Genocide in Gaza
Electricity cut off, no petrol, an absence of drinkable water, together with grotesquely reduced healthcare, all point in one direction, warns Ian Spencer
The bombing of the al-Ahli hospital on October 17 has brought an even sharper focus on the health of the population of Gaza. Around 500 Palestinians were killed in what, increasingly, seems likely to have been an Israeli attack.1 Many of those killed were taking refuge from the relentless bombing of one of the most densely populated areas on the planet.
At the time of writing, some 7,000 Palestinians, including at least 2,000 children and 1,000 women, have been killed by Israeli air strikes, while three times that number have been injured. There has also been the deliberate killing of Palestinian civilians in the occupied West Bank by both the Israel Defence Forces and Israeli settlers. And all that before Benjamin Netanyahu’s ‘next stage’: the expected ground invasion of Gaza.
Aside from the deliberate destruction of health infrastructure, because of the Israeli blockade Gaza’s hospitals have no access to the electrical grid and are dependent on local generators to maintain electricity. Israel has stopped access to food, fuel and water since October 9 as an act of collective punishment, following the Hamas incursion two days earlier. What few health facilities remain in operation are denied basic supplies. However, they have been suffering for the last 17 years of siege imposed after Hamas took power in Gaza.
Of course, there is more to health than hospitals. Even before the current Israeli attack, the Gaza Strip had a population of 2.2 million people, half of whom are under 18, in an area of 141 square miles. The population density of 15,000 per square mile is the outcome of the ethnic cleansing of Palestinians, since the Nakba of 1948, who had little choice but to take refuge in the strip. Of the 2.2 million Gazans, 1.2 million are registered by the UN as refugees. There is also widespread malnutrition, particularly when it comes to iron deficiency anaemia, which affects up to 50% of infants and young children.2
In the second quarter of 2023, the unemployment rate in Gaza was 46.4%. However, among the youth it was as high as 70%. Around half of Gazans lived in poverty even before the current Israeli attack. The relationship between poor mental and physical health, unemployment and poverty is widely understood. One consequence is a high infant mortality rate of 23 deaths per 1,000 live births (compared, for example, with the UK of four deaths per 1,000 or even 12.6 deaths in Jordan - itself home to many Palestinian refugees).
Unsurprisingly, the prevalence of mental health problems among Gazans was very high too. Over half of those screened were showing signs of depression and around 7% with post-traumatic stress disorder.3 Atrocities like the seizure and demolition of homes, oppressive policing, unlawful killings, detention without trial and torture - all inflict profound psychological damage and leave victims in a state of ‘learned helplessness’, resigned to their fate and vulnerable to depression and anxiety. In 2022 studies published by Save the Children showed that 80% of Gazan children were exhibiting signs of depression and anxiety.4
This would have long-term consequences, even if peace and stability were to come tomorrow. There is considerable evidence that prolonged trauma in childhood can have long-term consequences for the mental health of adults and even the subsequent children of those traumatised.5 Women, in particular, who have suffered malnutrition are likely to have children who are more prone to diabetes, obesity, cardiovascular disease and low-birth-weight children of their own.6 The Israeli bombardment and deliberate starvation of the population of Gaza is even an attack on future generations of Palestinians due to epigenetic damage to the foetus in utero.7
Since the Israeli attack, 1.4 million people have been displaced from their homes. Over a million were ordered to go south ‘for their safety’ - only to be bombed en route and to be subjected to the same air attacks in the south. The city of Khan Yunis was subjected to extensive bombardment, as tens of thousands moved there to escape bombing in Gaza City. Gaza is now completely dependent on pitifully small amounts of ‘humanitarian aid’ from the Rafah crossing. Oxfam has stated that “starvation is being used as a weapon of war against civilians”, who now have just 2% of their usual supply of food.
Medical personnel continue to work despite a health system that has effectively collapsed and the fact that many of them too have faced the loss of their entire families. The lack of basic supplies means that surgeons are forced to operate with minimal (sometimes no) anaesthetic and substituting vinegar for antiseptic. Operations take place by the light of torches or mobile phones. Needles and gloves must be reused without the possibility of proper resterilisation, leading to the danger of high rates of hospital-acquired infection and cross-infection. The sheer number of casualties requires battlefield tactics of triage. Often the badly injured must be left to die to preserve resources for the potentially saveable.8
There is growing evidence that Israeli air attacks have deliberately targeted ambulances, at least 15 of which have been hit - something strongly condemned by the Palestinian Red Crescent. Israel has bombed in the vicinity of the Red Crescent HQ and the Al-Amal hospital in Khan Yunis. The targeting of health personnel has not been confined to state facilities, but NGOs trying to provide aid in Gaza have also been attacked - Médecins Sans Frontières has counted 16 killed and 18 ambulances destroyed. The deliberate targeting of ambulances has meant that local aid workers have resorted to taxis and private cars to rescue the wounded and sick. MSF has also reported that it has already used half its emergency provisions, which it schedules to last two months in times of crisis.
An overcrowded ghetto, which is forced to concentrate its population even further in the south, is certainly at high risk of epidemic and water-borne disease. The greatest danger is now of cholera and typhoid. Much of Gaza is dependent on desalinated water, which will not be possible when the fuel runs out. Most of Gaza’s 65 sewage pumping stations and all five of its waste-water treatment facilities have been forced to close, meaning that now 90% of its water is unfit for human consumption. The lack of electricity from the grid now makes pumping water to residential areas impossible. People are increasingly going to be dependent on wells or aquifers, where water is contaminated with sewage.
The increased concentration of the population will easily facilitate the spread of Covid-19 and other diseases, which are typically fatal for the very young as well as the old and infirm. There had been 1,000 deaths from Covid even before the Israeli order to evacuate the north of the Gaza strip. Vaccination will assume a low priority in the face of the imminent death threat from Israeli bombardment, as will the treatment of Gazans with existing health conditions.
What does all this tell us? That disease is now threatening to turn ethnic cleansing into genocide.
The Israel Defence Forces responded quickly to attribute the attack to a misfired rocket from Palestinian Islamic Jihad. However, there is good evidence that the IDF lied - and not for the first time.↩︎
World Health Organisation (2012), A65/27.↩︎
Save the Children, ‘Trapped: the impact of 15 years of blockade on the mental health of Gaza’s children’ (2022).↩︎
B van der Kolk The body keeps the score New York NY 2014.↩︎
N Hart, ‘Famine, maternal nutrition and infant mortality’ Population Studies March 1993.↩︎
R Sapolsky Behave London 2017.↩︎
The Guardian October 24.↩︎