Gaza: Added to Israel’s 2007 blockade, current military assault catastrophic for civilian survival Print E-mail

 Volume 26 - Issue 02 :: January 17-30, 2009

WHO’s warning

By R. RAMACHANDRAN Scroll down to also read "Massacre of the Innocents"

Unless Israel’s aggression is ended immediately, Palestinians will be left to face the worst ever health crisis in their history.

An injured Palestinian man is moved by paramedics from a Palestinian ambulance to a waiting Egyptian ambulance at the Egyptian border crossing terminal for treatment in Rafah, Egypt, on December 29, 2008 (NASSER NASSER/AP )

A major fallout of the assault on Gaza by the Israeli Defence Forces (IDF) has been the worsening health situation of the people there and the near collapse of the already deteriorating health services. On December 29, within two days of Israel’s massive air strike on Gaza, the World Health Organisation (WHO) called for an immediate end to hostilities and urged Israel to remove all blockades to ensure the immediate provision of much-needed food, water, fuel, medicines, critical life-saving and trauma-care supplies and other humanitarian aid.

The intense shelling in the first two days left 330 people dead and 900 injured, of whom 115 were in critical condition, with 25 admitted in intensive care units (ICUs). In those two days, Israeli fighter planes, helicopters and drones bombed over 240 targets, the majority of them reportedly within the first hour. According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Operation Cast Lead, as Israel calls it, caused one of the highest single-day death tolls recorded in the occupied Palestinian territory since 1967.

The blockade since June 2007 and the Israeli attacks during February-March 2008 had greatly weakened the health care system in the Gaza Strip, including the functioning of hospitals and the access to health services, affecting even basic supplies. The health workers’ strike that began on August 30 and continued until the December 27 Israeli attacks only compounded the worsening situation.

As hospitals in Gaza lack equipment and expertise, many patients are referred to hospitals in Israel, Jordan and Egypt for specialised care. However, the proportion of patients who could not cross over because permits were inordinately delayed or denied by the Israeli authorities increased substantially between 2006 and 2008. Since Hamas assumed authority in Gaza, the number of patients forbidden to leave it “for security reasons” has increased steadily. The current hostilities have only aggravated these problems.

“The inability of the hospitals to cope with a problem of this magnitude, if the situation remains unchanged,” said the WHO statement, “will result in a surge of preventable deaths from complications due to trauma…. As a top priority, the shortages of essential and life-saving medicines need to be abated without delay. The current escalation of violence only compounds the health situation and unnecessarily exacerbates the fragile status of the civilians caught up in this conflict.”

On December 29, Health Minister Bassem Na’eem stated that hospitals in Gaza had run out of 105 essential medicines. There was also zero stock of 225 consumables and 93 items required for blood banks and laboratories.

Even though U.N. agencies and the International Committee of the Red Cross (ICRC) have been able to organise medical supplies in the past few days, the main challenge, according to the OCHA, is the shortage of medical equipment and spares. According to the WHO, at least 1,000 medical machines are out of order. The Ministry of Health (MoH) of the Palestine Authority (P.A.), headquartered in Ramallah in the West Bank, in fact reported even a shortage of trucks to deliver medical supplies to the hospitals and a lack of proper storage capacity.

“No safe space”
The WHO appeal warned of a rise in deaths and human suffering if the IDF attacks continued, with the civilian population bearing the brunt. With Israeli forces occupying thickly populated areas, which have become battle grounds, civilian populations have been put at grave risk.

“There is no safe space in the Gaza Strip – no safe haven, no bomb shelters, and the borders are closed, making this one of the rare conflicts where civilians have no place to flee,” notes the OCHA report of January 7.

Since ground operations began, the death toll has risen sharply. On January 6 alone, the bombing of a school run by the U.N. Relief and Works Agency for Palestinian Refugees in the Near East (UNRWA) in Jabalia killed 43 persons and injured 100. The Israelis claimed that the school was being used to fire mortars at the Israeli army, which the UNRWA rejected outright.

According to the MoH, as of January 7, as many as 683 Palestinians, about 15 per cent of them children, have been killed and at least 3,085, over 50 per cent of them women and children, injured. Of particular concern is the growing number of children killed and injured. Children account for nearly 56 per cent of the population in Gaza, and they remain dangerously exposed to the fighting around them, says the OCHA. The actual number of innocent victims would be greater as many are probably trapped, injured or dead under the rubble of buildings. According to the WHO, people were rushing to bury the dead without notifying the health authorities. Besides, many of the injured are not able to gain access to hospitals as Gaza has been virtually divided into two because of occupation by the IDF. Thus internal movements, even to transport medicines, remain dangerous. Only on the afternoon of January 7, the OCHA was able to coordinate, for the first time, a three-hour humanitarian ceasefire to allow the civilian population to gain access to medical services.

Even medical personnel are unable to report to work. On January 5, the ICRC attempted in vain to coordinate safe passage for a bus with 58 hospital staff. At the time of writing, the Palestinian Red Cross Society has waited for 48 hours for Israeli approval to reach those killed or wounded. Similarly, an ICRC team of war surgeons waited for over two days before it was granted access to Gaza to address the lack of surgical staff.

According to the MoH, six medical personnel have been killed and 30 injured, while 11 ambulances and three yet-to-be-used mobile clinics (donated by Spain) have been damaged in the attacks. Most of the windows of two paediatric hospitals have been broken in continuous shelling. As a result, all in-patients had to be kept in one ward of one of the hospitals. Only plastic sheets have been placed over windows of the affected wards, causing immense hardship to patients in the cold weather. There are fears of more attacks on hospitals after Israel alleged that Hamas may be using hospitals as hideouts. The director of El Wafa Rehabilitation Hospital, Gaza’s only rehabilitation hospital, received orders from the IDF to evacuate all staff and patients, but he refused, and everyone continues to be in the hospital.

Attacks on hospitals
In its report on January 6, the WHO stated: “International Humanitarian Law requires all medical personnel and facilities to be protected at all times, even during armed conflict. Attacks on them are grave violations of International Humanitarian and Human Rights Laws.”

Gaza has 27 hospitals. Thirteen of them are managed by the MoH and together have about 1,500 beds. Private hospitals and those run by non-governmental organisations have about 500 beds. Doctors are on 12-hour shifts, with some of them doing even 24-hour shifts. The MoH also manages 565 primary health care centres (PHCs), 24 of which are assigned to handle emergency services. Many of them remain closed periodically because of intense military activities. The MoH has also deployed many of the PHC staff to work in hospitals to meet the shortage of hands. In addition, the UNRWA manages 18 PHC centres, of which only 13 are functioning now.

The Shifa Hospital in Gaza City in the north is the main referral centre for specialised intervention, but the bisection of Gaza has made it impossible for patients from other parts of Gaza to reach Shifa. External referrals are coordinated exclusively through the Rafah crossing whenever it is open.

The division of Gaza has further complicated this process. On January 4, for example, 45 ambulances waited on the Egyptian side as damage to bridges and roads prevented both ambulances and patients from reaching Rafah. Also, the MoH has stopped all referrals to Israeli hospitals. As of January 7, a total of 133 patients have been evacuated through the Rafah crossing.

Since hospitals are being overwhelmed by the large influx of patients, they have adopted a strategy of discharging non-emergency patients quickly so as to free up beds for new casualties. But this, points out the OCHA, could seriously affect patients who need follow-up. According to the OCHA, the ICUs throughout Gaza are overloaded and there is an urgent need to evacuate the patients out of Gaza.

Mental and psychiatric problems are widespread among the traumatised people. While mental health centres remain open, the Gaza community mental health programme has suspended its activities. The programme’s main building suffered serious damage in one of the attacks on December 27.

A factor that is most seriously hampering medical services is the extensive damage to infrastructure in Gaza, particularly the supply of electricity, fuel and water. Nearly 75 per cent of Gaza has no electricity. The only power plant (it meets 51 per cent of the demand), which was in any case functioning only intermittently since November 2007 after Israel suspended delivery of industrial fuel for its operations, had to shut down on December 30, resulting in power outages that last 16 hours on average daily. In addition, 15 transformers have been damaged in the air strikes. There are no transformers available in Gaza; five transformers purchased are sitting outside Gaza and need coordination to be brought in.

Moreover, owing to damage to supply lines, even power purchased from Israel and Egypt is unavailable, and military attacks prevent these lines from being repaired.

All hospitals in Gaza have been without electricity since January 3. These were in any case depending on generators during the long power cuts. But the hospitals have warned that the generators are close to collapse and that they have fuel for only a few more days.

At the Shifa Hospital alone, this would have immediate consequences for 70 ICU patients, including 30 in neonatal care. Twelve operating rooms would be affected immediately, besides the shutting down of oxygen extractors, refrigerators for blood units and machines for emergency services. Also, all hospitals would be without heating and lighting. Lack of electricity has rendered only three of the PHCs functional.

Gaza’s water and sewage system is on the verge of collapse without power and fuel. Nearly 70 per cent of the population does not have access to running water. People who do run the risk of getting contaminated supply from the leakage of waste water. Sanitation services (including waste disposal) have not been working because of the continued hostilities. After five of Gaza’s 37 waste-water pumping stations shut down, sewage is flooding the farm lands of Beit Lahiya in northern Gaza and emptying into the sea. The remaining stations reportedly have fuel only for a few days. Following damage to the main pipeline between Beit Hanoun and the Ben Lahiya waste-water treatment plant, sewage is pouring into the streets of Beit Hanoun. According to the OCHA, the sewage situation has become highly dangerous, posing the risk of water-borne diseases spreading.

While the U.N. and other international agencies are struggling to control the situation, their power to intervene remains severely limited. Unless Israel’s aggression is brought to an immediate halt, Palestinians will be left to face the worst ever health crisis in their history.

 Volume 26 - Issue 02 :: January 17-30, 2009


Massacre of the Innocents


Israel savages Gaza with the express intention of eliminating Hamas, the determined resistance group in the occupied territory.
At the Jabaliya refugee camp in northern Gaza on January 7, Palestinians mourn the 46 victims of the Israeli attack on a United Nations-run school.

THE besieged people of Gaza were eagerly looking out for succour from the international community at least during Christmas and New Year, the traditional season of goodwill. The residents, wilting under the merciless blockade imposed by Israel since June 2007, were fast running out of essential supplies. Israel had used the six-month-long truce with the Hamas-led administration to further tighten the screws on the enclave. Many commentators compare the Gaza invasion to the siege of the Warsaw Ghetto by the Nazis in 1942-43.

Israel’s military intentions became clear in November when its army mounted armed incursions into Gaza and began targeting Palestinians for assassinations. When the Hamas-led militants in Gaza retaliated by firing a few rockets, Israel got the flimsy pretext it needed to mount a full-scale invasion on a defenceless people.

Starting from December 27, the full might of the Israeli Defence Forces (IDF) under the code name “Operation Cast Lead” was on display against the one and a half million people on the Gaza Strip, more than half of them children. The overwhelming majority of its victims so far have been civilians; Israeli jets and tanks have targeted civilian centres with impunity.

On January 6, Israeli shells hit a United Nations-run school that was sheltering mostly women and children. More than 46 of them were killed and another 50 were injured, most of them seriously. John Ging, a senior U.N. official in Gaza, told the media that the bomb that hit the school was a precision-guided one. He said the Israeli military had been given the precise coordinates of the school by the U.N. Ging said no place was safe in Gaza for civilians. “Everyone here is traumatised and terrorised,” he told the media.

Up until the second week of the war more than 750 Palestinians were killed and thousands injured. This is the highest Palestinian toll in four decades of occupation, and the figure is expected to be much bigger when a ceasefire is finally called. The few hospitals in Gaza, already under strain on account of the blockade, have not been able to cope with the tragedy. Israeli helicopter gunships have gone to the extent of targeting ambulances carrying the injured. Ehab Mahbub, a Palestinian doctor, was killed when his ambulance was hit by an Israeli missile. The appeals for blood are getting more and more desperate.

Karen Abu Zayed, the Commissioner for the U.N. Relief and Works Agency (UNRWA), said the need for aid “has never been so acute”. The media, both Israeli and international, have been kept out of Gaza despite an Israeli Supreme Court directive to the government to allow the media to cover the unfolding human catastrophe. The United States and other Western countries, which otherwise are great votaries of free media, have not been complaining too much about this.

“Disastrous” situation
Before the invasion, a spokesman for the UNRWA described the humanitarian situation in Gaza as “disastrous” and said the agency was unable to get medical supplies into Gaza for more than a year because of Israel’s blockade of the border crossings.

In 2008, the Israeli Supreme Court, behaving as an appendage of the state, ruled that the government was authorised to limit the supply of electricity, petrol and diesel to Gaza since these “diminished quantities sufficiently meet humanitarian needs”. The Supreme Court also sanctioned collective punishment for the hapless people almost a year ago. Collective punishment is prohibited under international law. “If the residents of the Gaza Strip deserve to be punished because of the Qassam rockets, then maybe all Israelis need to be punished because of the occupation,” prominent Israeli commentator Gideon Levy wrote in a recent article. The Jewish state, with the tacit support of sections of the Palestinian Authority and neighbouring Arab states, tried first to starve Gazans into submission. They had hoped that the population would rise in revolt and throw out the Hamas-led government. When that blueprint did not materialise, Israel prepared for a military assault to get rid of Hamas and other militant groups in Gaza. These are the only groups that are keeping the flag of resistance still flying in the occupied territories. A senior Israeli army officer told The New York Times that the purpose of the invasion was to “make Hamas either lose their will or lose their weapons”.

The U.N. has also not covered itself in glory as Israel keeps on violating all established international norms with impunity. Secretary-General Ban Ki-Moon has not explicitly condemned the targeting of civilian neighbourhoods. The Security Council has failed even to come out with a statement mildly censoring Israel. Instead, the U.N. has played into Israel’s hands by calling for “restraint” on both sides. In doing so, it has put Israel, which has the most powerful army in the region, and the Hamas militia, which operates under the jackboot of the occupation, on the same footing.

As Hannan Ashrawi, Palestinian political activist and member of the Palestinian Liberation Organisation, (PLO) said, the international community should have realised a long time ago that it is the Israeli occupation and the continuous brutalisation of Palestinians that is the root cause of the conflict. In the past seven years, more than 5,000 Palestinians have been killed by the Israeli army. The Israeli toll during the same period was 14 civilians, killed mainly by rocket fire. On the first day of the Israeli “death from above” campaign, more than 300 Palestinian civilians were killed. The Israeli army announced that it had dropped 100 tonnes of bombs in the first nine hours of the operation.

Massive violation

In GAZA city on January 8, a mosque destroyed in an overnight air strike (MAHMUD HAMS/AFP)

Professor Richard Falk, the U.N. rapporteur to the occupied territories, said in the first week of January that the Israeli attack on Gaza represented a severe and massive violation of international humanitarian law as defined by the Geneva Conventions regarding the obligations of an occupying power and the requirements of the laws of war.

The eminent American expert on international law also noted that Israel had ignored recent Hamas initiatives to re-establish the military truce after it expired on December 26. According to Falk, the Israeli military invasion and the catastrophic human toll it has caused “challenge those countries that have been and remain complicit, either directly or indirectly, in Israel’s violation of international law”.

This complicity, said Falk, extended to those countries knowingly providing military equipment for these illegal attacks. The U.S. is no doubt the main provider of arms for the Zionist state, but some other countries, such as India, are also filling its coffers, helping it to spread terror in the region. Israel is all set to supplant Russia as the biggest supplier of arms to India. In November, just as Israel was getting ready to invade Gaza, a high-level Indian delegation was in Tel Aviv to firm up multi-billion-dollar defence contracts. It is well known that Mossad and the Israeli state-controlled armaments industry have a big stake in all these defence deals.

The Communist Party of India (Marxist) and other Left parties have appealed to the Indian government to at least snap defence links with Israel in the wake of the Gaza invasion. President Hugo Chavez of Venezuela has shown the way to world leaders by expelling Israel’s Ambassador to his country. In a televised address, he compared Israel’s invasion of Gaza to the “holocaust” against Jews during the Second World War. He said the President of Israel and the President of the U.S. should be taken together to the International Criminal Court. “How sad that Israel continues to act as the assassin’s arm of the Yankee Empire,” Chavez said.

After flattening Gaza with bombs and missiles fired from their planes and helicopter gunships, Israel sent its elite troops, backed by heavy armour, into the territory. It dropped 1,000-kg bombs to flatten entire neighbourhoods and to prepare the ground for the advance of its troops.

The frontal combat started in the first week of January and involved street fighting, in which Resistance fighters led by Hamas were able to stand their ground. In response to the Israeli invasion, the Resistance has been able to increase the range and sophistication of its rockets fired from Gaza. The defiant rocket attacks continued despite Israeli forces slicing Gaza into three parts and focussing their attacks on tunnels and buildings used by Hamas fighters. More Israeli towns are now within the range of Resistance fighters. In two weeks of fighting, Hamas lost some of its leaders. Sheikh Nizar Rayyan, a senior leader, and nine members of his family were killed when an Israeli bomb hit his home in the Jabaliya camp, one of the most densely populated refugee camps in Gaza. Most of the government buildings in Gaza have been targeted. Buildings housing the Ministries of Education, Labour, Housing, Foreign Affairs and Transport have been destroyed. Israeli planes have dropped huge bombs on the Parliament building, the Law Ministry headquarters and the university. The Israeli government claimed that the buildings were “a critical component of the terrorist infrastructure”.

Relatives mourn the death of 10 members of a family in the attack on the U.N.-run school (MAHMUD HAMS/AFP )

The Hamas leadership has vowed to give a fitting reply to the IDF. Since 2007, in anticipation of an all-out Israeli assault, Hamas has transformed its armed wing – the 16,500-strong al Qassam Brigade, into a well-disciplined fighting force. They have been specialising in urban warfare. Hamas leader Ismail Haniyeh, speaking from an undisclosed location in Gaza in the first week of January, said the Israeli attacks should stop before any truce proposals could be considered. In a televised speech to Palestinians, Haniyeh said there should be an unconditional end to the Israeli aggression. He also insisted that the Israeli blockade must be lifted and all the border crossings must be opened “because the siege is the source of all Gaza’s problems”.

Sheikh Hassan Nasrallah, leader of the Hizbollah of Lebanon, said in a televised address immediately after the Israeli assault began that Israel would not succeed in Gaza. He observed that Israel had not declared any specific goals for Operation Cast Lead “because it will not be able to achieve them”. He compared the events with the 2006 war in Lebanon. “The players are the same, the battle is the same and the result will be the same,” he said. In an unprecedented move, Nasrallah made a call to the Egyptian people and the armed forces to use their influence to force their government to open the Rafah crossing so that the Israeli blockade on Gaza could be ended. “We say to the Egyptian regime, if you do not open the Rafah border, then you are partners in the crime,” he said in his speech.

In Lebanon, Hizbollah fighters could hide in the hills and the forests while staging their guerilla strikes and rocket attacks against the Israeli invading force. Gaza is only 45 km long and on an average only 6 km wide, and therefore not suitable for the kind of war the Hizbollah fought. But so long as Hamas remains standing, it can justifiably claim victory against an enemy armed to the teeth with the most sophisticated American-supplied weaponry. Arab League Secretary-General Amr Moussa, speaking after a meeting of Arab Foreign Ministers, said “the myth that the Israeli army is invincible has become a thing of the past”.

Ceasefire efforts
After the attack on the U.N. school building, the efforts to bring about a ceasefire have intensified. A joint French-Egyptian initiative, which calls on Israel to withdraw and Hamas to stop firing rockets, has been supported by the U.S. in the U.N. Security Council. United States Secretary of State Condoleezza Rice has, however, not called for a halt to the Israeli military operations even after the wilful targeting of the U.N. school. Both Israeli and Hamas leaderships have said they are studying the French-Egyptian proposals seriously.

The Israeli government announced on January 7 that the military would stop shooting for three hours every day to allow essential humanitarian supplies into Gaza. But the Israeli army also stated that it would respond immediately to any provocations. As of the second week of January, the Israeli establishment has indicated that it wants to continue the military offensive despite demands from the international community for an immediate ceasefire. Meanwhile, the defiant Hamas rocket-fire continues, underlining the fact that the Israeli war machine has not been able to achieve its stated goal of disarming Hamas fighters so far.