Document - Israel/Occupied Palestinian Territories: Health Professional Action: Deterioration of health care situation in Gaza
Public AI Index: MDE 15/016/2008
To: Health Professional Network
From: Health and Human Rights Team
Date: 13 March 2008
Health Professional Action
Deterioration of health care situation in Gaza
Amnesty International continues to be concerned about the worsening conditions of hospitals and other medical facilities in the Gaza Strip. Recent Israeli military air strikes and artillery attacks on Gaza have caused further damage to Palestinian medical facilities such as hospitals, clinics and ambulances and exacerbated the effects of the stringent blockade imposed by the Israeli authorities. Scores of Palestinians have been injured, many seriously, as a result of the recent escalation of fighting from 27 February to 3 March which also killed over 100 Palestinians, at least half of whom were civilians, and three Israelis, one of whom was a civilian.
Effects of the bombardment
The large number of Palestinians in need of medical assistance following the fighting has led Palestinian Ministry of Health hospitals in Gaza to declare a state of emergency. Hospitals have worked at full capacity under severe strain, struggling to treat injured patients. From 29 February, surgery was performed 24 hours a day in all 12 operating theatres of Gaza City’s Shifa’ hospital. The numbers of injured arriving and the necessity to cover the shortage in beds caused hospital authorities to stop medical treatment of dozens of other patients, including chronically ill patients, and send them home. While the International Committee of the Red Cross (ICRC) stated on 7 March that Shifa’ hospital had been able to return nine intensive care unit beds to the Coronary Care, Obstetrics and Gynaecology and Burns Units, which they had borrowed due to the influx of seriously wounded patients, the underlying problems affecting medical facilities in the Gaza Strip continue.
Funding shortages and increased consumption mean that scores of essential drugs are now out of stock in Gaza, and supplies of others are low. According to the World Health Organisation (3 March), Gaza Ministry of Health officials reported that 85 essential drug items, 52 medical supply items and 24 laboratory reagents are unavailable and are urgently needed by hospitals.
On 27 February, an Israeli air strike on the Interior Ministry also destroyed a mobile clinic, pharmacy and ambulance administered by the Palestinian Medical Relief Society. According to Oxfam, which funds the clinic, which supported 400 patients, a large share of pharmaceuticals supplies was destroyed.
Effects of the blockade
In February, the Israeli authorities started to cut electricity and fuel supplies to the Gaza Strip in response to rocket attacks into southern Israel by Palestinian armed groups in Gaza. As a result, the majority of the Gaza Strip is facing daily electricity cuts of 8 hours. Medical facilities must rely on emergency generators during these times, but these generators also need fuel to function. Fuel stocks in the Gaza Strip are extremely low; often hospitals only have enough fuel to maintain operational capacity for a few days. Further cuts in supply would shut the hospitals down within a very short time.
During the period of escalated fighting, the ambulance services in Gaza were also severely restricted due to fuel shortages. According to the World Health Organization, 23 out of 57 Ministry of Health ambulances and 7 out of 40 Palestinian Red Crescent Society ambulances were out of fuel and could not be refilled. These ambulances remained out of service until 2 March, when supplies became available. Ambulance crews were also unable, in some cases, to reach those needing vital medical assistance. In one case investigated by Amnesty International, on 1 March 2008 Safa’ Abu Seif, a girl aged 11, bled to death in north Gaza after she was struck in the chest by a shot apparently fired by Israeli soldiers who had taken over a house opposite and prevented anyone, including ambulance staff, from moving about in the area. Her body could not be taken from her house until 10 am next morning.
Essential services, including water and sanitation, are close to breakdown. According to the United Nations Gaza Humanitarian Situation Report (3 March 2008), some 30 percent of the population is currently without a regular water supply due to electricity cuts resulting from fuel shortages. The combined lack of electricity, fuel, spare parts and inability to upgrade networks has forced the Gaza Coastal Municipality Water Utility to continue dumping 20 million litres of raw sewage and 40 million litres of partially treated water into the sea daily.
There is also a chronic problem with the functionality of medical equipment in Gaza’s hospitals, in particular with regard to ICU monitors, mechanical ventilators and portable X-ray machines to support intensive care units. This is in large part a result of the restrictions imposed by the Israeli authorities on imports into the Gaza Strip, which frequently includes spare parts needed for medical equipment.
Restriction on import of hearings aids
Many other medical services and health care facilities in Gaza have been affected by the blockade. This includes the Atfaluna Society for Deaf Children, which is the main resource centre in Gaza for the hearing impaired, whose services include a school for 270 deaf children. The Atfaluna Society told Amnesty International that packages containing 100 hearing aids and 5,000 specialised hearing aid batteries have been prevented from entering the Gaza Strip. The Atfaluna Society has been unable to import hearing aids and hearing aid batteries since June 2007; as a result many Palestinians that need hearing aids are not receiving them while others, including 80 percent of the deaf children at the Atfaluna School, are no longer able to use their devices.
Denial of travel to get access to treatment
Amnesty International remains concerned that inhabitants of the Gaza strip who are in need of medical care not available in Gaza are being denied access to treatment outside by Israeli authorities. In addition to the inability of Gaza’s hospitals to deal with the high number of patients, medical facilities in Gaza also lack the specialized personnel and equipment to treat a range of conditions and complex injuries.
Almost all Palestinians, including some medical cases, are refused permits by the Israeli authorities to leave Gaza through the Erez Crossing to Israel. This has been the only crossing that Palestinians have been able to use to leave the Gaza Strip since the Israeli authorities closed the Rafah Crossing to Egypt in June 2007. While a deal between the Hamas administration and the Egyptian authorities led to the opening of the Rafah Crossing for some patients from 2 March, this deal came too late for at least five patients who died in ambulances en route to Egypt, in al-Arish or in Shifa’ hospitals waiting to leave.
Some 87 patients injured during the Israeli armed forces’ recent attacks have now been transferred to hospitals in Egypt. However, a number of other critically ill patients have still not been allowed to leave Gaza for the treatment they need. They include Karima Abu Dallal, whose Hodgkin’s lymphoma, which was responding to treatment, including radiotherapy and chemotherapy, last year in hospitals in Egypt and Nablus, has seriously deteriorated over the past weeks. She is now in Shifa’ Hospital in Gaza and said to be extremely weak.
Israel’s obligations to the civilian population
As an Occupying Power, Israel has the obligation under human rights treaties to which it is a party and under international humanitarian law to ensure the right to health of the population of Gaza, without discrimination. This includes the right of the inhabitants of the Gaza Strip to access timely, appropriate and affordable quality health care. Among other things, international law imposes a particular and absolute duty on the authorities to ensure protection and respect for persons who are ill, infirm and expectant mothers. Furthermore, under Article 55 of the Fourth Geneva Convention, Israel has the obligation to ensure, to the fullest extent of the means available to it, medical supplies to the population of Gaza.
Recommended action
Please write to the authorities below:
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explaining that you are a health professional concerned about human rights;
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calling on the authorities to immediately lift restrictions on Gaza which are preventing the supply of fuel, electricity, spare parts for medical equipment, humanitarian assistance and other crucial necessities such as hearing aids;
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pointing out that such measures do not target those responsible for rocket attacks against Israel and that such measures constitute collective punishment against the civilian population of Gaza – which is categorically forbidden under international law;
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expressing grave concern that patients are routinely prevented from leaving the Gaza strip to travel to the West Bank, Israel and other countries to receive the necessary medical treatment and that such denial puts their lives and health in danger;
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reminding the Israeli authorities that according to international law, Israel, as the occupying power in the Gaza Strip, must ensure that the residents of Gaza have access to the necessary medical care, as well as to medical care to the same extent as nationals of the State of Israel.
Addresses
Ehud Olmert
Prime Minister
Office of the Prime Minister
3 Kaplan Street
PO Box 187
Kiryat Ben-Gurion
Jerusalem 91919, Israel
Fax: +972 2 566 4838
Email: rohm@pmo.gov.il/ pm_eng@pmo.gov.il
Salutation: Dear Prime Minister Olmert
Ehud Barak
Deputy Prime Minister and Minister of Defence
Ministry of Defence
37 Kaplan Street
Hakirya
Tel Aviv 61909, Israel
Fax: +972 3 691 6940
Email: minister@mod.gov.il
Salutation: Dear Minister
Yacov Ben Yizri
Minister of Health
Israel Ministry of Health
2 Ben Tabai Street
PO Box 1176
Jerusalem 91010, Israel
Fax: +972 2 678 7662 / +972 2 623 3026
Email: sar@matat.health.gov.il/ pniot@moh.health.gov.il/ www.health.gov.il
Salutation: Dear Minister
COPIES TO:
Dr Yoram Blachar
Chair of the Israel Medical Association
PO Box 3566
Ramat-Gan 52136, Israel
Email: malke@ima.org.il
Please also send copies to diplomatic representatives of Israel accredited to your country.
If you receive no reply within six weeks of sending your letter, please send a follow-up letter seeking a response. Please send copies of any letters you receive to the International Secretariat, attention of Health and Human Rights Team, 1 Easton Street, London WC1X 0DW or e-mail: health@amnesty.org