The way forward for the reconstruction of a viable health service in Gaza
Gazan society is enduring its fifth health emergency in 12 years, and the biggest since 2014 (when Operation Protective Edge caused 2,200 deaths, destroyed 80,000 homes, and rendered 500,000 people homeless). (1) This time as before the main Shifa hospital has been overwhelmed - it received 1,948 wounded people, of whom 25% needed emergency surgery and intensive care. The Ministry of Health building, 9 hospitals, 19 clinics and the only Covid testing laboratory were all bombed and damaged or totally destroyed. (2) (3) (4) Targeting health facilities and staff is a breach of the Fourth Geneva Convention. Moreover health services continue to experience the debilitating effects of Israeli blockade, now 14 years old, which operates as a form of societal de-development.
So what future for Gazan health services? Comprehensive public health care run by the Ministry of Health remains the basis for everyday specialist and emergency treatment. Access to medications, instruments, reliable fuel sources, support of personnel, and training have been hindered and not funded during these years of blockade, a collective punishment for the people of Gaza. This time the reconstruction of Gaza cannot be dealt with as before and the denial of a properly functioning health system for the people of Gaza must end.
It seems that finally the governments of some leading countries, the UN, and the EU representatives are stating that now is the time to confront the root causes of Gaza’s tragedy. They identify the occupation and blockade of Gaza as the central issue. In 2013 the UN Secretary-General found that “the blockade and related restrictions contravene international humanitarian law as they target and impose hardship on the civilian population, effectively penalizing them for acts they have not committed”. However, nothing has been done to date. Indeed, last week UK foreign secretary Dominic Raab has been in Tel Aviv shaking Israeli premier Benjamin Netanyahu’s hand, as if for a job well done, and in Geneva the UK and 3 EU states have voted against a proposed UN enquiry into the conflict.
As doctors and academics, we call again for an immediate first step: the ending of the Israeli blockade of Gaza, starting with the depleted health sector. While funding is needed now to bolster the health service on an emergency basis, the key issue is the development of a viable health system based on local experience and the often heroic efforts of Gazan health professionals who because of the blockade have been denied the opportunity to upgrade their skills, including abroad. Moreover, these recurrent health emergencies in Gaza have increased dependence on a diverse network of international, costly and far from perfect functioning private health services. International health-related aid has been largely channelled through the Palestinian Authority in the West Bank, which has no land bridge to Gaza, with the Gazan Ministry of Health often excluded from direct planning. We strongly recommend that the Ministry in Gaza is afforded the central role in all plans to facilitate the reconstruction of a viable health service
The signatories to this appeal include 200 UK doctors.
The signatories declare no conflicts of interest.
Competing interests: No competing interests