The hostilities between Israel and Hamas over the past 10 days have caused significant damage to the health system in Gaza, putting the Palestinian population at risk of increased spread of COVID-19 – after six weeks in which new cases had been in sharp decline.

The health system in Gaza is now facing severe shortages of essential medicines and supplies and it’s only COVID test facility was destroyed. The closure of border crossings has restricted the entry of medical supplies – although Israel said late Thursday night that it would begin opening the borders to humanitarian aid if a cease-fire with Gaza’s Hamas authorities, due to take effect at 2 a.m. local time, holds. 

“WHO calls for the urgent facilitation of humanitarian access to the Gaza Strip to allow entry of essential medical supplies, referral of patients to facilities outside the Gaza Strip, and passage of medical teams and humanitarian personnel,” said Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, at a press conference on Thursday that came just ahead of the Egyptian-brokered cease-fire agreement with Israel. Hamas began a missile assault on Israeli cities 10 May, in reprisal for Israeli moves to evict several Palestinian families from homes in East Jerusalem and Israeli police clashes with Palestinians around the city’s Al-Aqsa Mosque, Islam’s third holiest site.  Israel responded with heavy aircraft raids over Gaza, targeting offices and high-rise buildings of strategic importance, and damaging a vast labyrinth of underground tunnels, which Israel says were used by Hamas fighters hide from Israeli attack.  

Over 245 deaths and 6,700 injuries have been reported in the Gaza Strip and West Bank during the violence, according to WHO, while in Israel, 12 people including two children have been killed.

What’s more, however, the aerial bombing of Gaza damaged or destroyed 19 health facilities, a desalination plant that supplies clean water to 250,000 people, and Gaza’s main COVID-19 testing laboratory. 

Gaza, which has been under an Israeli blockade since the Islamist Hamas Party took control of the enclave in 2007, has seen intermittent flareups with Israel that have grown in intensity as Hamas gained more missile power to hit deeper into Israeli territory. Neither Hamas nor the Israeli government recognize each other as legitimate authorities.

More than 90 attacks on health care workers have been recorded in the West Bank and Gaza Strip, with 21 recorded in the Gaza Strip and 70 in the West Bank, Mandhari said, adding that, “WHO also calls for the immediate cessation of hostilities and an end to attacks that either directly or indirectly impact health care in the occupied Palestinian territory.” 

In the Israeli-occupied West Bank, the Palestinian Authority, which is recognized by Israel, has limited self-rule, under the terms of the 2003 Oslo Accords. However, the past two weeks also saw a wave of West Bank Palestinian demonstrations and clashes with Israeli troops in support of the Hamas as well – creating barriers to access of health facilities, particularly in East Jerusalem, which is under Israeli control.

Damage to Health and Water Facilities – Interrupts Essential Health Services and COVID Testing and Vaccinations

In Gaza, the only functioning COVID-19 testing lab, housed in the Al-Rimal health clinic in Gaza city, was damaged on Monday by an airstrike. It processed over 2,500 tests per day, as well as administering COVID vaccinations and providing other essential health services. 

The damage to water desalination plants and water sanitation hygiene (WASH) infrastructure increases the risk of waterborne diseases and impacts hygiene, which is a central component of COVID-19 public health measures, said WHO officials.

Along with that, 46% of essential drugs and 33% of essential medical supplies also are out of stock in Gaza. And heavy damage to roads, including the main road to Shifa Hospital, one of Gaza’s largest hospitals, is obstructing ambulance access.

WHO has procured and delivered US$200,000 worth of essential medicines to hospitals in East Jerusalem, and has a convoy ready with US$500,000 worth of rapid diagnostic tests, equipment, and medical supplies destined for the Gaza Strip. 

“The fighting must stop immediately. Until a ceasefire is reached, all parties to the conflict must agree to humanitarian pause to ensure access into and out of Gaza for humanitarian staff and critical goods…to allow for safe movement, and for the delivery of assistance,” said Dr Rik Peeperkorn, WHO Head of the Regional Office for the West Bank and Gaza Strip.

“We need a ceasefire, we need a humanitarian pause,” said Dr Richard Brennan, WHO Regional Emergency Director for the Eastern Mediterranean. “We need the humanitarian access. We want all the crossings to be opened to let the aid in and let the sick and injured out.”

“If we are speaking about the current political and security situation in the region and in the occupied Palestinian territory in particular, there is no health without peace,” said Mandhari.

Some 75,000 people have been displaced by the violence, with 47,000 seeking shelter at 58 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East. The overcrowding at these shelters could facilitate the spread of the SARS-CoV2 virus, WHO officials said. 

COVID Figures Likely Don’t Reflect Local Situation 

Both the West Bank and Gaza were just coming out of a third COVID wave when the violence escalated. The damage to health infrastructure, testing capacity, and water sanitation facilities will likely cause the pandemic to worsen, officials said. 

Even before the hostilities started on 10 May, cases were sharply declining from a peak of 2,500 new cases in April, to less than 600 as of May 10. And that trend has continued over the past week. However, officials are concerned that recent data is misleading, due to the current absence of testing and tracking procedures, particularly in Gaza. 

About 5.4% of Palestinians in Gaza and the Occupied West Bank have received at least one dose of a COVID-19 vaccine – doses obtained through the WHO co-sponsored COVAX initiative or from donations.   

This is in stark contrast to Israel’s national vaccination campaign, which has immunized 62.8% of the population with at least one dose. 

WHO currently has a convoy of 10,000 more Sinopharm COVID-19 vaccines waiting to enter Gaza as soon as possible to provide jabs to more of the population, said officials.

“Overall there is still a huge shortage of vaccines in the occupied Palestinian territories and the coverage is still way too low,” said Peeperkorn.

WHO announced that US$7 million will be needed for the health response in the occupied Palestinian territories over the next six months. 

The plan is to first provide assistance to Gaza for acute health needs and then focus on rebuilding the health infrastructure and strengthening the health system to ensure a functional primary health care system is established once again, said Peeperkorn.

In the midst of the ongoing conflict, a heated political debate is expected to take place in the upcoming World Health Assembly (24 May -1 June) on a draft resolution on the health conditions of and assistance to provide the Palestinian population.  Israel has long complained that setting the resolution as a separate agenda item for the WHA represents disproportionate and politicized treatment of the Palestinian issue – as compared to the many other humanitarian flash points around the world – which do not get the same prioritization at the WHA forum.

Image Credits: WHO.