Gaza: Civilians Trapped with Nowhere to Flee

Doctors Without Borders/Medecins Sans Frontieres (MSF) faces major problems in obtaining access to the wounded. The security conditions still prevent medical teams and humanitarian aid workers from providing aid to a population that has nowhere to flee and finds itself trapped.

The lull in fighting is not helping humanitarian aid workers do their job or patients to reach hospitals. It affects only Gaza City, not the urban areas on the outskirts. Our post-operative care clinic in Gaza City is open every day, but given the risks, very few patients manage to get there.

MSF's Palestinian medical team continues to provide care in the immediate area of their place of residence, but these activities are also very limited in comparison to the enormous needs.

On Wednesday, January 7, MSF teams visited three schools housing displaced persons. They evaluated the medical needs there and distributed medical supplies and medications. There are doctors in the group and they are providing care.

MSF field teams are in constant contact with Palestinian hospitals and report that hospital workers are exhausted by the flow of wounded patients, especially at night.

An MSF surgical team is currently in Jerusalem. It includes a vascular surgeon, general surgeon, nurse/anesthetist, operating room nurse and an anesthesiologist specialized in intensive care. MSF hopes that they will be able to enter the Gaza Strip as soon as possible. This team will support the Palestinian medical teams at the Shifa referral hospital.

MSF is also awaiting final authorization to bring in 21 tons of medical supplies, including two inflatable tents. The tents would be used to increase intensive care in-patient capacity and, possibly, set up an additional operating room. An MSF logistician will also join the field teams to set up these facilities.

A Health Situation Worsening for Over a Year

While the problems in the Palestinian health care sector have become even more striking as the conflict intensifies and violence achieves crisis levels today, they have been persistent and predate these episodes of extreme violence.

For MSF, the situation in Gaza has been worsening for nearly a year, the consequence of multiple political and economic factors.

Years of Israeli-Palestinian conflict and violence; the economic embargo, which was tightened in January 2008 (specifically with regard to electricity and fuel supplies); the inter-Palestinian clashes in summer 2007, which targeted hospitals; the forced strikes among hospital staff; attacks on humanitarian aid workers; and the blocking of access to medical care have all helped, over time, to sap and weaken the health system in the Palestinian Territories. Hospitals have experienced a host of maintenance and operating problems, health services have been limited, medical supplies and medications have been in short supply and access to specialized care outside the Gaza Strip has been restricted. Similarly, while supply problems are not new, the current surges of violence have increased the pressure on already-weakened health facilities.

In addition to the problems resulting from the economic blockade, internal conflicts have arisen over the last year. With two competing health authorities (one under the Palestinian Authority, and the other, Hamas), Palestinian health professionals have been squeezed by conflicting interests. They face contradictory instructions, blocked access to health care, difficulties at the workplace based on political affiliations and reduced quality of care. The “general strike” called by the Palestinian health workers’ union on August 30 (which resulted in 50 to 80 percent levels of absenteeism among critical hospital employees) thus had catastrophic consequences for access to care for the 1.6 million residents of the Gaza Strip, already profoundly affected by the years of conflict.