When people started to share the Facebook post “Dear world: How is the lockdown? – Gaza,” I felt uncomfortable. Though the posters sought to generate empathy for the 2 million Palestinians trapped in the Gaza Strip, the attempt to compare the closure that free citizens of the West are experiencing to the 13-year siege on the Strip is, at the very least, tasteless. Now that the virus has crossed the military checkpoints and 12 Palestinians have been diagnosed as infected, the distortion of this comparison is going to become tragically clear.
Gaza residents will suffer not just from the natural complications the virus causes, but from the fact that the siege puts them at an extreme disadvantage in all three categories considered vital to battling the coronavirus epidemic: health services, social conditions that determine the level of health, and the ability to keep social distance from one another.
Extensive information has been published over the past few weeks on the readiness of the world’s health systems and their influence on coronavirus mortality levels. Basing themselves on South Korea – which unlike Italy and Spain managed to gain considerable control over the spread of the virus – experts argue that testing is crucial to saving lives. But today in Gaza there are very few testing kits (around 200) and as of March 24, only 144 people had been tested.
We also know that in some countries, people are dying because the hospitals can’t cope with the huge number of patients needing ventilators. Doctors in the United States and Israel are warning that the number of available ventilators – 52 and 40 per 100,000 people, respectively – is not sufficient. Meanwhile, in Gaza, there are three ventilators for every 100,000 people, a ratio that will prove to be a death sentence for many.
Gaza has some 30 hospitals and major clinics that provide 1.3 beds for every 1,000 people. Israel has over twice the amount – 3.3 beds available for every 1,000 people – while in the EU the average is 5.4. The difference between Gaza and Israel, which has occupied the enclave for 40 years and continues to control its borders, is not just extremely grave, but also an expression of what Prof. Sara Roy of Harvard University has called “de-development”: the deliberate weakening of the economic and social capabilities of the Gaza population.
Social conditions that determine the health level
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The perspective gained from a narrow analysis of medical capabilities to fight the virus in a particular area is likely to be somewhat limited. One of the things that I stress in the course Human Rights and Public Health, which I teach as part of the global public health program at Queen Mary University of London, is that the conditions that a person is born into, raised in, lives in and works in are no less significant than the quality of the health system that he or she has access to.
For example, to explain the gap between the infant mortality rate in Gaza (19.6 for every 1,000 births) and in Israel (2.6 per 1,000 births), or to understand why Israelis live on average 10 years longer than Gazans, one must examine not just the type of health services, but also the social conditions that determine the health level of a population.
The blatant fact that 53 percent of the population (some 1.01 million people) – among them more than 400,000 children – subsist on an income that’s less than the international poverty line of $4.60 a day helps understand why the lives of Gazans are shorter. Extreme destitution and lack of food security means that most of the population can’t meet the minimum daily calorie intake required. Moreover, over 90 percent of Gaza’s water isn’t potable.
So while the Israeli government stresses the importance of washing yours hands several times a day, Gaza residents are worried about the lack of drinking water. The fact that most Palestinians live hand to mouth makes it clear that the effect of the coronavirus on Gaza will be a thousand times more grave than for other countries.
The ability to keep social distance
There is no option for isolation in Gaza. The history of epidemics shows that quarantine is one of the most effective ways to prevent a virus from spreading. But how can the 113,990 refugees living in the Jabalya refugee camp, which sits on 1.39 square kilometers of land, stay physically distant from one another?
In the A-Shati camp, the population density is even greater: 85,628 refugees live on 0.51 square kilometers. The camp has only one clinic and one food distribution center for the entire population. In other words, in the eight Gaza refugee camps, the existing lifesaving systems – health services and food supply – will become dangerous bottlenecks, petri dishes for the lethal virus.
The Hamas government is quite aware of the looming dangers, but it has limited options. Schools have been emptied and are serving as quarantine centers, with eight people housed in every classroom and bathrooms serving some 200 men and women. This method can be compared to stuffing prisoners into an isolation cell and hoping that they won’t infect each other.
Every expert knows that prisons are viral habitats. When the outbreak began, Iran immediately released 70,000 prisoners, and other countries followed suit. But Gaza itself is a prison that is in very bad shape after years of blockade.
Gaza’s Palestinians don’t have enough physical space to implement the distancing that public health experts are recommending, and their health system, which has been starved for decades, won’t be able to cope with what’s going to happen. Nor is it reasonable to expect other countries to offer assistance when the epidemic is raging within their own territories, and all of this is on top of a worsening global economic crisis.
It isn’t clear how many Palestinians will die, but what is clear is that the lockdown we are experiencing and the one Gazans has been living under for years are totally different. For us, the lockdown is meant to save. In Gaza, the lockdown will kill.
Prof. Neve Gordon teaches at the School of Law at Queen Mary University of London.