Gaza’s COVID Crisis: Vaccine Shortage, Domestic Violence and Few Hospital Beds

A doctor and humanitarian worker in the Gaza Strip tell of hospitals at breaking point, children collecting plastic from junkyards, and the feud between Hamas and Fatah hampering the distribution of COVID vaccines

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A Palestinian reading the Koran in front of a coronavirus-inspired mural during Ramadan in Gaza City earlier this month.
A Palestinian reading the Koran in front of a coronavirus-inspired mural during Ramadan in Gaza City earlier this month.Credit: MOHAMMED ABED - AFP
Jotam Confino
Jotam Confino
Jotam Confino
Jotam Confino

“If you ask people on the street in Gaza what they want right now, it’s such a tough question that they don’t even know how to answer it,” says Najla, a Palestinian humanitarian worker from Gaza City who is currently focusing her efforts on raising awareness about COVID-19.

Najla, who spoke to Haaretz in a phone interview and asked that her full name not be published, described an atmosphere of despair among Gazans, who are currently dealing with a new wave of the virus in the coastal enclave. “There are so many day-to-day issues Gazans deal with, such as lack of electricity, jobs, and food. Getting basic medical treatment is a nightmare. The list is just so long, so it’s difficult to pinpoint one specific thing they want to improve,” she says.

Like elsewhere in the world, the first COVID-19 cases in Gaza were detected in March 2020, causing the ruling Hamas leadership to order strict quarantine rules for those entering through the Strip’s borders. The situation was well marshalled for the first few months, but when the total number of cases neared a thousand at the end of August, Hamas ordered the first full lockdown, closing all mosques, stores and schools.

From the start of the pandemic, the United Nations and Gaza’s Health Ministry warned that the extreme density of life in the Strip and poor health system meant that a coronavirus outbreak could jeopardize the health of the entire enclave.

Hussein al-Hajj, a 71-year-old COVID-19 patient, lies in his bed at the intensive care unit for coronavirus patients at the Turkish-Palestinian Friendship Hospital in Gaza City last week.Credit: EMMANUEL DUNAND - AFP

Restrictions were eased in early October, when the number of cases started to decrease, but the Strip went into lockdown again in mid-November for several months.

A third lockdown was ordered at the start of April when the number of daily cases peaked at almost 2,000. Although the number of new daily cases in Gaza has fallen to about 800, the number of deaths remains comparatively high with about 10 a day on average over the past week. The total number of deaths to date is 884, and the challenges are numerous – ranging from lack of vaccines to overcrowded hospitals.

Gaza currently has enough doses to fully vaccinate 55,000 people, but as of last week only 33,000 people had been fully vaccinated. The United Arab Emirates has donated tens of thousands of Russia’s Sputnik V vaccine, and others are available via the UN-backed COVAX program. However, the ongoing feud between Hamas and the Palestinian Authority in the West Bank affects the number of vaccines available for Gazans.

“I’m worried about the limited coordination between the PA and the de-facto authority [Hamas], which is due to the political division. This is definitely compromising Gaza’s share of the vaccines,” says Najla, 40.

A Palestinian health worker displaying a box of Russia's Sputnik V vaccine sent by United Arab Emirates earlier this year.Credit: IBRAHEEM ABU MUSTAFA/REUTERS

A further problem is that while many countries are experiencing some degree of vaccine skepticism, Gazans seem particularly reluctant when it comes to trusting the science behind the COVID vaccinations.

According to a survey this month by the Jerusalem Media and Communications Center, only 30.5 percent of Gazans said they would take the vaccine. It’s a problem Najla is fully aware of and trying to correct. “There’s a general misconception in Gaza about vaccines, which creates distrust. There’s also a lot of misinformation and rumors circulating on social media,” she says.

The issue isn’t unique to Gazans, of course: The survey also found that only 55.9 percent of Palestinians in the West Bank would take the vaccine if they were offered it.

Dr. Allam Nayef, 41, works in an intensive care unit at Gaza’s largest medical center, the Al-Shifa Hospital. He agrees with Najla that there’s a problem with anti-vaxxers, but says the biggest problem is that all of the Strip’s hospitals need more trained staff. When his hospital in Gaza City opened its first intensive care unit for seriously ill COVID patients earlier this month, it was full within 24 hours and the oxygen supply collapsed. Until then, the hospital had only taken in COVID patients in moderate condition, placing them in isolated beds on normal hospital wards.

A Palestinian refugee receiving aid from the United Nations center in Gaza City last year.Credit: MOHAMMED ABED / AFP

“I remember working one night at the COVID ward in the European Hospital near Khan Yunis, having to take care of 33 patients. I had six brand-new doctors with me, which was basically like working alone,” Nayef recounts. “I felt sorrier for them than for the patients, to be honest, considering how inexperienced they were.

“We desperately need more doctors in Gaza,” he stresses. “It’s so bad that at one point, four out of 11 doctors at Al-Shifa were infected with COVID, leaving just seven doctors to run the entire COVID ward.” Nayef himself was infected with COVID earlier this year, but recovered and returned to work after 12 days.

Besides being short-staffed, Gaza’s hospitals are also in dire need of medical equipment. According to Nayef, there are some 2,150 beds available in Gazan hospitals, but only 64 of them are allocated for COVID patients in ICUs. This means that all of the hospitals need to be creative, placing isolation beds on non-COVID wards.

“At the beginning of the pandemic, we urgently needed more ventilators. We eventually got more from international donors, but it was hard to get them into Gaza because Israel wouldn’t allow it,” Nayef relays. Israel, however, denies those claims.

In a statement to Haaretz, a spokesperson for the Coordination of Government Activities in the Territories (COGAT) said Israel “initiated a wide range of activities, in cooperation with the international community, in order to stop, to the extent possible, the spread of the virus. Among these activities, COGAT has been coordinating the entry of medical equipment and protective means donated by the international community, and holds permanent situation assessments together with different international organizations, in accordance with the dynamic infection rates and the level of morbidity, in order to fit the activity to the changes on the ground.”

A Palestinian medical worker collecting a swab sample from a boy to be tested for COVID in the southern Gaza Strip in January.Credit: IBRAHEEM ABU MUSTAFA/REUTERS

New challenges

Despite the high number of deaths and new cases in recent months, some of the lockdown restrictions have been eased since Hamas ordered a third lockdown at the beginning of April and ahead of the Muslim holy month of Ramadan.

“There’s a full lockdown on the weekends [Friday and Saturday], and a partial one during the rest of the week with a nightly curfew starting at 8 P.M., limiting people’s freedom of movement and prohibiting businesses from being open,” Najla says.

But Nayef says people break the nightly curfew without being punished. He thinks Hamas is doing a good job when it comes to making decisions on when to ease lockdowns, as it knows that most people rely on day-to-day income and therefore suffer financially during longer periods of lockdown. The combination of three lockdowns and the ongoing Israeli and Egyptian blockade brought the already poor living standards in Gaza to a new low, while creating new challenges for children, both Najla and Nayef say.

Nurses and patients at the COVID-19 coronavirus intensive care unit at the Turkish-Palestinian Friendship Hospital, Gaza City, last week.Credit: EMMANUEL DUNAND - AFP

“The economic situation is harsh – even more so than it was before the pandemic,” Najla says. “Children in Gaza are supposed to learn from home, but most of them don’t have the equipment to attend online classes. If you’re a household with five kids and only have one device that can go online, how are you supposed to learn?” she asks.

UNICEF published a report last November revealing that the number of cases of child labor had risen substantially in Gaza during the first half of 2020: 909 boys were engaged in "nonhazardous" work (up from 602 in 2019, a 51 percent rise), while the corresponding number for girls was 213 (up from 184 in 2019, a 16 percent rise).

The economic hardships endured by parents harshly affect Gaza’s children, Najla adds: “A lot of children are forced to do hazardous labor to help provide for their family, like going to junkyards to collect plastic and selling random things. You see this all the time,” she says.

Like in other countries, domestic violence was another issue magnified by the pandemic. Najla describes the burden on women as “a huge problem” in Gaza.

Young Palestinian girls reading the Koran during Ramadan, in Gaza City earlier this month.Credit: MOHAMMED ABED - AFP

According to a report by the UN Population Fund last June, domestic violence surged in both the West Bank and Gaza during the early stages of the pandemic. The report referenced the Women’s Affairs Center in Gaza, which said there had been an “increase in violence against women, including verbal, physical, psychological and sexual violence, resulting in increased fear, tension, grievance and psychological stress.”

The international humanitarian agency CARE, meanwhile, found similar trends in Gaza in its 2020 report, concluding that COVID “largely disproportionately impacted women and girls as their traditional roles have been magnified, resulting in increased labor and responsibilities in situations of economic downturns, school closings, and frontline-healthcare provision.”

The recent announcement by the United States to send $15 million to Gaza and the West Bank, earmarked for the COVID response, as well as reinstating $150 million in aid annually to UNRWA (the UN agency supporting more than 5 million Palestinian refugees across the Middle East), couldn’t come at a better time. In addition, Qatar is channeling hundreds of millions of dollars to Gaza each year, to help ease the living conditions of its citizens.

Yet Gazans’ faith in the international community, and hopes for an easing of the blockade, are slim.

Palestinian Health Department teams mourning the death from COVID-19 of a fellow medic at Gaza's Al-Shifa Hospital earlier this week.Credit: MOHAMMED ABED - AFP

“In recent years, the population in Gaza has lost hope in the international community, its own government and, above all, the Israeli government’s policies toward Gaza. And what you see is that people don’t even try to speak out anymore. They simply need a dignified life, waiting for the blockade to be lifted,” Najla says.

Nayef is equally pessimistic about the future. “Nobody in Gaza can predict what will happen in six months,” he says. “They can’t even predict what will happen tomorrow. We live in constant chaos; it’s either Israeli warplanes flying over our heads or COVID threatening our lives.”

Cemetery workers covering the grave of the senior physician from Gaza's Al-Shifa Hospital who died after being infected with COVID-19. Credit: MOHAMMED ABED - AFP

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