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Overwhelmed Healthcare Systems in Gaza Struggle Through Evacuation Orders

Displaced families in Gaza are on the move after the latest Israeli evacuation orders. Around nine in 10 Gazans have been displaced at least once since the war began. Photo: UNRWA

Displaced families in Gaza are on the move after the latest Israeli evacuation orders. Around nine in 10 Gazans have been displaced at least once since the war began. Photo: UNRWA

By Naureen Hossain
UNITED NATIONS, Jul 12 2024 – For nine months, over 2 million people in the Gaza Strip have been forcibly displaced in the wake of the armed conflict between Israel and Hamas. The ongoing fighting and displacement have put significant strain on humanitarian organizations on the ground to address even basic health needs.

The United Nations and other humanitarian organizations have stressed that the healthcare system in Gaza has collapsed or has suffered undue pressure as a result of the fighting. Out of 36 hospitals in the area, 13 remain open, operating with partial functionality.

This includes Nasser Hospital, which now stands as the last hospital providing comprehensive healthcare services. It has been overwhelmed with patients in the wake of evacuation orders issued on July 1 by Israeli authorities for the east and south of Khan Younis. Patients and medical personnel working in the Gaza European Hospital, located in Khan Younis, evacuated ahead of time.

Although an official from the Israeli defense force stated that patients and medical personnel were exempt from the evacuation order, this was not conveyed to the humanitarian groups on the ground. 

Andrea de Domenico, UN-OCHA’s Head of Office in the Occupied Palestinian Territory, told reporters in a virtual press briefing on July 3 that OCHA was not informed. He stated that it was likely that those who evacuated acted based on past experiences where hospitals were specifically targeted for raids or military bombardment, and so they took preemptive measures to evacuate before the Israeli military moved in on Khan Younis.

Evacuation orders have devastating implications for the fragile health infrastructure by disrupting the functionality of health facilities within and adjacent to evacuation zones, as one spokesperson from the World Health Organization (WHO) told IPS. They impede access for both healthcare providers and patients, and they compromise the efficacy and security of humanitarian operations. In addition, this only increases the burden on other hospitals that are now charged with receiving patients from evacuated areas.

As one of the remaining hospitals providing comprehensive care, Nasser Hospital has been operating beyond capacity with limited supplies, amidst destruction in the surrounding area, which WHO staff on the ground have said is ‘indescribable’. The area surrounding the hospital is laden with heavy layers of debris, destroyed buildings, and no stretch of an intact road. Its pediatric ward has now hosted more than 120 patients since July 5, despite its 56-bed capacity.

OCHA and the World Health at Nasser Medical Complex in Gaza earlier this year. UN and other humanitarian agencies have been struggling to ensure health care continues. Credit: OCHA

OCHA and the World Health at Nasser Medical Complex in Gaza earlier this year. UN and other humanitarian agencies have been struggling to ensure health care continues. Credit: OCHA

It is also operating with dwindling medical supplies and holds responsibility for sterilizing equipment for the surrounding field hospitals, according to Doctors Without Borders (DWB). Despite the critical need for supplies, DWB trucks and convoys carrying these supplies have been unable to enter Gaza since April. As recently as July 3, trucks were denied entry due to ongoing fighting in the South.

“Overall, it’s a comprehensive issue—from shortages of beds and supplies to the lack of surgeons. With yet another hospital closed, patients’ lives are even more at risk,” said medical team leader Javid Abdelmoneim, working in Nasser Hospital.

The issue of life-saving aid being restricted from entering Gaza has continued to persist and impact operations for humanitarian organizations on the ground, including the UN. As the WHO spokesperson told IPS, their trucks were unable to pass through last week as the Karem Shalom crossing remains closed.

Fuel has been identified as critical to the functionality of health facilities and aid operations, and yet shortages are rampant. A WHO spokesperson stated that hospitals have been forced to work with limited supplies of fuel, electricity and solar systems, and this has only hindered groups from properly functioning.

Power blackouts in newborn/ICU and kidney dialysis units place their patients at critical risk. The lack of fuel also impacts the water and sanitation sectors, which require at least seventy-thousand liters of fuel a day, and yet in the last few weeks, they have only received less than ten percent of what is needed.

Only 500,000 liters of fuel have been brought in during the first week of July, and 2 million liters were brought in in the month of June, which humanitarian organizations note is a fraction of the fuel needed to sustain humanitarian, medical, and WASH operations—at least 400,000 liters per day.

Trash and sewage buildup and a lack of clean water, among other factors, have all led to the spread of water-borne diseases and upper respiratory infections. According to the WHO, since mid-October 2023, they have reported cases of diarrhea, lice and scabies, skin rashes, impetigo and chicken pox.

“While a healthy body can more easily fight off diseases, a wasted and weakened body will struggle and become more susceptible,” one WHO spokesperson told IPS.

Meanwhile, acute food insecurity has ravaged Gaza. Since the start of the war, food insecurity has been a major concern for humanitarian actors in the region and globally.

The Integrated Phase Classification (IPC)’s special brief acute food insecurity projected that 96 percent of Gaza’s population, or 2.15 million people, would be experiencing extreme levels of food insecurity between June 16 and September 30, which includes over 495,000 people who face catastrophic food insecurity. More than half of the households reported that often, they did not have any food in the household, and more than 20 percent go full days and nights without eating. The violence and repeated displacement have challenged people’s ability to cope or to access humanitarian assistance.

This is further exacerbated when humanitarian workers are also forced to relocate for their own safety and move their operations. Domenico stated that the constant movement also means that warehouses containing fuel and supplies are abandoned as a result. In the case of UN agencies such as OCHA and its partners, humanitarian operations may be considered a parameter of activity that is (or should be) protected from military activity. Their presence is likely to signal to people that it may be safe to be there or that their basic needs will be met.

So far, 34 people have died from malnutrition and dehydration, according to the Ministry of Health. Of those deaths, WHO notes that 28 of them are children. A group of independent experts has warned that famine has spread throughout the Gaza Strip, noting recent cases of children who have died due to hunger and malnutrition, one of whom was as young as six months old.

“With the death of these children from starvation despite medical treatment in central Gaza, there is no doubt that famine has spread from northern Gaza into central and southern Gaza,” the experts said in a shared statement.

The IPC special brief notes that only a cessation of the armed conflict and sustained, uninterrupted humanitarian intervention could reduce the risk of famine. Humanitarian organizations have struggled to maintain their operations while hostilities have persisted in the Gaza Strip, endangering and displacing more than a million civilians multiple times over, along with humanitarian workers who have risked their lives to continue providing what little life-saving aid can cross the border. Military violence has continued despite international condemnation and repeated demands for a ceasefire.

Organizations such as WHO and Doctors Without Borders have coordinated with health partners and agencies on the ground, namely UNRWA, to provide primary care, support vaccination campaigns, and deploy emergency medical teams. As the WHO notes, however, these efforts can only support the health system; they cannot replace it.

IPS UN Bureau Report

Note: This feature was published with the support of the Airways Aviation Group.


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Women & Girls Find their Sexual & Reproductive Health on the Frontlines of a Battle they Didn’t Start

Credit: UNFPA/Eldson Chagara

 
Nsanje, Malawi – Eliza, 30, and her newborn baby at their home in Dinde camp after their home collapsed and they were displaced during Storm Freddy in March 2023. Eliza’s newborn is receiving a checkup from Fainess Yobe, UNFPA Technical Officer for Health System Strengthening. Cyclone Freddy was reportedly the longest-lasting tropical storm on record and caused severe flooding and mudslides, with the worst damage in Madagascar, Malawi and Mozambique.
Meanwhile, as Africa emerges as epicentre of the climate crisis, women and girls find their sexual and reproductive health on the frontlines of a battle they didn’t start, UNFPA reports find.

By Angela Baschieri
UNITED NATIONS, Jul 12 2024 – Droughts, cyclones, floods and extreme temperatures – these are the ‘new abnormal’ of a world in which weather-related events are becoming increasingly prolonged, intense and frequent.

While Africa contributes only 2 to 3 per cent of global greenhouse gas emissions and it is the least responsible for the global climate emergency, the continent has emerged as the epicentre of the global climate emergency.

Africa is warming faster than other parts of the world, resulting in lower crop yields and sparking conflict over scarce resources such as water and arable land. Millions continue to be displaced as their homes and livelihoods are destroyed by extreme weather events. Once separated from the communities that sustain them, they become more vulnerable.

While this cascade of crises affects almost everyone, women and girls are impacted differently and disproportionately – especially when it comes to their sexual and reproductive health. The communities and networks that they depend on for family planning and maternal health care, and for protection from gender-based violence are disrupted by extreme weather events. What follows is a spike in unintended pregnancies, maternal and newborn deaths, and child marriages.

This unseen toll that climate emergencies exact on women and girls’ sexual and reproductive health is emerging across Africa, triggering untold suffering. Poor, vulnerable women and girls in at-risk countries are needlessly finding themselves in grave danger – when a safe and prosperous future can be secured.

It begins with recognizing that women and girls are on the frontlines of a crisis they did not create – and that it will take strong commitments, backed by significant global climate financing, to safeguard their sexual and reproductive health.

It is in this context that UNFPA, the United Nations sexual and reproductive health agency, in partnership with Queen Mary University London and the International Development Research Centre (IDRC), launched an analysis of governments’ climate commitments, capturing the realities and unique needs of Africa’s divergent regions.

The analytical report, Taking Stock: Sexual and Reproductive Health and Rights in Climate Commitments, includes three sub-regional reports – one for East and Southern Africa, one for West and Central Africa, and one for Middle East and North Africa. Each presents a detailed analysis of the climate plans and commitments of countries under the Paris Agreement in 2015.

UNFPA’s analysis of the climate plans of 46 African countries reveals that considerations for sexual and reproductive health of women and girls are absent from the vast majority of published climate commitments. Only 17 countries have integrated sexual and reproductive health and rights into their national climate plans.

The consequences of extreme heat and climate change are undeniable. There is increased risk of stillbirths; mounting food insecurity threatens maternal and newborn health; and climate-related displacement is exposing more women and girls to gender-based violence (GBV), including harmful practices such as child marriage and female genital mutilation. These vulnerabilities are compounded in the African context, among the most vulnerable in the world to climate change.

In East and Southern Africa, climate change-driven tropical cyclones are proving increasingly common, spreading waterborne diseases such as cholera and damaging hospitals, putting women with complicated pregnancies in peril.

Yet only 8 out of 19 national climate plans include references to sexual and reproductive health and rights (SRHR) and GBV. And where these are in fact referenced, they typically mention only maternal and newborn health, HIV and AIDS, and GBV – and they are seldom backed by specific programme actions and budget lines.

In North Africa, multi-year droughts are threatening the livelihoods of millions, forcing many women to become heads of households as men are more likely to migrate in search of economic opportunities.

While most countries reference the impacts of climate change on SRHR and GBV, only a few outline specific initiatives aimed at strengthening resilience to climate change through providing SRHR and GBV-related services.

West and Central Africa is plagued by intensifying floods, extreme drought, intense rainfall and desertification, which are exacerbating pre-existing vulnerabilities, including climate-related conflict and diminished access to natural resources, affecting food security.

Yet just 6 out of 22 national climate plans address SRHR and GBV, referring to maternal health, menstrual hygiene and GBV. Even then, most of these countries have not backed this up with meaningful action plans – a failing that must be addressed.

“Governments should ensure more adaptive measures to sensitize women and girls on climate change, while putting in place safety nets to ensure that they continue to have access to sexual and reproductive health services even in times of climate events and displacement,” said Fatou Jeng, the founder of Clean Earth Gambia.

This youth-led climate organization has mobilized thousands of Gambian youths to build marginalized and vulnerable communities’ resilience to climate change.

It is critical that countries prioritize sexual and reproductive health and rights in their climate commitments and strategies. Protecting vulnerable populations is a moral imperative and human rights issue, and must be pursued urgently alongside efforts to reduce emissions.

Yet, while global efforts are not keeping apace with the increasing scale and speed of climate impacts, there is hope on the horizon. The fund established at COP28 in 2023 for responding to climate-related loss and damage can and must deliver much-needed funds and resources to at-risk African countries.

In addition, wealthy countries can and must significantly increase global climate finance aimed at helping women and young people prepare for a future of climate shocks.

Greater access to financial and technical assistance from wealthy countries can facilitate better data collection on how the climate emergency is impacting women and girls in Africa, so that programmes can help those who need it most. It can also strengthen health systems so they are climate-resilient and ensure services are more mobile, stocks are pre-positioned, and adequate staff are in place.

Africa has one of the most demographically diverse populations on the planet, including the world’s youngest population. There is an important ally when it comes to climate action – it is the very women and young people being impacted by climate change.

“More often than not, NDC [National Determined Contribution] discussions are confined to government boardrooms, yet the proposals that stem from them affect the youth and make women, particularly those living with disabilities, invisible and marginalized,” said Kenyan Imali Ngusale of the UNFPA Joint Youth Working Group on SRHR and Climate Change. If given the chance and offered a seat at the climate table, women and young people offer a wealth of innovative solutions.

Putting the sexual and reproductive health of women, girls and young people at the heart of climate action is vital. By focusing a global community of interested parties, governments and climate financiers, the world can deliver on climate action and climate justice to safeguard the planet.

Angela Baschieri, PhD, is UNFPA Technical Lead on Climate Action

IPS UN Bureau

 


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