One of the essential drugs supplied by MAP at the CDS in Gaza City.
Gaza has teetered on the brink of disaster for years as a result of Israel’s blockade, which is in violation of international law. It has managed to avoid becoming a full-scale humanitarian catastrophe largely due to the resourcefulness of its people and the more than 300 illegal tunnels linking it with Egypt – which have been Gaza’s lifeline.
With almost all of the tunnels now closed by the Egyptian officials, as well as partial closures of the Rafah crossing – and no expectation of Israel’s blockade coming to an end soon – there is an air of anxiety in this tiny, densely populated stretch of land, which is cut off from the West Bank almost as much as it is from the rest of the world.
Last week, driving from Erez crossing into Gaza, the first obvious sign of the tunnel closures that I observed was the small number of cars on its usually congested streets. (There were queues of men, young and old, at a UNDP warehouse, where rice, flour, oil and other food essentials were being distributed, but this is nothing new in this highly food-aid-reliant population.)
Imports of heavily subsidised Egyptian fuel had stopped, and only petrol from Israel, costing twice the price, was available in petrol stations. As a result, petrol stations were largely empty, in contrast to recent images of queues lasting hours as people waited to fill up vehicles and jerry cans with cheaper Egyptian fuel.
The queues had now migrated from petrol stations to service taxi stands, as more people turned to these out of necessity to get around Gaza.
One petrol station manager said that ordinary people, already severely cash-strapped, were calculating the absolute minimum amount of petrol needed to complete an essential journey, purchasing petrol in very small volumes. He said the fuel restrictions, and the high cost of Israeli petrol, were killing his business.
Below the station manager’s office, on the forecourt, a boy was filling several plastic Sprite bottles with fuel for the family generator. Another enterprising customer was filling his small tanker with fuel to sell in other locations in Gaza to the minority who are able to pay above-average prices.
Elsewhere on Gaza’s streets, tunnel closures were most apparent in the number of partially completed buildings and gravel roads, with work frozen due to the huge drop in the quantity of construction materials coming through the tunnels.
In every neighbourhood I visited up and down the enclave, construction sites were lifeless, with roads, universities, homes and other buildings left unfinished. Prior to June, some 7,500 tonnes of construction materials were delivered through the tunnels each day. That figure currently stands at just 150 tonnes a day.
I visited two families, one of whose home was completely destroyed during last November’s eight-day assault on Gaza by Israeli forces. Situated in a poor Bedouin community outside of Gaza City, this family of 10 was relying on the support of neighbours. I interviewed the family amid the rubble of their former home.
Another home, that of Sana Abu Jazar and her family, suffered major structural damage during November’s attacks. Their corrugated metal roof would routinely jump during the bombing raids, she said, and almost every wall showed major cracks or gaping holes.
Given the blockade and its impact on Gaza’s economy, neither family can afford to rebuild or repair their home, and with the prospect of a wet and cold winter in the offing, both families expressed deep concern about their welfare.
Some 12,000 people in Gaza remain displaced as a result of extensive damage caused to their homes in Israeli attacks and the restrictions on construction materials.
Unlike the West Bank, Palestinians living in Gaza have access to the sea – though the blockade has also severely undermined its utility. Fuel shortages and fishing limitations imposed on fishermen by the Israeli military have made their livelihood largely unsustainable and risky.
Jihad, a 45-year old fisherman and father of five, with three disabled children, was born into the trade – his grandfather and father were both fishermen. We spoke as he mended and prepared his fishing nets for another night of fishing within the six nautical mile limit imposed by Israel (it should be 20 nautical miles, according to the terms of the Oslo agreements).The price of fuel has made fishing unviable for many fishermen, particularly those with larger boats, he says.
“Beyond six miles you find big fish that bring money, but less than six miles the fish are small and don’t generate any money, and I can’t feed the family with the money the small fish bring. I have to factor in the risks of crossing the six mile radius and the violent Israeli response.”
The Egyptian navy has also started attacking Gazan fishermen who drift into Egyptian waters, Jihad adds.
I ask how sustainable the current situation is.
“What can I do? I can’t do anything,” Jihad says. “We try to live and adapt. If we have money, we will provide for our family – if we don’t, we can’t.”
The blockade also means that 90 million litres of untreated and partially treated sewage are pumped into the sea each day, creating public health hazards.
Mohamed al Jafarawi, a civil enginner with Gaza City municipality, points to several areas along Gaza’s coast, indicating a number of pump stations.
“With the power cuts, the pump stations can’t transport the sewage away from the centre here to the south. People in the sea often find themselves suddenly covered in sewage around these pumps,” Mohamed says, as we look at dozens of people swimming in the sea, many of them fishing.
Off the streets, in Gaza’s hospitals and medical warehouses, the effects of increasing isolation are visible. Over 30% of essential drugs and 50% of essential medical disposables are at zero stock levels in Gaza, with more nearing zero stock levels. The partial border closures at Rafah are exacerbating this shortfall.
Dr Ashraf, who heads the Central Drug Store at Gaza’s main hospital, al Shifa, says the shortages mean that patients are suffering.
“All Ministry of Health services are affected by shortages, some more than others. About half of chemotherapy agents for cancer patients are at zero stock level. If one item in the protocol is absent, the whole protocol has to be stopped, with a direct impact on the patient.
Ophthalmology, psychotropic agents and orthopaedics are also affected, all in varying proportions,” Dr Ashraf adds.
“The impact is that patients are suffering because we can’t offer drugs and disposables, so patients are having to provide them themselves. Sometimes they have to go outside of Gaza to find the service, but it’s very difficult currently via Rafah. Sometimes operations are cancelled except for absolute emergencies because of the shortages of medicines and medical disposables,” he adds.
The system, and patients, are having to stretch current supplies, Dr Ashraf Abu Mhadi says, which is counterproductive and puts patients’ welfare at greater risk.
“We hope that MAP and other organisations can help provide drugs that are very much needed. For example, medicines for kidney transplant – a patient must take them or the kidney will be rejected. They will lose the kidney and then their life. Take haemodialysis as an example: haemodialysis must take place or else kidney failure results. The patient must clean their blood 3 times a week, but often we can only do it two times, sometimes once, a week, depending on stock availability. We have to make it last, depending on the levels available and demand,” says Dr Ashraf.
“It affects the patient and the cost of care, as they’ll need additional medicines to address the problems arising from increased toxins in system,” he adds. “The actual cost increases dramatically for the patient.”
In the neighbouring, MAP-supported burns unit – the main burns facility for all of Gaza – Dr Nafaz, the unit’s director, says that the blockade has caused an increase in the number of burns victims. The fuel shortages mean that the Central Power Plant is only working at half capacity, so power cuts average 12 hours a day, and are up to 16 hours long in other areas of Gaza.
“Previously, the most common cause of burns in Gaza was domestic trauma – burns in children and women,” says the soft-spoken specialist. “But over the past few years, due to the electricity cuts, people have had to use candles and primitive stoves, lighters and generators, and these are responsible for about 30% of major burns,” he says.
The blockade and its economic impact is also contributing to chronic malnutrition among some of Gaza’s youngest generation, says Dr Adnan Wheidi, medical director of Ard al Insan. Stunting in these children will have life-long repercussions. he says, affecting the development of their organs, including their intellectual development.
There is a deepening gloom among those I spoke to as the situation in Gaza is likely to deteriorate further in the months ahead if the situation in Egypt doesn’t change.
For the 1.7 million people of Gaza, effectively trapped in the enclave, this means even further shortages of essential medicines and medical disposables, further power cuts, and further inflation.
“We believe that God won’t abandon us,” Dr Ashraf says stoically. “If the situation continues as it is, the coming days will be more difficult and the suffering will increase. We are still receiving some medicines and supplies that we were meant to receive months ago, so we are able to replenish some zero stock items that we’re running low on. But in the months ahead, we won’t have them. Patients will suffer further.”
(Source / 17.10.2013)