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Rebuilding health services in Gaza won’t be possible while Israel maintains blockade, says report

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6644 (Published 04 November 2014) Cite this as: BMJ 2014;349:g6644

Fuel and Gazan hospitals: Israeli siege and the politics of permanent emergency

Last August we published a rapid response at bmj.com to publicise the cumulatively devastating effects upon Gaza’s health system of 12 years of Israeli blockade and their strategy of de-development and impoverishment of Gazan society. Israeli restrictions have produced chronic shortages of almost all essential medicines and hospital equipment, of fuel to run hospital generators, the cancellation of all elective surgery (affecting more than 6000 people), hospital closures, and many doctors and staff on reduced or no pay. (1)

In addition, since March Israeli snipers have been firing military grade ammunition and maiming bullets (2) at the border at unarmed demonstrators, killing 257 to date (3). This week BBC Radio 4 quoted the UN for the total number wounded - more than 23,000! (4). Medicines Sans Frontieres estimates that “...a massive 3,520 people will need further surgery..”, far beyond the grossly depleted resources available...”.(3) The shooting continues: on Friday 25 January 1 person was killed, and 153 injured, including 34 children, 5 women, 1 journalist, and 5 paramedics on duty. (4) Indeed, since March, 3 clearly marked medics have been shot dead on duty, 580 medics wounded, and 94 ambulances damaged (5-7). The targeting of health workers is itself a war crime.

We write again now at a point when Gaza’s hospitals are in particular peril of total shutdown because of lack of electricity or fuel to run generators. To keep up the pressure of the siege, Israel rations the entry of fuel into Gaza, including imposing conditions on donors like Qatar. One of the hospitals that nearly shut last week was Al-Nasr Children’s hospital, which currently has 8 children in intensive care, 30 premature babies in the nursery, 100 other child inpatients, and 250 children attending the emergency department. Another, Al-Rantisi Children’s Hospital, has 45 children with renal failure, 4 children in intensive care, 10 child inpatients with cancer, 70 others needing chemotherapy,10 children with chronic lung disease, 5 with heart disease, and 10 with other diseases. A third, Al-Najjar Hospital, serves 263, 000 people, has 65 beds (including 23 child beds), has 93 patients in renal failure, should provide key laboratory services, and sees hundreds of cases in its emergency department every day. A fourth, the Eye Hospital, sees 2500 cases and performs 250 surgical procedures monthly (glaucoma, cataract, retinal surgery). 1250 patients with diabetic retinopathy, glaucoma and chronic corneal conditions are threatened by loss of sight if services stop. Also living hand to mouth is the psychiatric hospital, which currently has 29 inpatients.

This grotesque situation, a violation of the 4th Geneva Convention that guarantees unfettered access to medical facilities for conflict-affected populations, is an intended element of the siege, and persists because no one with political clout challenges Israeli impunity. A UN General Assembly resolution last year has been simply ignored. And no sanctions have been requested yet.
Gazans are turning to the solidarity of the international community and to UN for the lifting of the siege and for justice, for how long more should they wait?

(1) BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3299 (Published 13 August 2018)
(2) BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3295 (Published 13 August 2018)
(3) https://www.msf.org/gazans-injuries-risk-permanently-shattering-lives-pa...
(4) https://www.ochaopt.org/content/gaza-strip-early-warning-indicators-dece...
(5) https://www.nytimes.com/2018/12/30/world/.../gaza-medic-israel-shooting....
(6) https://www.btselem.org/gaza_strip/20180718_paramedic_rozan_a_najar_kill...
(7) http://www.mezan.org/en/post/23360/One+Protester+Killed+and+153+Injured+...

Competing interests: No competing interests

31 January 2019
derek a summerfield
hon sen clin lecturer,
2. Vittorio Agnoletto, professor in globalisation and public health, University of Studies, Milan. 3. Swee Ang, consultant trauma and orthopaedic surgeon, Barts Health, London UK 4. Andrea Balduzzi, researcher in Zoology, University of Genoa 5 Franco Camandona, Surgeon in Obstetric and Gynecology, E.O. Galliera Hospitals, Genoa, Italy 6. David Halpin, retired orthopaedic and trauma surgeon, Exeter UK 7. Ghada Karmi, University of Exeter, UK 8. Paola Manduca, retired Professor of Genetics & Pres NWRG-onlus 9. Marina Rui, Prof of Physical Chemistry, Univ of Genoa 10. Gianni Tognoni, Mario Negri Institute, Milan, Italy 11. Guido Veronese, Associate Professor, Clinical and Community Psychology University of Milano-Bicocca, Italy
Instituie of Psychiatry, Psychology & Neuroscience, King's College
London SE5 8BB