As the conflict in the Gaza Strip intensifies, Gaza’s health systems have collapsed, and the humanitarian crisis is at a boiling point. United Nations official Jens Laerke said last week, “If there is a hell on Earth today, its name is northern Gaza. People who remain there, the corners of their existence are death, deprivation, despair, displacement and literally darkness.”
Hospitals in northern Gaza — which operate as sites of both treatment and refuge — are being forced to shut down as they run out of fuel. The Palestinian Red Crescent Society (PRCS) on November 13 said al-Quds, the second-largest hospital in the enclave, was under siege, witnessing intense gunfire from Israeli military as thousands of patients, families, aid workers and journalists were trapped. “Medical staff are making every effort to provide care to patients and the wounded, even resorting to unconventional medical methods amid dire humanitarian conditions and a shortage of medical supplies, food, and water,” the PRCS said.
Healthcare workers and aid agencies say essential supplies are drying up in other parts, endangering millions in the populated strip of land. Israel on October 21 partially lifted its blockade on Gaza, but refused to allow fuel into the region citing concerns that Hamas would divert it for military purposes. On November 9, Israel agreed to a daily four-hour humanitarian pause, to allow aid to enter the enclave while giving civilians in northern Gaza time to flee to ‘safer’ places in the south. As of November 15, Israeli officials have said they will allow fuel shipments for humanitarian operations.
Tommaso Della Longa, of the International Federation of Red Cross and Red Crescent Societies (IFRC), speaks to The Hindu’s Saumya Kalia about the humanitarian crisis unfolding in the Gaza Strip, and the critical need for continued humanitarian aid flow.
This interview was conducted on November 13, 2023. The situation is rapidly evolving and deteriorating on the ground, so facts and figures may have changed. The Israeli military on November 15 said it was carrying out a ‘raid’ against Hamas militants in Al Shifa Hospital, the biggest hospital in the Gaza Strip where thousands of Palestinian civilians are seeking shelter. Reports suggest the military has raided the surgery and emergency departments and is carrying out bombings in the medical complex. The raid represents “a new crime against humanity, medical staff, and patients”, the Palestinian health minister has said.
What is happening at the al-Quds Hospital in the Tal al-Hawa area of Gaza, where medical staff, patients and families are trapped without access to food, electricity or water?
In the last seven days, the hospital was completely cut off from everything — there was heavy shelling around the hospital, and some literally in front of the hospital, about 30-40 metres away. It has started to create some ‘collateral damage’: windows broken, smoke inside, panic amongst patients. For the people who are living in the hospital, it’s not really collateral damage, but a continuous nightmare. More roads, more infrastructure around the hospital have been destroyed. Even ambulances cannot go in and out. The situation is really volatile, and it’s changing pretty quickly. One big, enormous challenge is communication: we don’t have a continuous flow of information about what is going on; sometimes it takes us four, five, six hours to get new information. People who have sought refuge maybe in the last hour have decided to leave because they don’t feel safe any more, so we can’t be precise about the numbers.
PRCS Tcolleagues declared yesterday that the al-Quds hospital is out of service. This is deeply concerning, not only for the patients and the people who are inside the hospital, but for all the people in Gaza City and in the north of the Gaza Strip. For thousands.... this means that they will not have any more access to facilities, or to emergency medical services.
We have said since the beginning of this conflict: we need proper humanitarian access, we need continuous flow of humanitarian aid, we need to be able to bring medicine and medical equipment to the north of Gaza, and we need fuel (fuel is not allowed inside Rafah border). Fuel is a life saving item for people in Gaza.
[al-Quds is the enclave’s second-largest hospital. Residents have also reported heavy airstrikes and shelling around Al-Shifa hospital, the largest healthcare facility in Gaza, where 1,500 patients, 1,500 medical personnel and between 15,000 and 20,000 people are seeking shelter].
The United Nations likened northern Gaza to ‘hell on Earth’. Are aid workers seeing a difference in the scale of bloodshed, as compared to previous conflagrations? Is this humanitarian crisis of a scale seen before?
I’ve been to the Gaza Strip many times in the last 15 years, during or before the recent conflicts. I have never seen something of this scale, and never this level of suffering. At the same time, I’m not a fan of comparing suffering, because even if one child has lost their life, it’s already too much.
The worrying part... is what will happen to all the people that have moved to south Gaza. [Israel Prime Minister Benjamin Netanyahu urged civilians to flee north Gaza and move to southern parts where they have established ‘safe zones’]. Firstly, it’s not like the South is a safe place. Secondly, the humanitarian system in the South is also on the brink of collapse, if not, already collapsed. Thirdly, there is no system of relief; after an emergency, say, an earthquake, flood, tsunami, or any other conflicts, neighboring countries have refugee shelters or tents, there are field hospitals, and places where you can get food and water... In this case, it’s not there.
People — civilians — must be respected and protected in any situation. They should be protected while they’re fleeing, when they arrive, but also, if they don’t want to leave.
As of October 27th, at least 72 healthcare facilities have been attacked according to the WHO; this is other than schools and refugee sites. Which place in Gaza is ‘safe’ right now to access aid and shelter?
There has not been a safe space in Gaza in the last four weeks since the beginning of the conflict. Now, we can argue that the southern part of the Gaza Strip is much safer than the north, where there is heavy fighting and shelling. But even yesterday (November 12th), there was heavy bombardment in Khan Younis, which is the south of Gaza.
Here the mental health, the psychological needs are immense. Can you imagine a family moving with a child, from an area that is under bombardment day and night, and doesn’t know where to go and how to survive? The mental toll — it’s enormous. Plus, lack of food, lack of water, lack of logistics — it’s really concerning because we don’t know what will happen next.
What is currently available right now in terms of aid, and what more is needed?
What is entering now are water, medical supplies, medicines, and some non-food items like clothes and blankets. All of those are absolutely needed.... Even for the people who are living in makeshift shelters, they need support as winter’s coming, the weather will pose a big risk for thousands and thousands of people. But what is missing here is fuel. Without fuel, there is no humanitarian operation. You need fuel for trucks, ambulances, water sanitation, desalination of water.
The needs in Gaza were dire even before. We’ve been concerned about water, healthcare investment for years. [A World Bank report noted that public health centers across Palestine “have remained stagnant due to chronic underinvestment over the last decade”]. Now the situation is only collapsing, because when there are no logistics, when ambulances cannot work, when hospitals stop functioning, even Western or a high-level health system cannot work at the level that is needed.
Even before the current escalation, 80% of Gaza’s population relied on humanitarian aid to meet basic needs, as per a United Nations report. Is this estimate accurate? What role has humanitarian aid played in Gaza?
Yes, indeed. The Gaza Strip was already in a difficult humanitarian situation before this conflict. It is not the first time that they have been under siege; not the first time they have been without basic amenities...
There is a layer of suffering in an already difficult situation. Before this conflict, between 500-600 trucks were entering Gaza per day, including fuel, and including commercial items and not just humanitarian aid. Now, in the last two weeks, we had almost 800 trucks in 14 days... The humanitarian response should scale up as soon as possible. We really need to get a continuous flow of humanitarian aid inside Gaza, including fuel. This humanitarian aid also needs to reach the north; we cannot differentiate between the south and the north and we need to reach the people who are more vulnerable.
I don’t want to underestimate the positive signs of having the Rafah border open — it’s a lifeline for the Gaza people. But still, way more needs to be done.
The United Nations said that 20 of the 36 hospitals in Gaza are no longer functioning and that the 16 that continue to operate are providing only the bare minimum of services. What are the health needs on the ground?
The health condition is dire. We’re talking about hospitals with empty shelves, about surgeries done without anaesthesia. We’re talking about the delivery of babies, not even in an operation room. It’s unbearable. Moreover, for people who are waiting inside the hospitals and trapped in the middle of shelling, the hospitals will still close down, and people will no longer have access to these sites and facilities. [Two premature babies died at the Al-Shifa Hospital, as the facility ran out of fuel to power the neonatal intensive care unit, according to reports.]
All health-related challenges are linked to the fact that there is no clean water available. People are drinking salty water, and they are adding sugar to make the salty water more drinkable for their children. This will lead to a health catastrophe, triggering outbreaks and other infections. What is more frustrating is that this disaster inside a disaster can be prevented — if you give healthcare and humanitarian workers the space and resources to prevent this.
The Palestine Red Crescent Society on November 9 said a paramedic in West Bank was shot in the back during a raid by the Israel Occupation Force in Jenin Refugee Camp. How many workers have been injured so far?
Under international humanitarian law, aid workers, ambulance, hospitals and civilians must be protected. Since the beginning of the conflict, we lost seven members of our network. [The United Nations say it has lost more than 100 aid workers in Gaza]. Three of the staff and volunteers were bringing patients to the hospitals in Israel, at the beginning during the attacks. They were killed in the line of duty. Later, paramedics of the PRCS were killed in two different incidents. Also in that case, they were dealing with injured people. They were in or nearby their ambulance, they were wearing protective gear , and still, they were killed.
This is a stark reminder of where the level of the violence in the conflict has arrived, and the fact that not even healthcare and humanitarian workers get the protection and respect they need to operate. It’s a moral obligation, but even more importantly, it’s a legal obligation. Sadly, these [legal frameworks] failed to protect their lives.
Our colleagues at the PRCS tell us that every time that they go out, they say goodbye to each other. They don’t know if they would come back.
Countries on October 27 adopted a resolution for calling for an “immediate, durable and sustained humanitarian truce leading to a cessation of hostilities.” Israel on November 9 agreed to put a daily four-hour ‘humanitarian pause’ in Gaza. Will these pauses help the situation on ground?
Communication has been very difficult, so I have not received a lot of information about the state of pauses. What I can say, however, is every effort, every step (to bring) some of the fighting to stop, to get us a few moments, is welcome. But these need to be consistent and organised with the humanitarian agencies. And this [pause] needs to be clear for the civilians. There is a great level of confusion in the last four weeks among the people in Gaza: they are getting different information.
We welcome any possible efforts that will get some pause to the fighting, but we need to get more information on the operational level to understand how these work. It’s in the hands of the politicians, governments, diplomats and international community to decide which tool to use — you can call it ceasefire, humanitarian pause, truce.... What we are concerned the most with is that it [the war] needs to stop. And we need to create a safe humanitarian space where we can operate again.
An Israel military official on November 9 denied there is a humanitarian crisis in Gaza. To what extent are you and other aid workers seeing mis- and disinformation, and is this impeding your efforts?
Sadly, this is something we are seeing everywhere in the world and it’s adding to a very polarised context. What everyone should remember is that dis- and mis-information are having a tangible impact on the life or death of people... [it hampers the ability] to build trust with the communities. For instance, to put in place a humanitarian pause for X amount of hours, you need not only logistics in place but you also need to build trust within that community for those X amount of hours to be used in the right way. Without engaging the communities and without building trust, it’s not possible. These layers of mis- and dis-information inevitably create more complexities.
What message would you like to put across to explain the humanitarian situation?
It’s a call to the international community, to give safe access [to aid and healthcare workers] in Gaza, and really create a safe humanitarian space where we can work. The suffering of people, it has reached a horrific level. We are seeing babies in incubators about to die because there is no electricity in the hospital; we are seeing thousands of civilians, including elderly people, walking for kilometres and kilometres without a destination in sight.
We really need to find a way to get a dignified humanitarian answer to their needs, and we need to do this with the assurance of safety and protection of workers.