Alison Barrett writes:
Humanitarian agencies and global health leaders are calling for unimpeded and urgent access to the Gaza Strip to address the devastating humanitarian crisis there following the announcement of a ceasefire deal between Israel and Hamas.
The ceasefire announcement “is just about the best news we could have hoped for to start the new year”, the Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, said today.
“We welcome this news with great relief, but also with sorrow that it has come too late for those who have died in the conflict, and with caution given that we have had false dawns before, and the deal has not yet been confirmed.
“Although the agreement would only come into effect on Sunday, if both sides are committed to a ceasefire, it should start immediately. We urge Israel’s cabinet to approve the deal, and all sides to honour and implement it.”
The Israeli Government is due to consider the ceasefire deal today (17 January).
António Guterres, Director-General of the United Nations, said the “priority must be to ease the tremendous suffering caused by this conflict”.
He called for a “rapid, unhindered and safe humanitarian relief for all civilians in need”, and for parties to seize the opportunity to “establish a credible political path to a better future for Palestinians, Israelis and the broader region”.
“Ending the occupation and achieving a negotiated two-state solution with Israel and Palestine living side by side in peace and security, in line with international law, relevant UN resolutions and previous agreements remain an urgent priority,” he said.
Since the ceasefire deal was announced, it has been reported that Israeli attacks on the Gaza Strip have escalated and at least 82 people in Gaza killed by Israeli forces, according to Al Jazeera.
Ongoing toll
Following 15 months of sustained Israeli attacks on civilians and infrastructure, the recovery and rebuilding will take years of sustained peace and international commitment, according to Simon Eccleshall, Head of Programmes at Doctors Without Borders/Médecins Sans Frontières.
Eccleshall told Croakey “the cessation of hostilities alone is insufficient to address the extensive humanitarian crisis that unfolded over the past 15 months”.
The physical and mental health toll on individuals is incalculable and “will scar generations”, Eccleshall said.
“Since 7 October 2023, Gaza has been relentlessly bombed, critical food, water and medical supplies cut off, and tens of thousands of people suffering from illness ranging from critical injuries, diabetes, and cancer have been left with minimal, if any, care,” he said. “Children are malnourished and at risk of dying from starvation in addition to diseases.”
The destruction of Gaza’s infrastructure, including its healthcare system, will leave a population struggling to survive for years to come, according to Eccleshall.
The conflict has resulted in more than 46,000 deaths in Gaza, 806 in the West Bank and more than 1,000 in Israel, which includes people involved in the 7 October 2023 attack by Hamas, according to the latest data by the Palestinian Ministry of Health.
The actual death toll in the Gaza Strip in particular is likely much higher than recorded. A study published in The Lancet last week estimates that the Palestinian Ministry of Health data on deaths due traumatic injury in the Gaza Strip may be under-reported by 41 percent, likely a result of the ongoing Israeli attacks on healthcare facilities impacting the ability to efficiently record deaths.
Dr Sue Wareham OAM, National President of Medical Association for Prevention of War (Australia), echoed Eccleshall’s comments, telling Croakey, “the ceasefire is of course extremely good news and vastly overdue. It is imperative that it lasts and is not an interim measure”.
Wareham said healthcare in Gaza has been virtually destroyed, by attacks on “not only its infrastructure, but – critically – its people”.
The challenges in re-establishing care in such conditions are incalculable, she said.
Urgent needs
Wareham told Croakey that the immediate needs for the people of Gaza are humanitarian. “Yet, there is no detail in the ceasefire agreement about whether full and unimpeded access for food, clean water, emergency medical and other healthcare will be secured,” she said.
The agreement states that “humanitarian aid procedures…will be done subject to the humanitarian protocol agreed upon under the supervision of the mediators”. It also says that “all ill and wounded Palestinian civilians will be allowed to cross via Rafah border crossing”.
“But that does not explain how hundreds of thousands of ill and wounded people will reach the crossing, and where they will go – and whether any who leave will be allowed back into their homeland if they wish to return,” Wareham said.
A relief effort within Gaza – commensurate with the scale of the destruction – is needed, she said. Prime responsibility must fall on “those nations whose action or inaction has contributed most to this catastrophe”.
Wareham said, “for children and adults dying from cold, hunger, dirty water and lack of very basic healthcare, the emergency measures cannot wait”.
“In the longer term, the impacts of the past 15 months on Palestinians, especially the children who have experienced so much terror and deprivation, will be lifelong and probably intergenerational, as it will be for Israelis who have also known terror,” she said.
There could not be a better example of the need to address the root causes of conflicts before desperate and catastrophic hatred and violence erupt, she added.
“Globally, the consequences of the deliberate targeting of healthcare and its people must send alarm bells through health communities,” Wareham said.
“One of humanity’s most basic human rights, the right to healthcare, has been under savage and relentless attack.
“This right must be reasserted and international law – which prohibits such attacks – upheld by appropriate prosecutions for crimes committed.”
Long-term priorities
Eccleshall told Croakey that MSF’s work in Gaza to respond to this crisis “has only just begun”, and that patients in need of specialised medical care “have nowhere to go”.
WHO estimates that more than 12,000 people in Gaza require medical evacuation for life-saving treatment.
“At this rate, it would take five-ten years to evacuate all these critically ill patients, including thousands of children. In the meantime, their conditions get worse and some die,” Dr Tedros said.
Prior to the ceasefire agreement, he called on the Israel Government to increase the approval rate for medical evacuations, expedite the approvals process and allow all possible corridors and border crossings to be used for safe medical evacuations.
Eccleshall said MSF has been trying to organise medical evacuations including for a two-year-old with leg amputations.
He said the organisation has “only managed to evacuate three children so far and it took three months”. The recovery of injured children in Gaza depends on them getting timely care – “these delays can lead to life-long disabilities and even death from infections”, he said.
Beyond healthcare, the blockade has severely restricted access to clean water, food, and other essential supplies, exacerbating the humanitarian crisis, according to Eccleshall.
“The deprivation of these basic needs constitutes a form of collective punishment inflicted on the people of Gaza.”
MSF says the ceasefire must transition into a sustained peace that allows for the comprehensive rebuilding of Gaza’s healthcare system and other vital services.
“Immediate and unimpeded access for humanitarian aid is essential to commence the extensive rehabilitation efforts required”, Eccleshall said.
“We must recognise that the level of devastation we are looking at is going to take the long-term mobilisation of an entire international community to begin to rectify the total devastation of Gaza,” Eccleshall said.
“While the ceasefire is a welcome development, it is merely the beginning of a comprehensive process needed to restore dignity and health to the people of Gaza.”
MSF calls for a concerted effort to rebuild the healthcare infrastructure, ensure the protection of civilians and medical personnel, and address the profound physical and psychological traumas endured by the population.
“The medical consequences of the war in Gaza have been catastrophic and unlike anything MSF teams have witnessed in decades of providing humanitarian medical care in conflict zones,” Eccleshall said.
“Our medical staff, both local and international, describe the scale of death and destruction as unprecedented.”
Eccleshall told Croakey that many MSF colleagues – experienced humanitarians who have worked in some of the world’s most severe conflict zones – report that they “have never seen such levels of devastation, so many dead or severely injured and amputated children, or such sustained and brutal bombing campaigns as those that have been happening in Gaza”.
Public health call for action
In a BMJ commentary last week, leading Australian public health professionals called for the wider public health community – including medical practitioners, allied health professionals, epidemiologists and academics – to take action on the health and humanitarian catastrophe in Gaza.
Although published prior to the ceasefire agreement, the main messages remain relevant.
“Inaction in the face of the unmitigated suffering being inflicted on the people of Gaza will be our collective shame,” writes Dr Tania King, Dr Guy Gillor, Professor Rob Moodie, Associate Professor Karen Block, Associate Professor Cathy Vaughan and Professor Anne Kavanagh from The University of Melbourne’s School of Population and Global Health, Professor Nancy Baxter, Deputy Executive Dean of the Faculty of Medicine and Health at University of Sydney, Professor Fiona Stanley AC from The University of Western Australia, Dr Margaret Beavis OAM and Dr Sue Wareham OAM at the Medical Association for Prevention of War.
They emphasise the role of public health researchers and practitioners in promoting population health, preventing disease and reducing health inequalities “in times of both peace and war”.
The authors called on the public health community to lobby governments to support action to address the critical health needs of the people of Gaza both now and into the future including mass vaccination campaigns, provision of clean water and the medical evacuation of injured children for specialised treatments, they write.
“This is a health and humanitarian crisis. War is one of the greatest threats to human health,” they write.
“Whether politics are complicated or not, there is nothing complicated about the need to respond to the dire health and humanitarian needs of innocent civilians, many of them children.”
More commentary
Further reading
The role of public health professionals in addressing the health and humanitarian catastrophe in Gaza, Dr Tania King and colleagues in The BMJ
Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture–recapture analysis, by Zeina Jamaluddine and colleagues in The Lancet
Gaza health official: 4,500 amputation cases recorded since beginning of Israeli genocide, Palestinian Information Centre
Israel’s total destruction of a whole healthcare system threatens us all, by Dr Sue Wareham in John Menadue’s Public Policy Journal
Beyond the Israel–Hamas ceasefire, the future looks unclear. Here are six key unanswered questions, Ian Parmeter in The Conversation
Israel and Hamas have agreed to a ceasefire. It doesn’t guarantee a peaceful end to a devastating war, Dr Marika Sosnowski in The Conversation
Tragically overdue ceasefire will not repair lives of Palestinians shattered by Israel’s genocide in Gaza, Amnesty International, 16 January 2025
Oxfam welcomes Gaza ceasefire, urges permanent end to hostilities, accountability, an end to atrocities and lifting of blockade, Oxfam Australia, 16 January 2025
Gaza: Any pause must become a definitive ceasefire to protect children and allow life-saving services, Statement by Save the Children, 15 January 2025
Statement by UNICEF Executive Director Catherine Russell on the announcement of a ceasefire in the Gaza Strip, 15 January 2025
Statement from PANZMA Medical Missions Division on the Announcement of Ceasefire, 16 January 2025
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