified 225 waste disposal sites & informal landfills, noting that the actual number is higher given that smaller sites are often not visible on satellite imagery. Report noted the threat of antimicrobial resistance (AMR) linked to the destruction of wastewater infrastructure as well as heavy metal exposures from munitions. Environmental consequences may render Gaza uninhabitable & cause ecosystem & public health problems in the region from toxic contamination of agricultural lands & aquifers penetrating the food chain. 

• Most of the water is undrinkable & sewage flows in the streets.
  

  Food & Nutrition

• Of 13 operational bakeries, 6 in the north receive enough fuel to keep running a few days, causing 2 in Gaza City to close 7/8-19. Markets in northern Gaza lack protein (meat & poultry), only a few locally produced vegetables are available--& unaffordable. Community kitchens lack supplies to support the thousands of newly displaced people, & lack of cooking gas forces cooking on wood & plastic from furniture & waste to cook with its health & environmental risks. In central & southern Gaza, community kitchens face similar shortages due to the irregular entry of aid through Kerem Shalom Crossing. There are 7 functioning bakeries, all in Deir al Balah; 5 bakeries in Rafah remain closed. As of mid-July, ~630,000 cooked meals prepared in 180 kitchens were provided across the Strip, including ~20,000/day in the north, 610,000/day in central & southern Gaza. 

• Some Palestinian farmers in Gaza continue to farm despite “unimaginable challenges,” reports Action Against Hunger. Agricultural production was 11% of GDP in 2022, but has largely ceased due to war, displacement, destruction of croplands, & lack of tools & inputs. AAH has prioritized key areas to support farming, including “emergency supplies such as seeds, fertilizers & agricultural tools,” repair of “greenhouses, irrigation systems and water resources,” and trainings “on safe agricultural practices in the midst of conflict-induced contamination, … renewable energy installations, water conservation, & smart agricultural technologies” – all with the goal of building a resilient agricultural sector capable of functioning during the crisis. 

Other

·       Latest satellite imagery reveals new roads that appear designed to support the long-term presence of Israeli troops.

West Bank, including East Jerusalem

• Killed: 563 (131 children) 7 this week, UNICEF: On average, one Palestinian child was killed in the West Bank, including East Jerusalem, every 2 days since October 2023, a nearly three-and-a-half-fold increase from the previous 9 months

• Injured: ~5,520 (~850 children), 17 this week

• 14 Israelis killed, including 9 soldiers & 5 settlers, ~106 Israelis injured, including 91 soldiers, 1 this week. 

• Since October 2023, there have been 1,143 Israeli settler attacks on Palestinians, 108 led to Palestinian fatalities & injuries, 916 led to damage to property, 119 caused both.

• >665 structures have been demolished in the West Bank & East Jerusalem since the beginning of 2024 due to the lack of building permits, displacing 811 people. 

  Attacks

• 7/23, Israeli forces shot & killed 2, arrested 2 in Sa’ir, north of Hebron. 

• 7/24, 2 killed, 1 in Tubas,1 during a home demolition in Qalandiya Refugee Camp. 

• 7/22-3, 1 killed in Tulkarm City, 5 in Tulkarm Refugee Camp, 7 injured. Israeli forces withheld 4 of the corpses. An injured Palestinian was tied to the front of an Israeli army jeep as it drove through the streets. Damage to multiple road sections in & around the camp was reported as were disruptions of water, electricity, & internet services. Since October, 22% of West Bank casualties have been in Tulkarm, including 115 killed by Israeli incursions & 39 killed by airstrikes. This is 10x greater than the previous year.  

• 7/16, undercover Israeli forces raided Balata Refugee Camp (Nablus), injuring & transporting 2 to a hospital. 

• 7/16, 3 settlers injured when Israeli forces mistook them for Palestinians, shot at their vehicle near the Beit El (DCO) checkpoint (Ramallah). 

• 7/19, Israeli forces shot & killed a 19-year-old in a search-and-arrest operation in Beit Ummar (Hebron). 

Settler Attacks and Property Damage

• 7/16, 2 armed settlers seized a farmer’s bulldozer while he was working in Beit Dajan, Nablus. Uniformed settlers then blindfolded him, held him for about an hour, then transferred him to a military jeep that returned him to his village. 

• 7/17, settlers put nails on a road connecting Turmus'ayya & Al Mughayyir villages (Ramallah), damaging a farmer’s vehicle on his way to his fields, recently burned by settlers. The next day, settlers from Adei Ad & other outposts used a bulldozer & a truck to break into & steal material from a Palestinian factory in Area B of Turmus'ayya. Closures by Israeli forces since October have made the area inaccessible to Palestinians. 

• 7/20, 3 armed settlers set their dogs on a 15-year-old collecting scrap metal, stole & burned his vehicle near Ni’lin (Ramallah). 

• 7/20, armed settlers from Peduel stole 25 sheep.  

• 7/21, settlers from Esh Kodesh attacked a group of Palestinian, Israeli & foreign activists with sticks, stones & metal bars, injuring & hospitalizing 2 in Qusra (Nablus). 

Demolitions

• 7/16-22, Israeli authorities demolished 48 structures (45 in Area C , 3 in East Jerusalem) due to the lack of impossible-to-get building permits. This displaced 57 (29 children) and affected 180 (88 children). 

·       Since October, Israeli authorities demolished 1,247 Palestinian structures across the West Bank, of which 39% (481 structures) were inhabited homes. This displaced 2,836 people (1,245 children), ~half during Israeli military operations in Jenin, Tulkarm & their surrounding refugee camps. 

Other

·       With the closure of checkpoints, Palestinians with Israeli citizenship cannot come to Jenin & Tulkarm to shop, West Bank Palestinians cannot leave to work in Israel, cutting incomes & building militancy, destroying the West Bank economy.

Israel

·       Knesset (parliament of the "Jewish state") voted to preclude any possibility of a "Palestinian state" in Palestine.

·       Israeli army will begin to vaccinate against polio all soldiers operating in Gaza or due to enter there soon, after a high concentration of the virus was found in sewage in Gaza.

·       Israeli public health professors call for a cease-fire to stop it spreading & prevent an epidemic among Gazan and Israeli babies.

·       Israel’s education minister & the country’s national union of students are backing a draft law to limit academic speech in the country, which the heads of leading universities have attacked as “McCarthyite” & fundamentally undemocratic. Legislation would give a government-appointed committee the power to order the firing of academic staff that it decides have expressed “support for terror”. If universities refuse, their funding would be cut.

·       7 senior lecturers at the prestigious Einstein Institute of Mathematics are departing against the backdrop of the Netanyahu government's judicial overhaul & war. 

·       Knesset approves first reading of a trio of bills aimed at shutting down UNRWA. The first bill would ban the organization from operating on Israeli territory, passed 58-9. The second, aimed at stripping UNRWA personnel of the legal immunities & privileges afforded to UN staff in Israel, passed 63-9. The third, which would brand UNRWA a terrorist organization & require Israel to cut ties with it, passed 50-10.

·       Ahead of a High Court of Justice hearing on a petition calling for a system to evacuate sick & wounded from Gaza for necessary medical care, COGAT along with WHO, is planning an initial medical evacuation of 250 sick & wounded Gazans from Eilat. 

·       Israeli forces have been publishing degrading photographs & videos of detained Palestinians, including children, a form of inhumane treatment & an outrage on their personal dignity that amount to war crimes, Human Rights Watch said. 

US

·       In November 2023, APHA adopted a policy statement calling for a ceasefire in the Israel-Hamas war, along with release of hostages & detainees & humanitarian aid into Gaza, at its annual meeting. The brief statement passed with a 90% vote in the Governing Council, making APHA the first US professional health organization to call for a ceasefire. In 2024, despite APHA’s annual meeting’s theme of “Building Trust in Public Health and Science,” “APHA Executive Board & Joint Policy Committee has betrayed trust in the policy statement process by removing the new policy statement calling for health equity in Palestine.”

·       House passed an amendment barring the State Department from citing the Gaza Health Ministry’s death toll statistics for the Israel-Hamas war, effectively halting discussion of the war’s deaths if it is signed into law.

·       Democratic Senator Chris Van Hollen said he will not attend Netanyahu's address, accusing him & "his extremist partners like Ben-Gvir and Smotrich" of sabotaging & undermining the U.S.-Israel relationship. Democratic Senator Jeff Merkley has also said he will not attend the speech. Rep. Delia Ramirez, a progressive Democrat, said Netanyahu's planned address is "a slap in the face to the thousands of Americans who have been demanding a cease-fire. We cannot work toward peace while giving a war criminal the floor."

·       7 major US labor unions called on President Biden to "immediately halt all military aid to Israel."

·       Thousands of protesters demonstrated around Capitol Hill voicing opposition to Netanyahu who addressed a joint session of Congress. This included hundreds of American Jews who were arrested while engaged in prayerful civil disobedience, demanding an immediate arms embargo on Israel.

·       American healthcare workers demand Biden & Harris end support for Israeli assault on Gaza in open letter.

Sources

OCHAOPT, Electronic Intifada, + 972, Haaretz, The Guardian,  New York Times, The Wire, Mondoweiss, Human Rights Watch, UNICEF, Reuters, APHA International Health Section’s Palestine Health Justice Working Group, The Times of Israel, Aljazeera, Nation of Change