Urgent health update: Consequences of war on Gaza, West Bank/East Jerusalem, Lebanon (and now Syria) 12/13/24

UN Appeals for funds for Palestine

“The UN and partners estimate that at least US$6.6 billion is required to address the humanitarian needs of 3.3 million people in Gaza and the West Bank, including East Jerusalem… Israel must take immediate and effective measures to ensure the essential needs of civilians are met. This includes lifting all impediments to aid and fully facilitating humanitarian operations, including the distribution of essential goods to Palestinians in need. Humanitarian actors anticipate being limited in what they can achieve in 2025 due to severe restrictions on humanitarian actors and ever greater challenges to their ability to operate, including intensified and coordinated anti-UN rhetoric strategically aimed at delegitimizing humanitarian efforts. Full compliance with international humanitarian law would allow humanitarians to use the full US$6.6 billion required and meet the essential needs of civilians.”

Find a Summary of the appeal here: Find the full (non-downloadable) 48 page document here:

MEDICAL JOURNALS

• Syria: Doctors warn of refeeding syndrome and infections in released prisoners

BMJ 2024; 387 doi: here (Published 11 December 2024)Cite this as: BMJ 2024;387:q279280%

Doctors from Syria who work for the British National Health Service (NHS) report “Holocaust-like” scenes that have unfolded at the liberated Saydnaya military prison 18 miles north of the Syrian capital, Damascus, after the fall of Bashar al-Assad. 12/8, teams including the Syrian led humanitarian volunteer organization the White Helmets and the Independent Doctors Association (IDA), a medical non-governmental organization serving Syria from a base in Gaziantep, Turkey, entered the 40 ,000 prisoner capacity compound. The IDA’s director, Mahmoud Mustafa, who was among the doctors who entered Saydnaya, described the scenes inside the liberated prison as “unimaginably tragic.”

• Gaza: Aid workers are killed in Israeli airstrikes as attacks on hospitals continue.

BMJ 2024; 387 doi: here (Published 09 December 2024) BMJ 2024;387:q2767 Six more aid workers have been killed in Gaza, including three World Central Kitchen (WCK) staff members, who were killed by an Israeli airstrike on their vehicle, bringing the total confirmed death toll among humanitarian workers to 343 since 7 October 2023, the UN has reported.

• The prevalence of armed conflicts, terrorist attacks, and industrial accidents necessitates clinician understanding of blast injuries in both civilian and military settings.

NEJM Blast injuries are a complex form of trauma, resulting from the explosive release of energy. This review focuses on the mechanisms and classifications of blast injuries and presents essential knowledge for initial diagnosis and management.
This article is a reminder of what blast injured patients should be receiving for care and is a stark reminder of what the injured in Gaza do not have access to.

REPORTS

• Amnesty international confirmed this week what many others have already said: Israel is committing genocide in Gaza. But the report goes to many lengths to prove one critical element in the case against Israel: that the genocide is fully intentional. report

• Since the beginning of the war, I have volunteered as an emergency doctor in Gaza to help my people. Over more than a year, I have witnessed countless horrors and been repeatedly displaced by Israeli bombardments and invasion. I have lost loved ones, seen patients die in horrific ways, and feared for my own life — and yet, even in the darkest moments, I have found glimpses of light. here

• Report from Air Wars: Patterns of harm analysis, Gaza, October 2023
By almost every metric, the harm to civilians from the first month of the Israeli campaign in Gaza is incomparable with any 21st century air campaign. It is by far the most intense, destructive, and fatal conflict for civilians that Airwars has ever documented. here

• The plight of the Palestinian scientist: Four Palestinian researchers describe how the conflict in Gaza and the West Bank has hindered their careers in science and medicine. here

• A new study of the psychological impact of the war on Gaza’s children has found that 96 percent of children feel death is imminent with 49 percent wishing to die because of the war. Conducted by the Community Training Centre for Crisis Management (CTCCM) with support from the War Child Alliance, the organizations said the study “paints a harrowing picture of children’s mental health in Gaza.”
report, summary

• Four months after its first report on the mental health impact of Israel's military assault on every aspect of life in the besieged strip, where Gaza's mental health professionals are working, the Gaza Community Mental Program (GCMHP) released its second detailed report: "There, People Suffer And Die."
GCMHP, summary

• A new report by the Israeli human rights group B’Tselem documents a shocking rise in harassment, detention and abuse of Palestinians in the occupied West Bank city of Hebron. The report includes testimony from 20 Palestinians who were attacked by soldiers in the city center of Hebron between May and August 2024, apparently chosen at random and detained for spurious or arbitrary reasons. The victims describe being punched, kicked and sexually abused, beaten with rifles, clubs or chairs, being whipped with a belt, having foul-smelling liquid poured on them, and, in one case, even being stabbed by Israeli soldiers. here

INTERNATIONAL DAY OF PERSONS WITH DISABILITIES

• More than 4,000 amputations and 2,000 cases of spinal and brain injuries have been recorded in the besieged Gaza Strip since the start of Israel’s genocidal offensive in October last year. “The majority of those who have lost limbs are children,” Mohammad Abu Salmiya, Director of the Al-Shifa Medical Complex, said during a press conference to mark the International Day of Persons with Disabilities held at Nasser Medical Complex in southern Gaza last week, the Middle East Monitor (MEMO) reported. here

GAZA

Israeli air, land, & sea bombardment continues across Gaza, causing further civilian casualties, and destruction of houses & other civilian infrastructure. The 66-day siege of northern Gaza has choked off all humanitarian aid, leaving between 65-75,000 people without access to food, water, electricity or reliable health care, as intensified attacks increase casualties. Evacuations continue, as 5,500 people were forcibly displaced 12/4 from 3 schools in Beit Lahiya to Gaza City. Constant Israeli violations of the ceasefire in Lebanon, widespread bombing of Syria, and the expansion of the war to the West Bank constitute a health and human rights emergency.

(Numbers are cumulative through 12/10/24, per OCHAOPT & Palestinian Ministry of Health.)

Find more details here:

Killed: 44,786+ (284 this week) as of 12/10

Injured: 106,188 (784 this week) as of 12/10

Israeli soldiers killed in Gaza: 384 (4 this week)

Israeli soldiers injured in Gaza: 2,485

Hostages in Gaza: 100

Israeli attacks

• 12/4, Israeli airstrike on 21 tents sheltering families in Al Mawasi “safe” zone (Khan Younis) killed 23 (4 children), injured others, and displaced 110. This is the 7th attack on IDP tent encampments (4 in the “safe” area) in the past 2 weeks. Medical Aid for Palestinians (MAP) Gaza Director said: “has proven once again that nowhere is safe in Gaza from Israeli military attacks. People there have been left in a constant state of fear and psychological distress, haunted by the fact that there is no place for them to shelter.”

See the MAP statement here:

• See a SOS Children’s Villages statement here:

• 12/3, 6 killed and 10 injured in an UNRWA school in Gaza City. 21 attacks on schools in November killed 73 people.

• 12/4 & 8, 35 killed and others injured in Gaza City.

• 12/5, 22 killed and others injured in 2 strikes on homes in Beit Lahiya.

• 12/6 & 8, 45 killed (6 children) in An Nuseirat and Al Bureij camps, Deir al Balah.

• 12/10, Israeli strikes across Gaza killed at least 34 Palestinians overnight medics told Reuters. The Palestinian Civil Emergency said most of those killed were from the same family, including women and children. Images posted online showed the bodies lined up in a single mass grave in the town.

• 12/12, Israeli occupation forces killed Dr. Saeed Joda while en route to Al-Awda Hospital in Jabaliya, in the northern Gaza Strip. Al-Awda Hospital said in a statement that Dr. Joda was the sole orthopedic surgeon serving the northern Gaza Strip, an area that has been under siege for 70 days. The Palestinian Ministry of Health in Gaza confirmed Dr. Joda’s death, stating that he was struck by an Israeli Quadcopter drone while traveling from Kamal Adwan Hospital to Al-Awda Hospital to treat the wounded. The ministry reported that the drone directly targeted him, killing him instantly. In response, it called on international and human rights organizations to ensure the protection of hospitals and medical personnel as they carry out their humanitarian duties.

• 12/13, Israeli strike overnight on a post office sheltering Palestinians in central Gaza killed at least 30 Palestinians and wounded 50, medics told Reuters.

Health and Health Care

• Between 12/3-7, Kamal Adwan Hospital (Beit Lahiya) was attacked 4 times, killing 7 (4 medics and 1 child), injuring 3 medical staff, and damaging water, fuel tanks, and the oxygen station. A 16-year-old boy was killed at the hospital entrance in a wheelchair. 12/6, Israeli tanks surrounded the hospital and ordered its evacuation. Forces expelled some staff and displaced people before withdrawing; bodies of people killed by airstrikes littered the streets outside. The Indonesian Emergency Medical Team, deployed by WHO on 12/1 after 5 denials, was forced to evacuate. See WHO Director-General statement here:

• “We don’t even have a single ambulance to transport the injured from disaster sites,” Dr. Hussam Abu Safiya, director of Kamal Adwan Hospital. He recounted getting distress calls from people trapped under the rubble and being unable to dispatch emergency workers to help them. “The next day, their voices were gone, and they were counted among the dead, with their homes becoming their graves. This scene is repeated daily.”

• Between 12/2-8, Indonesian Hospital (Beit Lahiya) was attacked 4 times, injuring 3 staff and 6 patients, and damaging its generator and water tanks. The Gaza health ministry said 60 wounded people in the Indonesian Hospital in the enclave’s north were “at risk of death due to a lack of food and water” exacerbating their conditions. “The humanitarian situation inside the hospital has become extremely dangerous, as the wounded lack basic needs,” the ministry said, calling on the international community to intervene “to save the lives of these patients.”

• 12/3, Al Awda Hospital (Jabalya) was hit, damaging its 5th floor and courtyard.

• WHO delivered Kamal Adwan Hospital 10,000 liters of fuel, 200 WFP food parcels, blood, and medical supplies, and evacuated 23 patients to Al Shifa Hospital in Gaza City. WHO also delivered 24,000 liters of fuel and medical supplies to Al Shifa hospital. ICRC delivered medical supplies to Al Awda Hospital in Beit Lahiya and evacuated 11 patients to Gaza City.

• UNFPA reports “Women and girls across Gaza, including 50,000 pregnant women, have been left without the essentials to survive.” Maternal deaths, miscarriages and preterm births continue to rise, with particularly critical conditions in the North where 1,720 pregnant women and girls have been cut off from aid for 60+ days. Repeated attacks on Kamal Adwan Hospital, the last major facility providing maternal and newborn care, hamper access to care, with newborns “died due to a lack of incubators, electricity, and medical supplies.” 49 trucks loaded with UNFPA reproductive health equipment and supplies, including medicines that prevent childbirth hemorrhage, are held at the border.

• 12/3-4, WHO evacuated 19 patients (11 children) to Jordan. At least 14,000 medical evacuation cases are being denied by Israel.

• WHO reported 6 environmental samples from Khan Younis and Deir al Balah tested positive for poliovirus. The polio technical committee is collecting additional samples to evaluate the need for another polio vaccination campaign.

• In Gaza, where despair is everywhere, hope is the vital currency offered to children and their families by Dr Yasser Abu Jamei, the psychiatrist in charge of running Gaza’s biggest mental health charity. “Without hope, we cannot pass anything on to those families, to those children,” says Dr. Abu Jamei, who for the past 12 years has directed the Gaza Community Mental Health Program (GCMHP). “Without hope, we wouldn’t be here. We can’t give up on 1 million children who live in Gaza, struck every day by the difficulties they are facing. We need to find the hope in their lives.” here

• Medical workers in Gaza’s remaining hospitals and field clinics are pleading with the international community for desperately needed assistance and an arms embargo against the Israeli occupation, as they continue to work under indescribable conditions — including being deliberately targeted by Israel’s occupying forces. here

Food & Nutrition

• “The levels of hunger, devastation and destruction in Gaza … [are now] worse than ever.” See WFP Palestine Country Director Antoine Renard tweet here:

• Attempts to deliver aid into besieged North Gaza continue to be blocked after 60+ days of siege, leaving 65,000-75,000 without access to food, water, electricity, health care. As of 12/9, only 4 of 19 WFP bakeries remain operational as the entry of wheat flour is obstructed. The cost of a 25-kilo bag is NIS 20-30 (US$5.6-8.4) in contrast to central and southern Gaza, where cost is NIS 1,000 ($280) in Deir al Balah and NIS 875 ($245) in Khan Younis. The Israeli siege has stopped all Nutrition Cluster activities in the North.

• A new UNICEF survey: nearly 100% of children 6-23 months are not meeting minimum dietary diversity. Food cluster reports “Children and women are now increasingly searching through piles of rubbish for food scraps,” often barefoot and without gloves, facing disease and injury from waste and unexploded ordnance.

• In November, 4,133 children (of 75,000 screened) received outpatient treatment for acute malnutrition. A total of 33,588 children have been treated in 2024. Since July, admissions have increased to more than 4,000 per month.

• As of early December 2024, about 100,000 metric tons of food, equivalent to >2 months of food for the entire population, awaits entry to Gaza, withheld by the Israeli authorities.

• Israel’s siege of the north and ‘benevolence’ toward gangs looting aid trucks has led to severe food shortages and skyrocketing prices across Gaza.

Disability

• Prior to October 2023, there were 58,000 people with disabilities in Gaza (WHO estimates here: ) The war has added 26,000 more in “an epidemic of traumatic injuries with no rehabilitation services available” (UNRWA’s Lazzarini). UN deputy chief Amina Mohammed: "Gaza now has the highest number of children amputees per capita anywhere in the world — many losing limbs and undergoing surgeries without even anesthesia." Conditions are worsened by the destruction of hospitals and rehabilitation centers, restrictions on medical evacuation, and the limited entry of wheelchairs, crutches and hearing aids, medical supplies and food. This absence of necessary equipment not only affects physical mobility but also mental health, leading to widespread feelings of frustration and helplessness.

Water & Sanitation

• 12/3, the Coastal Municipalities Water Utility (CMWU) repaired and made their water desalination plant in Deir al Balah operational, serving approximately 8,000 people. Also their western Khan Younis utility is back online, providing water to >200,000 people. They dismantled and transported a plant from Rafah during the Israeli military operation there in May 2024 and hope to get it online to serve 60,000 people in Al Mawasi, western Khan Younis.

• In the 2nd half of November, WASH Cluster partners received only 16.7% of the fuel needed to meet WASH and public health needs, such as water production and distribution, sewage and solid waste management, and repair.

Aid

• 12/1- 9, of 197 planned aid movements requiring coordination with Israel, 30% (60) were facilitated, 43% (84) were denied, 16% (32) were approved but then impeded, and 11% (21) were cancelled. Aid missions to North Gaza were particularly disrupted: 16 of 17 attempts were denied while 1 was impeded (to Kamal Adwan Hospital). Missions to Rafah, under Israeli military attack since May, were similarly affected: All 11 requests between 12/1- 9 were denied.

• 12/4, a Red Crescent (PRCS) paramedic was shot and killed in Khan Younis returning from transporting patients to the field hospital in Rafah. 12/7, a PCD staff was killed at the entrance of Kamal Adwan hospital (Beit Lahiya), where he was supporting medical teams. Since October 2023, at least 356 aid workers. (349 Palestinians and 7 foreigners), have been killed.

• As of 12/7, UN and International NGOs have 1,001 trucks (53% loaded with food) awaiting entry to Gaza in Al Arish.

Other

• In northern Gaza, buildings weakened by airstrikes are collapsing on families seeking shelter from cold and rain.

WEST BANK, INCLUDING EAST JERUSALEM

This week, Israeli forces killed 8 Palestinians (1 child) and injured 39 (14 children).

Killed since October 2023: 968 (210 children) and injured: 15,879 (2,441 children)

Find more detail here:

Israeli attacks

• 12/3, an Israeli airstrike in Aqqaba village (Tubas), killed 2 and injured 1. Victims were taken to Turkish Hospital (Tubas City). Israeli forces raided the hospital, sealed all entrances, and opened fire inside, including in the ER. They detained medical staff and interrogated the hospital director before withdrawing. According WHO, between 10/7/23-11/28/24, Israel attacked West Bank health care over 650 times, mostly in Jenin, Nablus and Tulkarm.

• 12/3, Israeli settlement guards shot and killed a 15-year-old near his home in Silwan, East Jerusalem. The body withheld, his family was warned against funeral or condolence gatherings.

• 12/4, a 45-year-old Palestinian prisoner (detained in Tulkarm in November) was declared dead in an Israeli hospital. The circumstances remain unclear.

• 12/6, Israeli forces shot and killed a man in Balata Refugee Camp (Nablus). The Red Crescent was denied access and the man was transported in a private vehicle to the hospital.

• 12/7, Israeli forces shot and killed a man at Qalandiya checkpoint (Jerusalem). Soldiers closed the checkpoint, teargassed Palestinian journalists and vehicles, and denied the Red Crescent access. They later raided his home in Ar Ram (Jerusalem) and violently dispersed people who came to offer condolences.

• 12/7, a Palestinian driver rammed an Israeli soldier near the entrance of Al Fawwar refugee camp (Hebron) and fled. In the ensuing search, Palestinians threw stones at the Israeli forces, who responded with live ammunition. injuring 3. The perpetrator later turned himself in.

• 12/9, an Israeli airstrike killed 2 in Tubas.

• 12/13 Israeli forces mortally wounded Mohammed Ahmed Maslamed, a 23-year-old disabled man in the town of Beit Awwa. The IOF said that the soldiers that shot Maslameh "sensed danger" after entering the town.

Settler Attacks

• This week, settlers carried out 38 attacks against Palestinians, causing injuries and/or property damage. Since 10/7/23, OCHA documented 1,737 attacks by settlers against Palestinians. Since 10/7/2023, settler attacks and access restrictions displaced 300 Bedouin households (1,762 people, 856 children).

• Armed settlers: attacked and set fire to a home and cars in Huwwara, south of Nablus, injuring and displacing 5 family members; vandalized and terrorized a family in Hebron; assaulted 2 men in At Tayba village (Ramallah); raided a home in Bariet Al Minya village in Bethlehem where they destroyed possessions and 2 water tanks, and set fire to a storage tent and its 3 tons of fodder.

• Twenty Palestinian cars were torched by settlers in the dead of night. Had a lone resident of a quiet residential street in El Bireh not been awake, the fire could have reached the homes under which the cars were parked.

Demolitions

• This week, Israeli authorities demolished 31 Palestinian-owned structures for lack of Israeli-issued building permits, displacing 26 (13 children). Since 10/7/23, Israeli authorities destroyed 1,956 Palestinian West Bank structures, displacing 4,729 Palestinians (2,000 children).

• 12/3, Israeli Civil Administration and military demolished 7 homes and 3 agricultural structures in An Nabi Samwil village, for lack of Israeli-issued building permits. They displaced 4 households (20 people, 9 children) and revoked Israeli-issued access permits, necessary in the community isolated by the Barrier and checkpoints. Although attempting to obtain permits, the demolitions were carried out without final orders or proper notification.

• 12/10, after an Israeli Supreme Court ruling, Israeli forces evicted a family of 10 (6 children) from their home in Silwan, East Jerusalem, where they had lived since 1979, fighting eviction since 2015. 215 East Jerusalem Palestinian households (948 people, 408 children) face eviction and displacement by Israeli settler organizations.

ISRAEL

• Speaking at a meeting of the Religious Zionist party, far-right Finance Minister Bezalel Smotrich said “the time has come” to occupy the Gaza Strip and “take civilian control away from Hamas.”

• The IOF announced that an investigation into a drone strike on a residential apartment in central Israel found that the Air Force failed to classify it as a hostile object. The spokesperson admitted that "failing to activate alerts was a mistake."

• Amid growing concerns of human rights violations in Israeli detention centers, a Haaretz investigation revealed that four Palestinians died during investigations by Israel's internal security service, since the start of the war in the Gaza Strip. Of the four cases opened, half were dismissed.

• Israel’s defense minister has told his troops to prepare to spend the winter holding the demilitarized zone that separates Syria from the Israeli-occupied Golan Heights. Netanyahu toured the summit of Mount Haramun in the U.N.-designated buffer zone. Netanyahu said the Golan Heights would “forever be an inseparable part of the State of Israel.” U.N. called for an urgent de escalation of airstrikes on Syria by Israeli forces, and their withdrawal from the U.N. buffer zone.

LEBANON

• Israel has intensively used white phosphorus on a strip in southern Lebanon that matches a zone its army has marked as a red “no go” zone on maps it distributes to Lebanese people, telling them not to return to their homes there.

• A US-brokered ceasefire started on 11/27, but both sides have accused the other of repeated violations. Israel has launched near-daily strikes, mostly in southern Lebanon, that have killed scores of people since the deal took effect.

SYRIA

• Netanyahu announced Israel’s intention to violate its disengagement agreement with Syria, as Israeli forces invaded and occupied several positions inside Syrian sovereign territory, including the summit of Mount Al-Sheikh. Israeli forces moved further into the Syrian Golan, forcing entire towns to evacuate.

• Israeli Navy launched a wide-scale assault on Syrian military vessels, aiming to dismantle Syria's naval fleet and prevent its assets from being seized by hostile forces, the IOF said. The British security firm Ambrey said the IOF targeted at least six Syrian naval vessels in an attack on the Syrian port of Latakia. Later, the IOF estimated that

US

• Israeli security firms, contracted by several universities in the US and Canada, are being used to suppress pro-Palestinian protests, raising concerns over the erosion of free speech and academic freedom on campuses.

• A US nonprofit has raised hundreds of thousands of dollars for an Israeli sniper unit for the stated purpose of buying scopes, silencers, and other equipment. The unit, which is nicknamed Rephaim, or “Ghosts,” has since been implicated in possible war crimes and killing over 100 people in Gaza and has been tied to the killing of four unarmed Palestinians in Gaza since October 7, 2023

INTERNATIONAL

• The UN General Assembly adopted a resolution demanding an immediate, unconditional and permanent cease-fire between Israel and Hamas in Gaza and the immediate release of all hostages. The resolution passed with 158 states in favor.

SOURCES

OCHAOPT, The Guardian, Palestine Chronicle, Mondoweiss, +972, Haaretz, New York Times, British Medical Journal, Democracy Now, Aljazeera, New England Journal of Medicine