Amid an ongoing food crisis caused by Israeli-imposed restrictions on aid entering the Gaza Strip, increasing numbers of people are exposed to the long-term effects of malnourishment. This includes growing risks of contracting communicable diseases and bacteria as their immune systems weaken due to the lack of food and clean water.
Patients have been turning up with symptoms of flu and intestinal problems. “Lately, we’ve also witnessed children suffering from skin rashes due to the lack of clean water for bathing or washing,” said Mohammad Abu Zayed from Doctors Without Borders (MSF). Other conditions linked to the shortage of water include, quite obviously, dehydration and Hepatitis A.
According to MSF reports, forcibly displaced families living in Rafah are surviving on as little as 3.5 liters of water per day, even though a single person needs at least 2-3 liters of water daily. There is no running water in the camps, and most of the infrastructure was destroyed in Israeli bombardments.
Estimates by MSF state that around 70% of the people in Gaza are now forced to drink salinized or contaminated water. The shortage of potable water is certainly linked to the increased spread of diarrhea, made even worse by the fact that existing sanitation infrastructure is nowhere near the required standards. In a report from Rafah, UNICEF observed that sometimes there is only one toilet for 500-700 people.
As public health infrastructure in the Strip has been razed to the ground, instead of relying on their own testing capacities, international and Palestinian public health authorities are working their way around. Among other things, they are attempting to foresee what kind of infections are present by observing data collected from Israeli soldiers. Since October 7, Israeli sources have reported that soldiers were diagnosed with resistant strains of bacteria and fungi associated with respiratory and bloodstream infections.
At the same time, Israeli Occupying Forces (IOF) continue to attack health infrastructure in Gaza. Hospitals in southern Gaza continue to report ongoing sieges and sniper attacks, in addition to bombardments in their proximity.
Nasser Hospital in Khan Younis, which is providing shelter to 10,000 forcibly displaced people in addition to hosting 300 health workers and over 400 wounded people, is under sniper fire, making it impossible for the hospital to function.
Similarly, Al-Amal Hospital in the same area, associated with the Palestine Red Crescent Society (PRCS), was forced to evacuate. The hospital has been besieged by the IOF for the past 17 days, and a lack of oxygen and other medical supplies has already caused the death of patients. Following the evacuation, some 200 people remain at Al-Amal, but the end of the attacks is nowhere to be seen.
In the previous days, PRCS reported the killing of several staff members in Israeli attacks, including paramedic Mohammed Al-Omari, who was deliberately targeted by the IOF while he was assisting in the evacuation of Al-Ahli Hospital in Gaza City, and Hedaya Hamad, director of PRCS’s youth and volunteer department, who was killed when she attempted to help injured people sheltering at Al-Amal. More PRCS members were interrogated and arrested by the IOF, including managerial cadre from Al-Amal, and volunteers Tamer Mohammed Hussein Shanin and Hamdan Samer Abu Khattar.
If the IOF does not stop the siege of Al-Amal Hospital soon, the hospital will be forced to cease operations, dealing an immense blow to the decimated health system: already in January, only 6 ambulances were left in Gaza. That equals 1 ambulance per 362,000 people. The WHO benchmark stands at 1 ambulance per 50,000 people, presumably in conditions where there is still some remaining road unobstructed by rubble or military checkpoints.
Reflecting on this scenario, Tommaso Della Longa from the International Federation of Red Cross and Red Crescent Societies said he didn’t “want to even think about the possibility” of Al-Amal closing, but that if the current situation persists, “it will be very difficult to continue activities in the hospital.”
The impact of the attacks is even bigger when taking into account the fact that over 70% of Gaza’s health staff was displaced from their original workplaces, and those who remain work under severe psychological trauma and in fear for their lives and that of their families. Those still trying to provide care in northern Gaza are, without exception, working without any essential supplies.
Those in the southern areas might still get glimpses of medical resources, but those are far from the amounts needed. Surgeons report about being forced to choose among patients, focusing on those who have more chances of surviving over those in need of complex care, including patients with burns. At the Emirati Maternity Hospital in Rafah, each incubator hosts 2-3 babies to try to make up for missing equipment.
At the same institution, more than 80 deliveries occur each day, of which 15% are C-sections, said the WHO. Sometimes, the mothers are discharged as soon as 6 hours after the procedure, and are forced to go back to unsanitary living conditions in the tent camps. “The situation is more than catastrophic,” said Mohammad Salama, head of the neonatal intensive care unit at Emirati Maternity Hospital.
“Every day, a lot of babies are dying in front of our eyes. There is nothing we can do for them.”
The situation in children’s and women’s health continues to be of particular concern, and has been recognized as one of the priorities to address from the earliest phases of reconstruction of the health system in Gaza. While the first step remains sustaining existing health services, primarily through achieving a ceasefire and end of direct attacks against healthcare, this must be soon followed by the scaling up of health resources.
Initial considerations about what awaits Gaza’s healthcare in the following period were discussed in Jordan earlier this week, where a coalition of academic institutions, international organizations, and health workers met to identify key priorities. Among others, the swift reconstruction and strengthening of primary healthcare and scaling up of the local health workforce were highlighted, with the target being set at ensuring the presence of over 70 nurses and midwives to 1,000 people – as opposed to the 20 per 1,000 people who were present before October 7, 2023.