Gaza Health System on Verge of Collapse, Israeli Defense Officials Warn Ministers

State of Gaza health services could lead to direct international intervention in next conflict

Palestinian medics wheel a wounded youth, who was shot by Israeli troops during a protest on the border, into the treatment room of Shifa hospital, Gaza City, December 14, 2018.
Adel Hana,AP

The serious condition of Gaza’s health system – on the verge of collapse – would make it difficult for the Israeli army to fight in the Strip for long and could lead to intense international intervention, defense officials said in an assessment presented to the security cabinet.

The ministers were told, for example, that wounded civilians – who would presumably comprise most of the casualties in a military clash – would not be able to receive initial medical care. Senior officials told Haaretz that in light of the report, it would be difficult to wage war and receive international support for the operation.

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The report comes as all parties try to come to an arrangement for the Gaza Strip that would maintain long-term quiet.

Israel has already received a report on the health situation from an international medical agency, which entered the Strip to assess the condition of Gazans wounded by shooting. That document was also sent to international agencies, some of which are helping mediate the contacts between Israel and Hamas.

The report given to the security cabinet shows that around 6,000 people with bullet wounds are still awaiting urgent operations. Most of the wounded are not receiving proper medical care and a quarter have developed bone infections that if untreated will lead to amputations. At this point there is no agency that could treat those thousands of people.

The report noted that Gaza is seriously short of doctors, particularly specialists, because any physician who could find work in another country has emigrated. Gaza hospitals are missing 60 percent of their required drugs, particularly generic drugs, antibiotics and painkillers.

Every week hundreds of wounded people come to the hospitals following the demonstrations at the border fence, dozens of them with bullet wounds, joining the 30,000 others who have been shot.

Hospitals in Gaza have reduced expenses by closing departments, with most of their efforts focused on providing initial treatment in the emergency rooms and trauma wards. There is almost no way that patients with cancer, diabetes or dialysis needs can be treated; they are simply being sent home.

Political sources who saw the report blamed the Palestinian Authority, saying it wants Gaza’s health system to collapse. The PA is supposed to transfer 150 million shekels ($41.6 million) to Gaza annually for medical equipment and drugs, but Palestinian President Mahmoud Abbas has halted the transfer to pressure Hamas.

During the 2014 Gaza war, the Gaza health system was in difficult straits, but it was in better shape than it is now. At that time the health system was still supported by the UN refugee agency UNRWA with Israel’s backing – and for the 52 days of fighting, the organization provided assistance at 70 locations, treating the wounded and evacuating them from combat zones.

Now, after U.S. President Donald Trump’s massive cut to the organization’s budget, UNRWA would have a hard time providing the same assistance.

Sinwar’s scenarios

Last week Hamas’ leader in Gaza, Yahya Sinwar, presented three possible scenarios regarding Gaza’s future to foreign officials with whom he met, who in turn presented them to senior Israeli officials. The first is Abbas taking responsibility for Gaza, but Sinwar believes that the PA chief is neither willing nor able to do so.

The second option is transferring control of Gaza to the United Nations or Egypt, which would try to sustain the Strip with its resources and aid.

The third possibility, which is least favored by Sinwar, is for Hamas to launch a war against Israel that would end with an international force occupying the Strip and trying to build a leadership acceptable to both Hamas and the PA. Sinwar made clear that under any of these scenarios, Hamas would not disarm, even though its income would be expected to drop, making it difficult for it to maintain its military wing.

Meanwhile, mediators are seeking to calm relations between Israel and Gaza. On Friday, unlike in the past, the Egyptian intelligence representative remained in Gaza during the demonstrations in an effort to have influence in the field. Hamas also strove to reduce the intensity of the demonstrations by limiting the transports to protest areas, on the grounds that it gets dark early. Actually Hamas was trying to avoid being embarrassed in front of the Egyptian intelligence official.

Egypt believes that any long-term arrangement must include Islamic Jihad as a party to the talks. This week delegations visited Egypt headed by Hamas leader Ismail Haniyeh and Islamic Jihad chief Ziad al-Nakhalah. This week Islamic Jihad posted a video showing the shooting of an Israeli paratroop officer last week on the Gaza border.

Diplomatic sources say the video was meant to make clear to Egypt and Hamas that Islamic Jihad must be taken into account – and apparently it succeeded.

A diplomatic source familiar with the details said the decision to talk to Hamas through intermediaries was a correct one given the difficulty in reaching a similar result through Abbas. The assessment in Israel is that Abbas has almost totally abandoned dealing with Gaza and is convinced that Israel and other countries have conspired to harm the Palestinians by undermining him and his rule.

The source argued that Israel made clear to Abbas that even if he wanted it, Israel would not start a war with Gaza.