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The main medical problem in the Gaza Strip is the Israeli occupation, Norwegian doctor and humanitarian Mads Gilbert told viewers during a webinar organised by the Middle East Monitor yesterday in association with PalMed Europe, an organisation of Palestinian doctors based across the continent. Gilbert and the other members of a panel of experts addressed the toll of Israeli air strikes on Gaza’s health sector and the implications during the programme “Gaza’s Health Sector: Challenges in War and Peace”.

The webinar followed Israel’s 11-day bombardment of Gaza last month, which killed at least 254 Palestinians, including 66 children and two senior doctors. It also left the Palestinian Health Ministry and Gaza’s main Covid-19 lab out of service.

The Chairman of PalMed Europe, Riyadh Masharqah, gave viewers a brief overview of the status of Gaza’s health sector and the challenges it has been facing over the past 15 years. He began by highlighting the social determinants of health affecting the 2.1 million Palestinians who reside in the besieged enclave, including a poverty rate of 53 per cent, an unemployment rate of 43.1 per cent, a water pollution level reaching up to 98 per cent and a power deficit that stands at about 50 per cent.

These were a few of the factors, Masharqah explained, which contributed to the alarming UN report in 2012 predicting that Gaza would become “unliveable” by 2020. He went on to highlight the Covid-19 status in Gaza, with 112,317 cumulative confirmed cases and at least 1,047 deaths. Only 36,512 people have been vaccinated fully due to the shortage of coronavirus vaccines delivered to the Strip.

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Israel’s recent assault placed further strain on Gaza’s health infrastructure, already struggling under the coronavirus pandemic and the tight Israeli blockade imposed on the territory since 2007. At least 48 severe and critical Covid cases remain in need of urgent medical care as Israeli bombing forced Gaza’s main coronavirus lab to shut down. The head of Gaza’s coronavirus response operation, Dr Ayman Abu Alouf, was killed in an Israeli attack on his home.

According to the World Health Organisation, nearly 30 hospitals and health clinics in the besieged Strip were either destroyed or damaged as a result of Israeli air strikes. Around 46 per cent of essential drugs and 33 per cent of essential medicines are unavailable.

Gaza-based neuro-Rehab and pain medicine consultant Dr Khamis El-Essi, who witnessed Israel’s latest bombing campaign first-hand, addressed the effects of the recent events as well as the circumstances created by decades of Israeli occupation and political instability on the health sector’s ability to cope and deliver its vital services.

A shortage of qualified medical specialists and limited postgraduate training, stressed El-Essi, is another massive challenge facing the health sector. Israel’s ongoing blockade of Gaza means that not only does staff access to specialist training remain highly restricted, but also patients’ access to specialised healthcare abroad, such as radiotherapy, oncology surgery and renal transplantation.

Norwegian Dr Mads Gilbert witnessed Israel’s earlier military offensives, Operation Cast Lead in 2008/9 and Operation Protective Edge in 2014, against the Palestinians in the Gaza Strip. He has been banned by Israel from returning to Gaza to provide training for Palestinian colleagues in emergency medicine. He believes that rebuilding the Palestinian health sector in Gaza and providing the necessary resources and training is essential, but is not enough.

Speaking about the responsibility of international health workers, Gilbert, who has worked as a medical solidarity worker with the Palestinians since 1982, said that health workers first and foremost need to “document, resist and change the root causes of ill health in Gaza and the occupied Palestinian territories”, namely “Israeli occupation, settler-colonialism and structural violence.”

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The Israeli bombardment of Gaza goes on, he explained. “It is a man-made disaster situation which is ripe for finding political solutions. On top of this pandemic, you get the last attack… double burdens, double stress, and there is really reason to complement and to admire the way that the doctors, the nurses, the paramedics, the volunteers, the medical students in Palestine handle this extreme situation.”

He pointed out that he finds it almost unbearable that this continues even as he speaks. “The continuation of the 14 years of siege and this merciless bombing, killing and destruction of infrastructure for ordinary people in Gaza.” Lifting the siege of Gaza, stopping Israeli attacks and demanding that world governments hold Israel accountable for its war crimes are a top priority, he concluded.

International human rights lawyer Haydee Dijkstal addressed the question of accountability and Israel’s obligations under international law.

“The issue of ensuring that the people of Gaza are able to access adequate medical care, facilities and treatment not only during the events that happened in May but also during a global pandemic is a very important topic and one that I approached from the perspective of international law,” she said. “In particular, we’re confronted by evidence that during the events in May, Palestinian health infrastructure including the Ministry of Health, hospitals and even doctors in their own homes… were targeted.” She noted that evidence of such acts are treated under three areas of international law: international human rights law, international humanitarian law and international criminal law.

Dijkstal touched on the International Criminal Court’s investigation which was launched in March into possible war crimes committed in the occupied West Bank, East Jerusalem and Gaza since June 2014. “The ICC provides an avenue for seeking justice and accountability,” she said. “While we do need to remain aware that the court’s work is slow and that often international justice is a mechanism that takes time… with that in mind, I think the recent developments before the court to officially open an investigation does provide some hope.”

She added “hesitantly” that the fact that an investigation has now been opened puts Israel on notice that these actions that are in violation of international humanitarian law, international human rights law and international criminal law are being monitored and can be investigated and potentially prosecuted, and will hopefully provide a deterrence.

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“The events last month make it hard to stomach whether or not Israel does find that to be a deterrence but I do think they will take notice that the prosecutor, especially a new prosecutor, is now monitoring these actions and that victims have the ability to submit evidence [and] highlight these crimes. The international community should support the work of the ICC in ensuring that there isn’t impunity for what is happening.”

Cardiology consultant Dr Amer Hamed, who is a founding member of the British Islamic Medical Association and senior advisor of its ethics committee, spoke about health ethical dilemmas in wartime and Israel’s ethical responsibility in light of its recent actions in Gaza.

The session concluded with a talk by the founder of Medical Aid for Palestinians, Dr Swee Chai Ang, who has worked in Lebanon and the occupied Palestinian territories over the past 20 years and was witness to the 1982 Sabra-Shatilla massacre in Beirut which her book From Beirut to Jerusalem documents. “We have the right to speak up for the Palestinians,” she stressed. “It is truly an inspiration to be able to be part of their journey.”

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