Overwhelmed Healthcare Systems in Gaza Struggle Through Evacuation Orders

Displaced families in Gaza are on the move after the latest Israeli evacuation orders. Around nine in 10 Gazans have been displaced at least once since the war began. Photo: UNRWA

UNITED NATIONS, Jul 12 2024 (IPS) – For nine months, over 2 million people in the Gaza Strip have been forcibly displaced in the wake of the armed conflict between Israel and Hamas. The ongoing fighting and displacement have put significant strain on humanitarian organizations on the ground to address even basic health needs.

The United Nations and other humanitarian organizations have stressed that the healthcare system in Gaza has collapsed or has suffered undue pressure as a result of the fighting. Out of 36 hospitals in the area, 13 remain open, operating with partial functionality.

This includes Nasser Hospital, which now stands as the last hospital providing comprehensive healthcare services. It has been in the wake of evacuation orders issued on July 1 by Israeli authorities for the east and south of Khan Younis. Patients and medical personnel working in the Gaza European Hospital, located in Khan Younis, evacuated ahead of time.

Although an official from the Israeli defense force that patients and medical personnel were exempt from the evacuation order, this was not conveyed to the humanitarian groups on the ground. 
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Andrea de Domenico, UN-OCHA’s Head of Office in the Occupied Palestinian Territory, told reporters in a virtual press briefing on July 3 that OCHA was not informed. He stated that it was likely that those who evacuated acted based on past experiences where hospitals were specifically targeted for raids or military bombardment, and so they took preemptive measures to evacuate before the Israeli military moved in on Khan Younis.

Evacuation orders have devastating implications for the fragile health infrastructure by disrupting the functionality of health facilities within and adjacent to evacuation zones, as one spokesperson from the World Health Organization (WHO) told IPS. They impede access for both healthcare providers and patients, and they compromise the efficacy and security of humanitarian operations. In addition, this only increases the burden on other hospitals that are now charged with receiving patients from evacuated areas.

As one of the remaining hospitals providing comprehensive care, Nasser Hospital has been operating beyond capacity with limited supplies, amidst destruction in the surrounding area, which WHO staff on the ground have said is ‘indescribable’. The area surrounding the hospital is laden with heavy layers of debris, destroyed buildings, and no stretch of an intact road. Its pediatric ward has now hosted more than 120 patients since July 5, despite its 56-bed capacity.

OCHA and the World Health at Nasser Medical Complex in Gaza earlier this year. UN and other humanitarian agencies have been struggling to ensure health care continues. Credit: OCHA

It is also operating with dwindling medical supplies and holds responsibility for sterilizing equipment for the surrounding field hospitals, according to Doctors Without Borders (DWB). Despite the critical need for supplies, DWB trucks and convoys carrying these supplies have been unable to enter Gaza since April. As recently as July 3, trucks were denied entry due to ongoing fighting in the South.

Overall, it’s a comprehensive issue—from shortages of beds and supplies to the lack of surgeons. With yet another hospital closed, patients lives are even more at risk, said medical team leader Javid Abdelmoneim, working in Nasser Hospital.

The issue of life-saving aid being restricted from entering Gaza has continued to persist and impact operations for humanitarian organizations on the ground, including the UN. As the WHO spokesperson told IPS, their trucks were unable to pass through last week as the Karem Shalom crossing remains closed.

Fuel has been identified as critical to the functionality of health facilities and aid operations, and yet shortages are rampant. A WHO spokesperson stated that hospitals have been forced to work with limited supplies of fuel, electricity and solar systems, and this has only hindered groups from properly functioning.

Power blackouts in newborn/ICU and kidney dialysis units place their patients at critical risk. The lack of fuel also impacts the water and sanitation sectors, which require at least seventy-thousand liters of fuel a day, and yet in the last few weeks, they have only received less than ten percent of what is needed.

Only 500,000 liters of fuel have been brought in during the first week of July, and 2 million liters were brought in in the month of June, which humanitarian organizations note is a fraction of the fuel needed to sustain humanitarian, medical, and WASH operations—at least 400,000 liters per day.

Trash and sewage buildup and a lack of clean water, among other factors, have all led to the spread of water-borne diseases and upper respiratory infections. According to the WHO, since mid-October 2023, they have reported cases of diarrhea, lice and scabies, skin rashes, impetigo and chicken pox.

“While a healthy body can more easily fight off diseases, a wasted and weakened body will struggle and become more susceptible,” one WHO spokesperson told IPS.

Meanwhile, acute food insecurity has ravaged Gaza. Since the start of the war, food insecurity has been a major concern for humanitarian actors in the region and globally.

The Integrated Phase Classification (IPC)’s acute food insecurity projected that 96 percent of Gaza’s population, or 2.15 million people, would be experiencing extreme levels of food insecurity between June 16 and September 30, which includes over 495,000 people who face catastrophic food insecurity. More than half of the households reported that often, they did not have any food in the household, and more than 20 percent go full days and nights without eating. The violence and repeated displacement have challenged people’s ability to cope or to access humanitarian assistance.

This is further exacerbated when humanitarian workers are also forced to relocate for their own safety and move their operations. Domenico stated that the constant movement also means that warehouses containing fuel and supplies are abandoned as a result. In the case of UN agencies such as OCHA and its partners, humanitarian operations may be considered a parameter of activity that is (or should be) protected from military activity. Their presence is likely to signal to people that it may be safe to be there or that their basic needs will be met.

So far, 34 people have died from malnutrition and dehydration, according to the Ministry of Health. Of those deaths, WHO notes that 28 of them are children. A group of independent experts has warned that , noting recent cases of children who have died due to hunger and malnutrition, one of whom was as young as six months old.

“With the death of these children from starvation despite medical treatment in central Gaza, there is no doubt that famine has spread from northern Gaza into central and southern Gaza,” the experts said in a shared statement.

The IPC special brief notes that only a cessation of the armed conflict and sustained, uninterrupted humanitarian intervention could reduce the risk of famine. Humanitarian organizations have struggled to maintain their operations while hostilities have persisted in the Gaza Strip, endangering and displacing more than a million civilians multiple times over, along with humanitarian workers who have risked their lives to continue providing what little life-saving aid can cross the border. Military violence has continued despite international condemnation and repeated demands for a ceasefire.

Organizations such as WHO and Doctors Without Borders have coordinated with health partners and agencies on the ground, namely UNRWA, to provide primary care, support vaccination campaigns, and deploy emergency medical teams. As the WHO notes, however, these efforts can only support the health system; they cannot replace it.

IPS UN Bureau Report

Note: This feature was published with the support of the Riana Group.