After 11 days of fighting between Israel and Hamas, the day-old ceasefire continued to hold on Saturday, but health officials in Gaza and international aid organizations now fear that another crisis is about to hit residents of Gaza in the form of a new wave of coronavirus cases. If so, it couldn’t come at a worse time: Gaza’s already inadequate health system is currently overwhelmed by multiple simultaneous health emergencies, and 98 percent of the 2 million Palestinians who live in Gaza have not yet been fully vaccinated against COVID-19.
Though both Israel’s government and Hamas have declared victory after the ceasefire, the conflict may have given the coronavirus the upper hand. Tens of thousands of Gazans sought refuge in shelters, community centers, and with neighbors amid hundreds of Israeli airstrikes during the conflict, and it’s not yet clear how many may have been exposed to people infected with COVID-19 while doing so, and may not be anytime soon, thanks to limited testing capacity.
The brutal bombing campaign killed at least 248 people in Gaza, including 66 children. More than 1,900 Gazans were also injured, and those patients have swamped the already overmatched health system in Gaza, which is perpetually understaffed, underfunded, and undersupplied — and where hospitals were at capacity with coronavirus patients before the fighting even began. Twelve people in Israel, including two children, were killed by rockets launched by Hamas.
In addition to destroying or damaging some 14,000 residences, Israeli airstrikes also damaged critical infrastructure in Gaza, cutting water supplies for 40 percent of residents, causing widespread power outages and shortages that have affected hundreds of thousands — and damaging or hobbling dozens of health-care facilities. Reports Reuters:
[During a U.N. briefing on Friday, World Health Organization spokeswoman Margaret Harris] called for immediate access for health supplies and personnel into the Gaza Strip, where nearly half of essential drugs are exhausted, and the establishment of humanitarian corridors. “The real challenges are the closures. We need entry of medical supplies,” she said in reference to border crossings.
On Gaza, which was heavily bombed by Israel during the conflict, Harris said 30 health facilities had been damaged and that road damage was obstructing ambulance access. Nearly all hospitals there were only partially operational and two were not functioning at all.
Gaza’s only COVID-test-processing lab was damaged and temporarily shut down on Monday by an Israeli airstrike on a neighboring building in Gaza City. The lab resumed operations on Thursday, and nearly 37 percent of the 547 tests it processed through Friday were positive.
Health officials in Gaza are concerned that COVID-19 is now spreading rapidly thanks to the conflict. Dr. Shadi Awad — who runs respiratory care at Gaza’s primary health-care center, al-Shifa hospital — told the Washington Post that displaced Gazans “had no choice” but to stop social distancing while sheltering from the bombardment:
Awad has been watching with alarm as a backlog of Gazans with coronavirus symptoms are able to come in for help now that they can safely leave their homes. On Friday, his staff recorded 40 positive cases of 50 people tested, nearly filling his isolation unit and the critical care beds.
The physician spoke in the courtyard of the sprawling hospital compound. Scattered everywhere was the detritus of the recent mayhem: uncollected garbage, empty IV bags, tubes and spent syringes. The ever-present buzz of an Israeli surveillance drone overhead was evidence that although the fighting was over for now, the tensions endured.
Early in the bombardment, the hospital evacuated its critical covid-19 patients to other treatment centers to make space. Now, the coronavirus wards are filling again, and the hospital is having to move equipment from one department to another to meet the need.
The hospital’s head of internal medicine and one of the leaders of Gaza’s pandemic response, Dr. Ayman Abu al-Ouf, was killed along with 12 members of his family when their apartment building collapsed following an Israeli airstrike last Sunday. Another colleague, Dr. Haya Agha, told the BBC last week that his death was “a catastrophe.”
“He took on the load of three or four doctors … and he was so hardworking that we thought he was invincible,” she explained. Dr. Abu al-Ouf supervised a ward of patients with severe COVID at the hospital. Added Dr. Awad, “He was lucky not to be killed by corona, and then he was killed by an airstrike.”
Gaza had suffered a surge of new COVID cases and deaths in April, likely due to the spread of the more transmissible B.1.1.7 variant, though the number of new infections confirmed per day had dropped down before the recent conflict. Now another, perhaps far-worse spike looms, not just because of the recent chaos and destruction, but also because so few Gazans have been vaccinated. While Israel is a world leader in COVID vaccinations, with more than 56 percent of Israelis now fully vaccinated, Gaza’s vaccine rollout is still barely off the ground. Less than 2 percent of the 2 million people living in Gaza have been fully vaccinated as of this past week, and only about the same amount have received their first dose. (Nearly 5.5 percent of Palestinians in Gaza and the West Bank have had at least one dose.) Enormous challenges remain, as the New York Times noted Saturday:
Michael Lynk, the U.N. special rapporteur on Palestinian human rights, said preserving vaccine access was crucial in Gaza, where inoculations were temporarily halted by the fighting. Gaza remains highly vulnerable to an outbreak, with less than 4 percent of its population fully or partially vaccinated. That’s far below the 60 percent in Israel, one of the highest rates in the world.
“Israel is the occupying power in the West Bank and in Gaza, and it has very strict obligations,” Mr. Lynk said. He said the United Nations has reminded Israel of those obligations.
Getting vaccine supplies into the territory has been hard enough. Gaza lacks funds to buy the doses, and although the territory is supposed to get aid from Covax, the global vaccine sharing program has been slow to deliver them. Recently, the Chinese government has said that it would donate doses to the U.N. agency that focuses on aid to Palestinian refugees.
As a report in the Lancet noted two weeks ago, Israel has denied rights groups’ assertions that it is responsible for public health of Palestinians in Gaza and the West Bank, and has only worked to vaccinate Palestinians who work in Israel or live in Israeli settlements (despite the fact that vaccinating Palestinians is quite obviously an epidemiological necessity). But even if COVID vaccines were more widely available, the Lancet report notes, more than half of Gazans may not take them:
Gaza has received more than 100,000 doses of vaccines from Russia, United Arab Emirates, and the international COVAX program, but vaccine hesitancy is high. 54.2 percent of the population said they would not accept a vaccine, according to a survey on April 21, by the Jerusalem Media and Communications Centre. “The reluctance of many, including medical staff, to be vaccinated remains a key concern,” the U.N. Office for the Coordination of Humanitarian Affairs said in its March situation report released on April 12.
Still, vaccinating more than 45 percent of Gazans would make a huge difference in preventing death and illness, and take at least some of the pressure off Gaza’s health system. But it will likely be a long road to get even there — particularly when the roads now need to be rebuilt.