With 754 new coronavirus infections reported in the Gaza strip on this Friday, the highest single-day total as of yet, COVID-19 appears to be taking a hold on the densely inhabited region (and testing is sparse in Gaza so the real figure will likely be far higher). Until now, Gaza was relatively spared from the successive waves of infections. The situation, however, may end up setting off a ticking time bomb in Gaza as the atrocious living conditions of many Gazans are ideal for disease spread with disastrous swiftness.
Indeed, in Gaza there are only 87 ICU beds with ventilators for 2 million people, and many are already occupied – with a capacity to admit and treat 3,234 COVID-19 cases faced with a total of 4,374 active cases (as of the 20th of November), an increasing number of severe cases, and a dearth of personal protective equipment (PPE), this capacity will rapidly be strained. In fact, the head of the European Gaza Hospital, Yousuf Alaqqad, said on Saturday that the hospital could announce at any time its inability to receive new cases, as the hospital and adjacent school used as a quarantine centre are now full. Moreover, electricity shortages and expensive fuel costs for generators are forcing doctors to choose to allocate electricity to patients most in need, such as choosing between running ventilators or lighting up surgery rooms. The difficult issue of triage is one that many Gazan healthcare professionals are now having to face.
The pandemic is only compounding an already dire public health crisis, with the 13-year blockade having made many treatments in Gaza unavailable, providing a difficult choice for the 9000 vulnerable patients each year that need Israel’s exit permits to leave Gaza for treatment, as they risk being infected with COVID-19 when they leave, or risk life-threatening conditions if they remain untreated. If they do leave Gaza for treatment, the mandatory isolation centres upon their return are often underequipped, providing additional risks of infection. The dense living situation in Gaza is also complicating self-quarantine and social distancing conditions, as well as the lack of PPE (only 42% of those that need it can afford or have access to PPE). Economic precarity and the lack of savings after years of hardship for many Gazans also makes isolation impossible.
Self-isolation or not, two successive lockdowns have had their toll on the already precarious economic conditions of many Palestinians. Workers in Gaza have seen their income fall by almost 90% since the start of the pandemic, and tens of thousands have lost their employment. Indeed, poverty rates have been predicted to rise by at least 10% by the World Bank because of the pandemic and almost 60% of Gazans are unable to afford basic food, medicine and supplies, especially as international aid to Gaza has been severely cut in recent years.
Children have also acutely suffered the effects of the lockdown; school closures and the introduction of remote learning has been a challenge for many families when faced with regular power cuts, patchy internet, and a lack of educational resources. Moreover, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) funding that runs the majority of schools, health services and humanitarian aid to Palestinians with refugee status is running dry – it now faces a $70 million funding shortfall and will be unable to pay its staff full salaries in November and December. Aside from the economic impact on many staffers (UNRWA is the main employer in Gaza after the local authorities) and the impact on Palestinian refugees, 80-90% of whom rely on the UNRWA for assistance, many children will see further disruptions in their learning. On top of this, 86% of Palestinian children and adolescents already suffer from symptoms of PTSD as a consequence of the ongoing conflict.
This impact is not only limited to children – the conflict and insecurity has led to 82% of Gazans manifesting signs of mental health issues, such as anxiety and stress as they worry about their inability to support and feed their families. However, 65% are unaware of how to access mental health and psychosocial support services. As economic insecurity and the pandemic worsens with winter’s approach, more Gazans will have to make the impossible choice between feeding their families or buying medicine for sick relatives, especially following the escalation of violence since August, and a tightened blockade by Israel.