Civilians Trapped with Nowhere to Flee
January 10, 2009
Security issues have complicated the situation in Gaza. Doctors Without Borders/Medecins Sans Frontieres (MSF) faces major problems in obtaining access to the wounded. The security conditions still prevent medical teams and humanitarian aid workers from providing aid to a population that has nowhere to flee and finds itself trapped.
The lull in fighting is not helping humanitarian aid workers do their job or patients to reach hospitals. It affects only Gaza City, not the urban areas on the outskirts. Our post-operative care clinic in Gaza City is open every day, but given the risks, very few patients manage to get there.
Our Palestinian medical team continues to provide care in the immediate area of their place of residence, but these activities are also very limited in comparison to the enormous needs.
On Wednesday, January 7, our teams visited three schools housing displaced persons. They evaluated the medical needs there and distributed medical supplies and medications. There are doctors in the group and they are providing care.
Our field teams are in constant contact with Palestinian hospitals and report that hospital workers are exhausted by the flow of wounded patients, especially at night.
An MSF surgical team is currently in Jerusalem. It includes a vascular surgeon, general surgeon, nurse/anesthetist, operating room nurse and an anesthesiologist specialized in intensive care. MSF hopes that they will be able to enter the Gaza Strip as soon as possible. This team will support the Palestinian medical teams at the Shifa referral hospital.
MSF is also awaiting final authorization to bring in 21 tons of medical supplies, including two inflatable tents. The tents would be used to increase intensive care in-patient capacity and, possibly, set up an additional operating room. An MSF logistician will also join the field teams to set up these facilities.
A Health Situation Worsening for Over a Year
While the problems in the Palestinian health care sector have become even more striking as the conflict intensifies and violence achieves crisis levels today, they have been persistent and predate these episodes of extreme violence.
For MSF, the situation in Gaza has been worsening for nearly a year, the consequence of multiple political and economic factors.
Years of Israeli-Palestinian conflict and violence; the economic embargo, which was tightened in January 2008 (specifically with regard to electricity and fuel supplies); the inter-Palestinian clashes in summer 2007, which targeted hospitals; the forced strikes among hospital staff; attacks on humanitarian aid workers; and the blocking of access to medical care have all helped, over time, to sap and weaken the health system in the Palestinian Territories. Hospitals have experienced a host of maintenance and operating problems, health services have been limited, medical supplies and medications have been in short supply and access to specialized care outside the Gaza Strip has been restricted. Similarly, while supply problems are not new, the current surges of violence have increased the pressure on already-weakened health facilities.
In addition to the problems resulting from the economic blockade, internal conflicts have arisen over the last year. With two competing health authorities (one under the Palestinian Authority, and the other, Hamas), Palestinian health professionals have been squeezed by conflicting interests. They face contradictory instructions, blocked access to health care, difficulties at the workplace based on political affiliations and reduced quality of care. The “general strike” called by the Palestinian health workers’ union on August 30 (which resulted in 50 to 80 percent levels of absenteeism among critical hospital employees) thus had catastrophic consequences for access to care for the 1.6 million residents of the Gaza Strip, already profoundly affected by the years of conflict.
“The Daily Pause in Bombing Has Not Changed Anything”
Jan 9 2009
A wounded patient receives treatment at Shifa Hospital in Gaza City.
Jessica Pourraz, Doctors Without Borders/Médecins Sans Frontières (MSF) field coordinator in Gaza, observes that the situation in the field remains unchanged. Given the security conditions, medical teams and humanitarian aid workers are still unable to deliver aid to a population that has nowhere to flee.
It is still extremely dangerous to move about because aerial bombing continues unabated. Ambulances have not received authorization to pass behind the tanks in search of the wounded. Most of those who reach a hospital are seriously wounded. Others remain at home, waiting for the fighting to stop so that they can seek treatment.
The daily pause in bombing has not changed anything. It affects only Gaza City, not the urban areas on the outskirts. Tanks have begun to return to those areas, including the neighborhoods of Beit Lahia, Beit Hanoun, Sijaya, and Zeïtoun. Given growing numbers of wounded civilians, that’s where you have to go to find them. Don’t be deceived—the lull in bombing is not helping humanitarian aid workers to do their jobs or helping people reach the hospitals. We are in Gaza, in the middle of everything, but we can neither reach patients nor do our work properly. There is a real problem. We need to be able to reach the wounded and the wounded need to be able to get to the hospitals. We have to be able to bring in supplies, which remain very limited because the trucks cannot move around.
Addressing specific medical shortages
We are providing medical supplies to hospitals, and our medical staff are treating the wounded and ill who are in areas close to those hospitals because it is too dangerous to move around. Hospital facilities are functioning with skilled staff. Between December 27 and January 5, Shifa Hospital performed more than 300 major surgeries, primarily amputations, cranial and multiple trauma procedures, and exploratory abdominal procedures—all difficult operations.
There is a lack of specialized surgeons. An MSF team with a vascular surgeon is scheduled to arrive—if the team manages to enter. This specialty is critical when dealing with wounded patients whose wounds bleed heavily. There is a space shortage in intensive care, but we are trying to arrange for the delivery of inflatable tents so that we can set up an intensive care unit and two operating rooms. If we have access, we have the resources necessary to provide medical care here.
A human catastrophe
“The displaced persons need drinking water and basic survival items …The worst is that humanitarian aid workers are there and can do nothing.”
A human catastrophe is playing out before our eyes. Usually, when a country is at war, people flee. However, in Gaza no one is fleeing. Gaza has the world’s highest population density, and Gazans have nowhere to go. People are living in a state of constant terror and want just one thing: for it all to stop. They cannot sleep. Every time you go to bed, you don’t know whether the house will still be standing in the morning.
Many families have left their homes, either because the tanks are approaching or because the house has been completely destroyed. They try to take refuge in schools, as best they can, but there is no safe place in Gaza today. The bombing is incessant. There is no electricity. The hospitals depend on generators.
Lack of food and basic supplies
Food is lacking, too. There are huge lines in front of the bakeries. Before the war, 1 million people—out of a total population of 1.5 million—received food aid. Today, the needs have probably grown but access has decreased. Trucks can no longer travel safely and people cannot get to the distribution centers. The displaced persons need drinking water and basic survival items, like mattresses and blankets—all those things that allow people to survive. The worst is that humanitarian aid workers are there and can do nothing.
January 7, 2009 : The military offensive in the Gaza Strip is affecting civilians indiscriminately, while medical teams continue to face serious obstacles to providing assistance. The international community must not be content with a limited truce, which is largely inadequate for providing lifesaving assistance. Read more »
January 4, 2009: More than one week after air strikes began on the Gaza Strip, and following the beginning of a land incursion by Israeli forces, surgical services in Gaza are overwhelmed and are in need of surgeons specialized in vascular surgery in order to deal with the increasing number of wounded people. Read more »
January 2, 2009: Three expatriate staff members from MSF were able to join local MSF teams in the Gaza Strip on Wednesday, December 31, 2008. They describe the tension and difficulties working in Gaza, with air strikes and bombings making it very difficult for patients and healthcare personnel to move around. Read more »