The health care crisis in Gaza is unthinkably grim, even by the standards of war-ravaged regions. Infectious diseases from chickenpox to cholera are sweeping through the population; crucial medical supplies are blocked at the border; and hospitals are overrun with critically wounded patients.
Four months into Israel’s brutal war on Hamas, the situation looks set to get worse.
Israel is poised to launch an invasion into Rafah, endangering more than a million Palestinians who have sought refuge in the southern city, largely women and children. Hope for a humanitarian respite are fading as U.S.-brokered cease-fire talks broke down in Cairo this week. And the U.S. has frozen funding to the main United Nations aid agency in Gaza, further endangering the already tenuous efforts to provide medical aid.
“The most emerging thing is the health issue,” Mai al-Kaila, minister of health for the Palestinian Authority, told The Hill this week. “Because we have lots of injured people per day. We have thousands, and there is no place to be to be treated, or no safe place to be treated, as you know that the majority of hospitals are out of service.”
Al-Kaila is based in Ramallah in the West Bank, which the Palestinian Authority controls, while her deputy is based in Gaza, which is governed by Hamas, the Palestinian militant group.
The Palestinian Ministry of Health estimates that more than 28,000 Gazans have been killed so far, 70 percent of whom were women and children, and an additional 8,000 are believed to be missing under the rubble, according to a report provided to The Hill.
Many hospitals ‘not functioning at all’
Saleem Zaru, executive director of the United Palestinian Appeal (UAP), said the ongoing conditions in Gaza are “reducing the hospital to a first aid clinic” in terms of functionality.
Nongovernmental organizations (NGOs) in the region that spoke with The Hill estimated there are currently only 13 hospitals operating on some level — representing roughly a third of hospitals that operated in Gaza before Hamas attacked Israel on Oct. 7. Al-Kaila said that figure is likely closer to nine, as hospitals send staff away to shelter from potential bombings.
“None of them are fully operational with all of the medicines and supplies they need. And many are not functioning at all,” Sean Carroll, president and CEO of the nonprofit Anera, said.
Gaza had a relatively robust medical infrastructure before the war began, according to al-Kaila, thanks in part to the robust presence of the U.N.’s Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).
“The health system in Gaza is composed of the government and UNRWA. And UNRWA has an excellent role in the health system in Gaza, and they are covering almost 70 percent of the population, because the majority of the population in Gaza are refugees,” al-Kaila said.
“Unfortunately, these clinics, whether they are governmental or UNRWA, only out of these clinics, 22 are working, and out of the 36 hospitals, nine hospitals are partially functioning.”
Israel’s blockade, blackout
On-the-ground efforts by NGOs such as Anera and the UAP to get resources into Gaza have been impeded or blocked by Israeli officials, according to Carroll and Zaru.
“In a period where you should’ve had 2,000 trucks, we’ve had 50 trucks. And Israel says it’s increasing the number of trucks all the time, and it’s just simply not true. It goes up, it goes down, and the average is still barely above 100 trucks a day,” Carroll said.
The UAP began stockpiling locally sourced medical supplies and pharmaceuticals in the region two years ago as part of its five-year strategic plan, Zaru said. While his organization was able to supply partner hospitals for the first one-and-a-half months of the war, access has since been cut off, with his group unable to send even one ambulance to its warehouse for additional supplies.
Zaru said his group is exploring possible telemedicine and mobile service options to provide aid, but those avenues require access to electricity, which is becoming an increasingly scarce resource.
“The Israeli occupation telecommunication blackout is hindering residents in Gaza from accessing crucial lifesaving information, reaching out to first responders, and obstructing various forms of humanitarian response,” the Health Ministry’s report says.
Medical products such as insulin and blood are in extreme shortage. Lack of testing facilities has left infections undiagnosed, allowing pathogens to spread more easily.
The Biden administration says it is regularly urging Israel to allow an increased flow of humanitarian aid into Gaza.
Inquiries to the Israeli Embassy in Washington, D.C., regarding facilitating aid into Gaza were referred to the Israeli government’s office of Coordination of Government Activities in the Territories, which did not respond when reached for comment.
Rising infections, fear of outbreak
According to Amani Mustafa, country director of Women for Women International in Palestine, who is based in the West Bank, the lack of adequate clean water and safe sanitation has already led to disease outbreaks, including more than 161,000 cases of diarrhea, about 85,000 among children under 5 years old.
“The food situation is terrible, and the health situation is terrible. Our partner, Wefaq, in Gaza says there are thousands of female cancer patients who do not have access to medication and protection. There are people who suffer from kidney failure and have to undergo dialysis but don’t have access to dialysis services. Due to poor hygiene, cases of scabies, lice and skin rashes are increasing,” she told The Hill.
Mustafa added that other health conditions include acute respiratory infections and some 6,000 cases of chickenpox.
The health ministry reported more than 223,000 cases of acute respiratory illnesses and more than 55,000 cases of scabies and lice.
Without prompt intervention, concerns are growing that some type of mass outbreak could occur within Gaza — with unsanitary conditions the norm and nowhere to bury decomposing bodies.
“When people are dying and no one is burying them, what would happen as a result of that? Diseases, illness, right? And that’s the fear, is that we reach a point where all 2 million Palestinian people that live in Gaza Strip became part of some sort of pandemic, a new disease, a new virus, a new thing, because of, you know, because people are not taking care,” John Dabeet, president of the U.S. Palestinian Council, told The Hill.
In Rafah, a struggle to stay alive
An Israeli offensive on Rafah would further endanger millions of Gazans who have fled to the city for refuge.
According to Mustafa, more than 1 million Palestinians are crammed into Rafah at the southern tip of the Gaza Strip, on the border with Egypt. The health ministry estimates the city’s population density is currently at 12,000 per square kilometer.
“Many are living in tent camps and makeshift shelters after fleeing bombardments elsewhere in Gaza. People who moved to Rafah, which was considered a ‘safe’ zone, fear a possible ground invasion, which will be catastrophic, adding to the already dire humanitarian situation,” she added.
The Biden administration has delivered increasingly forceful warnings to ensure Israel comes up with an adequate safety plan for keeping citizens safe in Rafah, as concerns grow of a potentially huge loss of life in the city that could spark a new wave of pressure and condemnation of Israel’s war against Hamas.
Marie Clarke, the chief programs officer at Women for Women International, told The Hill that women who work with their partner in Gaza — Wefaq Society for Women and Child Care — have expressed concerns over their increasingly dire situation.
Israel launched an attack on Rafah last week as part of a rescue operation to free two hostages taken captive during the Oct. 7, 2023, attack.
Amnah, a woman whose name has been changed to protect her identity, told The Hill of the chaos she experienced among those temporarily living in a Rafah refugee camp, as they heard bombs dropped from Apache jets.
“Everyone around our home living in tents got out of their tents and started screaming. It was a vision of fear and people running for their lives,” she said via a WhatsApp voice note.
“We are living a life where we breathe and eat just to stay alive. People leave their fates between the hands of God,” she added.
US funding freeze compounds pain
Compounding the problem of aid reaching Gaza is the recent allegations by Israel that 12 employees working for the UNRWA were involved in the Hamas Oct. 7 attack that killed about 1,200 people in Israel. Another 240 people were taken hostage; about half who remain in Hamas captivity.
The U.S. government — the largest donor to UNRWA — halted funding to the agency last month in response to the allegations, crippling the group’s ongoing aid efforts.
Al-Kaila, who worked for UNRWA for 17 years, called on the U.S. to revise its decision, arguing it cannot halt funding due to claims that have yet to be confirmed. Al-Kaila noted more than 30,000 people both in Palestinian territories and abroad are employed by UNRWA.
“They are doing a collective punishment for the refugees who are living in a very difficult situation and who are economically very poor,” she said.
“I think they should revise their decision and they should look for it in different angle, in the humanitarian angle.”
At a press briefing last month, White House national security communications adviser John Kirby said the White House needed to hold bad actors with UNRWA accountable, despite the work the larger organization is going.
“They have helped save literally thousands of lives in Gaza. They do important work. Doesn’t mean that there aren’t some folks in that group that — that need to be punished for, potentially, these kinds of behavior. But that doesn’t impugn the entire organization,” Kirby said.
The Hill has reached out to the White House about the impact of its freeze on UNRWA funds and plans moving forward. Secretary of State Antony Blinken addressed the impact of the decision earlier this month.
“We know that the work that UNRWA performs, the functions that it performs, have to be preserved because so many lives are depending on it,” he said. “And so going forward, we’re going to look to the actions that are taken. And as I said, it’s imperative that the functions be preserved.”
However, Anera’s Carroll said there is no feasible replacement for what UNRWA provides.
“There’s no agency or really any collection of agencies that can replace UNRWA,” he said. “They’re the largest service provider, the largest employer — and in the middle of war when not enough aid is getting to the people who need it, UNRWA can’t have its capacities cut out from under it.”
