The devastation of Al-Shifa Hospital. Image sourced from ABC TV

New report details how Gaza is being destroyed

Melissa Sweet
Melissa Sweet and Jason Staines
Thursday, April 4, 2024

Environmental determinants of health, Social determinants of health, Education, Child health, Disabilities, Conflict and war, Global health, WHO

Melissa Sweet and Jason Staines write:

The devastation caused by Israel’s assaults on Gaza and the implications for health, infrastructure, the economy and the environment have been detailed in a new report from the European Union, the World Bank and the United Nations.

Amid widespread focus this week on the deaths of seven World Central Kitchen workers, including Australian Zomi Frankcom, and the destruction of the Al-Shifa Hospital, the 32-page report provides wider context, describing “loss of life, forced displacement, and damages to social, physical, and productive infrastructure at an unprecedented speed and scale”.

The current situation would be worse than that described in the report, which provides only an interim damage assessment, and does not include the impact of hostilities in the West Bank.

“The ongoing conflict has unleashed unprecedented devastation, causing severe social and mental health consequences for women, youth, and vulnerable populations,” says the report, dated 29 March.

“Trauma pervades Palestinian society in Gaza today due to the large number of people killed and injured, multiple forced displacements, a continuing lack of security and safety, limited access to basic needs and facilities.

“All of Gaza’s population has seen its physical, economic, and psychosocial well-being directly and profoundly affected by the conflict.”

Overview of findings

Key points from the report include:

• With 84 percent of health facilities damaged or destroyed, and a lack of electricity and water to operate remaining facilities, the population has minimal access to healthcare, medicine, or life-saving treatments.

• The water and sanitation system has nearly collapsed, delivering less than five percent of its previous output, with people dependent on limited water rations for survival. Palestinians in Gaza are receiving less than half the daily water rations they need for short-term emergency survival

• More than half the population of Gaza is on the brink of famine and the entire population is experiencing acute food insecurity and malnutrition. Palestinians in Gaza now make up 80 percent of all people facing famine or severe hunger worldwide.

• As of 14 March, fatalities include over 1,200 Israelis and foreign nationals, and more than 31,000 Palestinians in Gaza.

• 659 people have been killed in attacks on healthcare, 843 injured and 98 ambulances destroyed or damaged

• The education system has collapsed, with 100 percent of children out of school. An estimated 56 school facilities have been destroyed, and 219 have been partially damaged. An estimated 17 universities and college campuses, 63 percent of the assessed campuses, are destroyed or partially damaged.

• With 92 percent of primary roads destroyed or damaged and the communications infrastructure seriously impaired, the delivery of basic humanitarian aid to people has become very difficult.

• Children are exhibiting alarming signs of emotional distress and trauma. Before the conflict, it was estimated that a total of 25,000 orphans between the age of 0 and 18 lived in Gaza. As a result of the conflict additional 17,000 children have been separated from their families, rendering them particularly vulnerable to various forms of exploitation and abuse.

•Environmental damage is widespread. Munitions and chemicals severely pollute the soil air, and water, with implications for human health, agriculture, and food safety. They also further contaminate Gaza’s scarce water resources.

• Because of the bombardments, there is an enormous volume of debris, estimated at 26 million tons, with leakage of petrol and other hazardous materials, and high levels of air, water, and land pollution. The removal of rubble alone would cost around US$327 million and would require a years-long effort.

• More than 690,000 menstruating women and adolescent girls in Gaza are suffering from the lack of menstrual hygiene supplies and water which negatively affects their hygiene and health, raising the risk of infection.

• Thousands of pregnant women will give birth in the coming months and have no access to adequate medical care for themselves or their newborn babies.

• People with disabilities, the elderly and those with chronic illnesses face heightened vulnerability exacerbated by displacement, loss of support networks and destruction of health facilities.

• The widescale destruction of built cultural heritage and the inability to resume cultural practices has an additional important impact on youth and the broader social fabric by impacting collective identity and memory, connections with places, and social cohesion.

• Of the approximately 980 registered NGOs in Gaza, the majority have ceased operations.

Mental health impacts

An Australian psychologist, Scarlett Wong, who has been working in Gaza with Médecins Sans Frontières (MSF), has described the trauma experienced by orphaned, unaccompanied children, and for people living with the threat of “unpredictable, indiscriminate shelling and bombing”.

“The entire population is traumatised and with images embedded in their minds of what they have seen and experienced, while the international community seems helpless to intervene or end the onslaught,” she said in an article published by MSF Australia on 2 April.

“I have heard countless stories of people who were tortured, made to watch their loved ones executed, body parts of friends around them and too many grieving mothers and fathers.

“It’s surreal that 40 minutes’ drive away, over the border wall, people are eating at restaurants, going out, going to school and work and living relatively normal lives… while here entire neighbourhoods are flattened, civil infrastructure destroyed and people are dying from man-made starvation.”

“If the entire international community cannot succeed in enforcing a guaranteed ceasefire upon civilians, hospitals and healthcare workers during this humanitarian crisis, then our hopes, beliefs and expectations for the legitimacy of international law and order should be seriously questioned.”

Al-Shifa Hospital

The World Health Organization, humanitarian organisations and United Nations experts have condemned the destruction and killing at Al-Shifa Hospital following a two-week siege by Israeli forces.

In a joint statement on 3 April, Tlaleng Mofokeng, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, and Francesca Albanese, Special Rapporteur on the situation of human rights in the Palestinian Territory occupied since 1967, deplored the destruction of the hospital.

“In the wake of the two-week siege and destruction of Al-Shifa Hospital, in which health workers and patients were among those reportedly killed, we urge UN Member States to implement all possible diplomatic, political and economic measures, and legal processes, to stop this horror,” they said.

“The extent of the atrocity is still unable to be fully documented due to its scale and gravity – and clearly represents the most horrific assault on Gaza’s hospitals.

“The besieging and destruction of a hospital and the killing of health workers, the sick and wounded, and the people who protect them, is prohibited by international law. Allowing this violence to take place has sent a clear message to the world and the international community that the people of Gaza do not have the right to health and critical determinants of health adequate for their existence.

“Al-Shifa Hospital was the largest single provider of health care in Gaza and its destruction was described by the World Health Organization as having ‘ripped the heart out of the health system’. By destroying it, Israel is denying access to healthcare to those most in need.”

An MSF statement said the exact number of casualties at the hospital were not yet known but public reports show that hundreds of people have been killed, including medical staff, and bodies are lying in the street. There have also been mass arrests of medical staff and other people in and around the hospital.

In January, when MSF staff visited the hospital, it housed some 50,000 people, with medical staff striving to maintain access to healthcare. Though the hospital was only partially functioning and desperately lacking supplies, medical staff were still treating over 200 patients in March.

Health sector responses in Australia

Croakey reached out to several health and medical organisations for comment on recent developments in Gaza.

The Medical Association for the Prevention of War Australia (MAPW) offered condolences to the families, friends, and colleagues of Zomi Frankcom and her fellow World Central Kitchen workers.

“At a time when people in Gaza are being starved, the provision of food and other aid could not be more important,” MAPW said. “Israel must stop denying and delaying aid, more access points must be opened, and humanitarian workers must be protected as required under the law.”

MAPW said it welcomed the Australian Government’s calls for a thorough investigation and full accountability for an apparently targeted attack.

“Nearly 200 other humanitarian workers – most of them UNRWA employees – have also been killed by Israeli forces since October 2023. Their deaths should also be thoroughly and impartially investigated.”

MAPW urged the Australian Government to take stronger action.

“Staff and patients are reported to have been subjected to horrific treatment and conditions during Israel’s siege of the Al-Shifa hospital. The hospital itself is in ruins; only 10 partially functioning hospitals now remain.

“The complete and systematic destruction of healthcare in Gaza is unacceptable, and we call on our Government to act. A Security Council ruling and ICJ orders have not been enough: political, economic and other penalties can and should be imposed on Israel immediately. ”

The Australian Medical Association referred Croakey to its previous statements on the conflict from October 2023 and January 2024, which said “the Australian Medical Association believes that all parties involved in the conflict in Israel and Gaza must respect the principles of medical neutrality during times of armed conflict” and it “supports the principle of medical neutrality in the conflict in Israel and Gaza”.

The George Institute for Global Health said the issue was “outside our field of expertise” as they “don’t have any projects involving aid workers in the conflict areas or anywhere else”.

The Public Health Association of Australia, Royal Australian College of General Practitioners, the Australian Nursing and Midwifery Federation and the Royal Australasian College of Physicians did not provide a response.