ocha gaza impact of two years of blockade

8/11/2019 OCHA Gaza Impact of Two Years of Blockade

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UNITED NATIONSOf ce for the Coordination of Humanitarian Affairsoccupied Palestinian territ ory

SPECIAL FOCUSAugust 2009

P. O. Box 38712 East Jerusalem 91386 l tel. +972 (0)2 582 9962 l fax +972 (0)2 582 5841 l [email protected] l www.ochaopt.org

LOCKED IN :T HE HUMANITARIAN IMPACT OF TWO YEARS OF BLOCKADE ON THE G AZA STRIP

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Building in north Gaza demolished during Cast Lead

This report documents the humanitarian impactof the blockade imposed by Israel since June 2007on the 1.5 million people living in the Gaza Strip.It focuses on the e ff ects of the import and exportrestrictions and the travel ban to and from Gazaon livelihoods, food security, education, health,

shelter, energy and water and sanitation. Thereport also describes how the recurrent cycles ofviolence and human rights violations, stemmingfrom the Israeli- Palestinian con ict and Hamassrule over Gaza, have compounded the su ff ering ofthe population in Gaza.


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SPECIAL FOCUS August 2009UN OCHA oPt

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Following the Hamas takeover of the Gaza Strip in June 2007, Israel has imposed an unprecedented blockade on all border crossings in and out ofthe Gaza Strip. 1 The blockade has locked in 1.5million people in what is one of the most densely

populated areas on earth, triggering a protractedhuman dignity crisis with negative humanitarianconsequences. At the heart of this crisis is thedegradation in the living conditions of thepopulation, caused by the erosion of livelihoods andthe gradual decline in the state of infrastructure, andthe quality of vital services in the areas of health,water and sanitation, and education.

The blockade, now in its third year, has takenplace alongside recurrent cycles of violence andhuman rights violations, stemming from the Israeli-Palestinian con ict and Hamass rule over Gaza.The denial of Palestinians right to leave Gaza, orto move freely to the West Bank, particularly whentheir lives, physical integrity, or basic freedomsare under threat, is another key component of thecurrent human dignity crisis. This denial had adevastating impact during Israels Cast Leadmilitary o ff ensive, launched on 27 December 2008,contributing to the signi cant loss of civilian lifeand the large number of seriously injured andtraumatized people as a result.

The three week-long Israeli o ff ensive also involvedthe widespread destruction of homes, infrastructureand productive assets. The ongoing restrictions onthe movement of people and goods to and fromGaza through the crossings has limited the ability

of all relevant actors to address the immense needsand challenges that emerged as a result of the mostrecent military o ff ensive.

Over the past three months, Israel has allowedentry into Gaza of a small number of truckloadscarrying goods previously prevented from entering,including limited construction, water, sanitationand education materials. While these are welcomesteps, their actual impact when compared to thecurrent level of needs in Gaza remains negligible.

This blockade has been characterized by the UNsmost senior humanitarian o ffi cial, John Holmes, asa form of collective punishment on the entire Gazanpopulation. 2 The UN, the ICRC, many states andhumanitarian organizations have repeatedly urgedthe Government of Israel to remove the restrictionson Gazas borders; to allow free access to agriculturalareas within Gaza, and to allow unrestricted shingin Gazas territorial waters. 3 These are the urgent rststeps needed to start the reconstruction of homesand infrastructure, the revival of the economy andthe restoration of human dignity in Gaza.

The closure of Karni, the largest and best equipped commercial crossing with the exception of aconveyor belt used for the transfer of grains.

Sweeping restrictions on the import of industrial, agricultural and construction materials.

The suspension of almost all exports.

A reduction in the amounts of industrial fuel (used to operate Gazas sole power plant), benzene,diesel and cooking gas allowed entry.

A general ban on the movement of Palestinians through Erez, the only passenger crossing to the WestBank, except for limited numbers of humanitarian cases.

The closure of the Rafah Crossing, directly controlled by Egypt, except for intermi t ent openings.

A signi cant reduction in the shing areas and farming land accessible to Palestinians.

Restrictions on the transfer of cash to banks in Gaza.

THE BLOCKADE IMPOSED IN JUNE 2007 INCLUDES:

EXECUTIVE SUMMARY


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The devastation of livelihoodsThe lack of essential imports, including raw

materials, coupled with the ban on exports,has decimated economic activity in the privatesector and resulted in the loss of approximately120,000 jobs. Over 40 percent of Gazasworkforce, or more than 140,000 people, arecurrently unemployed.

The local market has been saturated withpreviously exported agricultural products(mainly cut owers, strawberries and cherrytomatoes), reducing the income of producers.Approximately 3,500 households werenegatively impacted by Israeli-imposedrestrictions on shing in the sea of Gaza. Suchrestrictions signi cantly reduced the volumeof the shing catch and subsequent income of shermen in Gaza.

Rising food insecurity:

Approximately 75 percent of Gazas population(more than 1.1 million people) is food insecure,

up from 56 percent in the rst quarter of2008.4 The main causes of food insecurityare the increase in poverty, the destruction ofagricultural assets and the in ation in prices ofkey food items.

There has been a gradual shi f in the diet ofGazans from high-cost and protein-rich foodssuch as fruit, vegetables and animal products,to low-cost and high carbohydrate foods such

as cereals, sugar and oil, which can lead tomicro-nutrient de ciencies, particularly amongchildren and pregnant women.

Physical insecurityThe reported number of Palestinian fatalitiesduring Cast Lead ranges from 1,116 (IDF)to 1,455 (Palestinian Ministry of Health inGaza). Based on the cross-checking of multiplefatality lists, OCHA has identi ed the records

of 1,383 Palestinians, including 333 childrenwhose death was con rmed by at least two

independent sources; a signi cant proportionof these fatalities were civilians not involved inthe hostilities.

At least 360 people were killed since 15 May2007 (one month before the Hamas take over) inthe context of inter-factional violence. Individualssuspected of a ffi liation with opposition factionshave allegedly been the victims of arbitraryarrests, torture and extra-judiciary executions.

Inability to reconstructThe ban on the import of building materials hasprevented the reconstruction of most of the3,540 homes destroyed and the 2,870 homesseverely damaged during the last militaryoff ensive. No new construction for 7,500planned housing units to cater for Gazas rapidlyexpanding population has been possible due tothe lack of building materials available in Gaza.

More than 20,000 displaced people are forcedto continue living in rented apartments, in thehouses of relatives and in tents next to theirdamaged houses. Additionally a small numberof families continue to live in tented camps.The lives of these displaced families have beendisrupted with children being among the worstaff ected.

A protracted energy crisisThe reduction in the amounts of industrial fuelallowed entry has forced Gazas sole powerplant to reduce its level of production, creating

a 15-20 percent electricity de cit. Ninetypercent of the population currently experiencescheduled electricity power cuts of 4-8 hours aday. The remaining 10 percent have no electricitysupply due to the lack of construction materialsneeded to maintain and repair the network.

In the extreme heat of summer, families areforced to leave food without refrigerationfor hours; public institutions have to relyextensively on backup generators, causing

problems as a result of the inconsistent supplyof spare parts.

Two years of blockade in Gaza has resulted in:


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The deterioration of water andsanitation infrastructure

Some 10,000 people in northern Gaza still donot have access to running water due a lack of

available building materials to maintain andupgrade the water network.

As a result of the lack of adequate maintenanceand upgrading of the wastewater infrastructure,80 million liters of raw and partially-treatedsewage are being discharged daily into theenvironment. This has led to a further pollutionof the sea and underground aquifer, creatingserious health concerns; only 5-10 percent of the

water extracted from Gazas aquifer meets theWHO safety standards.

A challenged health systemFollow-up treatment for people su ff ering fromcomplex injuries and permanent disabilitiesin icted during the most recent Israeli o ff ensivehas created an enormous burden for a healthsystem weakened by shortages of facilities,

equipment, and drugs. The inability of medicalstaff to upgrade their knowledge and skillsdue to the continued travel restrictions hassigni cantly undermined the quality of healthservices in Gaza.

Patients in need of specialized treatment outsideGaza must go through an arduous and uncertainprocess to obtain the necessary permits requiredto leave Gaza, adding considerable anguish andstress to patients lives. Since January 2008, 40percent of the applications for permits to leaveGaza were rejected or delayed, compared toapproximately 10 percent in 2006.

Education underminedOver-crowding of schools as a result of theinability to expand and repair existing facilities,compounded by the recurrent shortages ofeducational materials delayed or deniedentry at the crossings, and frequent electricitypower cuts have contributed to a decline inschool a t endance and performance. In the rst semester of the 2007-2008 school year only20 percent of sixth graders in Gaza passed

standardized exams in math, science, Englishand Arabic.

Most students are prevented from accessinguniversities outside of Gaza due to the strictcriteria imposed by the Israeli authorities inrelation to the authorization of permits forstudents to exit Gaza as well as the limitedopenings of the Rafah crossing. For example between July and September 2008, prior to

the beginning of the last academic year, only70 students managed to leave the Gaza Stripthrough Israel to a t end universities outsideGaza.

Displaced child in northern Gaza. April 2009

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The already weakened economy of Gaza hasdrastically deteriorated during the past two years.According to the Palestinian Central Bureau ofStatistics (PCBS), in the rst quarter of 2009 over140,000 Gazans, willing and able to work, wereunemployed, constituting 41.5 percent of Gazasworkforce, up from 32.3 percent in the secondquarter of 2007; 5 unemployment among those lessthan 30 years of age reached almost 60 percent. 6 While these gures are among the highest acrossthe world, actual unemployment rates may beeven higher, as PCBS records workers who werenot formally laid o ff , but do not work and do notreceive salaries as temporarily absent employees,rather than classifying them as unemployed.The inability of the unemployed to sustain theirlivelihoods is a key factor contributing to theongoing human dignity crisis in Gaza.

The private sector has been devastated by the blockade. According to the Palestine Trade Center(PalTrade), since the imposition of the blockadean estimated 120,000 private sector jobs have been

lost, including jobs in the industrial, commercial,construction, agricultural and service sectors. 7 Anumber of coping mechanisms that have evolvedsince the imposition of the blockade, mainly theexpansion of the public sector by the Hamasauthorities and the growth of the tunnel economy(see below), have partially compensated for theloss of these jobs and prevented an even morepronounced increase in unemployment.

An ICRC household survey conducted in May 2008,af er nearly a year of blockade, indicated that over

70 percent of the surveyed families were living onan income of less than one dollar a day per person,and up to 40 percent of the families lived with lessthan 0.5 dollars a day per person (excluding thevalue of humanitarian assistance). 8 As elaboratedin this report (section II), the rise in poverty has hada negative impact on the level of food security andnutritional status of the population.

Import and export restrictionsDuring the two years following the imposition ofthe blockade, the daily average of truckloads ofgoods entering Gaza (112) was reduced to less thanone f h of the comparable gure for truckloadsentering in the rst ve months of 2007 (583). 9 Approximately 70 percent of imports during thisperiod consisted of food products, while mostindustrial, agricultural and construction materialswere either prohibited or severely restricted. Theimpact of these prohibitions and restrictions has been compounded by the absence of clearly de nedprocesses used by Israel for the authorization ofimports.

Prior to the blockade, 95 percent of the inputs used by Gaza manufacturers were imported throughthe crossings with Israel. 10 There are currentlyan estimated 1,700 commercial containers withimported goods on hold in warehouses in Israeland the West Bank, some since the beginning ofthe blockade, causing an estimated loss of US $10million, including freight container charges andstorage fees.

Exports were almost totally banned in the pasttwo years, with the exception of 147 truckloads of

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The systematic destruction of livelihoods

Graph 1: Daily average of imported truckloads


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cut owers and strawberries allowed out of Gaza,compared to a monthly average of 1,090 truckloadsexported during the rst ve months of 2007 to theWest Bank, Israel, and Europe. Even if manufacturers

were able to overcome the import restrictions, manysectors were dependent on the ability to export theirproducts; for example, previous goods regularlyexported from Gaza included 76 percent of allGaza-manufactured furniture products, 90 percentof garments and 20 percent of all food products. Asa result, 95 percent of the industrial establishments,or 3,750 establishments, were forced to shut downand the remaining ve percent were forced toreduce their level of activity. 11

The agricultural sector, which is the source oflivelihood to approximately 40,000 farmers, shermen, herders, and farm laborers has also beenaff ected by the blockade. 12 Essential materials suchas certain pesticides, seedlings, livestock, fuel, andspare parts for irrigation systems have been largelyrestricted since the imposition of the blockade,impacting on the level of overall agriculturalproduction. 13 The ban on exports has resultedin saturation of the local market with previouslyexported items (strawberries, cherry tomatoes,

green peppers and cut owers) pushing their pricesdown and reducing the income of 5,000 farmers and10,000 farm laborers. 14 As a result of the saturationin the market of previously exported agricultural

products some farmers have resorted to feedingtheir livestock with these products. 15

Cast Lead destruction

The state of the private sector in Gaza has beenfurther a ff ected due to the widespread destructionand damage incurred during the Cast Leadoff ensive. A comprehensive survey performed bythe Gaza Private Sector Council indicates that 268establishments were totally destroyed and 432

sustained damage, resulting in a combined lossestimated at US $139 million. 16 Forty percent ofthe a ff ected establishments (297) were industrial -small and medium size enterprises mainly in themanufactured food, textile, garment, furniture andplastic sectors, while the remaining 60 percent werecommerce, contracting, and fuel establishments.Though much of the damage was sustained byestablishments that had already shut down due tothe blockade, the recent damage means that these businesses will be unable to recover quickly onceconditions improve. 17

Gazan family in kitchen. Rafah Refugee Camp. May 2008

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The extent of damage caused to the constructionsector is signi cant in relation to the current lackof reconstruction capacity in Gaza. Twenty out of29 ready-mix concrete factories, as well as 39 otherconstruction-related establishments, were damagedduring the con ict, causing a loss of 70 percent ofthe sectors capacity and an estimated loss of USD$27 million. 18

In addition, the most recent Israeli military operationresulted in the widespread loss of productiveagricultural assets with an estimated direct lossof USD 180 million and an indirect loss over a sixmonth period of USD 88 million. 19

Access restrictions to land and sea

Farmers and herders working in areas that are inclose proximity to the Israeli border have facedextreme di ffi culties in continuing to farm their landas a result of restrictions imposed by the Israeli

military when they try to access agricultural landin this region. Following Israels disengagementfrom Gaza in August 2005, the IDF created a socalled bu ff er zone on a 150 meter-wide strip ofland along the border, where Palestinian accessis prohibited. 20 Warning shots are regularly redtowards Palestinian farmers working their land. 20 This bu ff er zone was o ffi cially expanded on 23

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Nahal Ozfuel pipeline

Kerem Shalom 0 4 82Km

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Former Israeli SettlementGreen houses

Refugee Camp

Built-up area

Open six days for international aidworkers,medical and humanitarian cases

Closed since June 11, 2007. Grainconveyor belt operational three daysa week. Cement lane completely

closed since Oct 29, 2008.

Partially open on five days aweek for limited types of fuels

No longer a crossing pointaccording to COGAT, Lastopen on 12 Sep 2008

Open on six days a weekfor limited movement of authorized goods

Open on ad hoc basis


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May 2009, when Israeli air force planes droppedthousands of pamphlets over di ff erent parts of theGaza Strip warning the population to maintaina distance of at least 300 meters from the borderwith Israel. Reports from Gazan farmers indicate

that access restrictions are occasionally imposed onagricultural areas as far as 1,000 meters from the border, on an ad hoc basis. As was previously thecase, access prohibitions are enforced by IDF troopspatrolling the border by means of opening warning re in the direction of the people present in theseareas. Since the imposition of the blockade, OCHAhas recorded 33 Palestinian civilians, including 11children, killed in border incidents and another61 people, including 13 children who have been

injured.

The Abu Eida family is an extended refugee family comprising 83 people, who prior to the last Israelioff ensive lived in 11 houses in an industrial zone (Izbet Abu Eida), east of Gaza City, approximately one

kilometer from the Israeli border. The family owned and operated two concrete factories, a citrus fruitpacking factory, 28 commercial and private vehicles, two farms, numerous fruit trees and livestock.

Following the onset of the Israeli ground o ff ensive, heavy gun re and intense military activity forcedthe family to leave the area without their belongings. When they returned, the family found that most oftheir property had been destroyed: ten of the 11 houses, as well as the two concrete factories, were almosttotally destroyed; all the livestock had been killed; the citrus, date and olive trees had been uprooted; andthe citrus packing factory was severely damaged. As a result of the extensive damage incurred duringCast Lead direct losses were estimated at several million dollars.

The family is now sca t ered in rented apartments throughout northern Gaza, fragmenting vital familyand social support networks. According to Yousef Abu Eida, one of the Abu Eida family heads, thechildren have been particularly a ff ected by the separation, with some su ff ering from depression andother related problems. While they continued to a t end their normal schools following Cast Lead, in thecoming school year, they will be relocated to new schools in closer proximity to their current alternativeaccommodation, which is likely to cause them further stress. Like many people in Gaza, the family ishaving di ffi culty coming to terms with the grave losses they have su ff ered and feel a considerable senseof anxiety regarding prospects for the future.

The Abu Eida family hopes to reopen part of the family business in the near future. In order to do so, it hascleaned up parts of the damaged sites, sold some land, and taken loans from other businessmen in order

to nance the resumption of business in the future. One production unit of the concrete-making factories,which was less damaged, has been repaired and is now ready to operate, provided that the import ofcement resumes in the near future.

DEVASTATED FAMILIES AND LIVELIHOODS: THE CASE OF THE ABU EIDA FAMILY

Similar restrictions have a ff ected the livelihoods ofapproximately 3,500 households reliant on shing.Since the beginning of Cast Lead, the IDF hasprohibited Palestinians from shing beyond threenautical miles (nm) from the shore, undermining the

volume of shing catch, the bulk of which is locatedin deeper waters than 3 nm. 21 This prohibitionfollowed a previous reduction of the shingzone in October 2006 from 12 to 6 nm. 22 Many shermen have been forced to adopt alternativestrategies, such as shing with smaller nets in the3nm accessible zone to try to catch smaller sh (e.g. baby sardines); for others the current situation has become unsustainable causing them to cease shingaltogether.


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The total shing catch in April 2009 amounted to79mt, which represents one third of the amount of

sh available in the market place in April 2007.23

The reduced supply resulted in a sharp rise in theprice of sardines, the most popular and a ff ordabletype of sh in the market; in May 2009, the priceranged between NIS 23-25/kg compared to NIS 10-12/kg the previous year. 24

Restrictions on the entry of cash intoGaza 25

The Palestinian Monetary Authority (PMA)estimates that the 43 banks branches in Gazarequire approximately NIS 200 million a monthto meet regular needs, while additional amountsare required by international agencies, such asUNWRA, to fund their operations. As part of theongoing blockade, the Israeli authorities have notallowed regular shipments of cash from West Bank banks to their branches in Gaza, creating a de citof shekel notes available. This has resulted in banksonly allowing partial payments and limits on single

day withdrawals of cash. This shortage of cash hashad serious consequences on the Gaza economy.

The salaries of Palestinian Authority (PA) sta ff arepaid electronically and the lack of available cashhas restricted employees from withdrawing theirsalaries. The lack of shekels has led to a partialdollarization of the economy in Gaza; publichoarding of cash; and has caused a shi f away fromthe formal banking system. According to The WorldBank, this reduces banks pro tability and threatensthe con dence of the entire banking system. Italso reduces the PMAs e ff orts to combat moneylaundering, which largely bene ts groups withaccess to cash from outside the banking system.

The tunnel economyThe tunnels situated under the border with Egypt,largely regulated by the Hamas authorities, haveprovided access to goods that would otherwise

be unavailable. Almost all possible goods arereportedly transferred through them, includingconstruction materials, livestock, fuel, cash, foodproducts and weapons. While de nitive statisticsare unavailable, various sources have estimatedthat the number of tunnels in operation is between400 and 600. 26 Thousands of people are employedin the transfer of goods through the tunnels, theconstruction and maintenance of tunnels, and othertunnel-related economic activity. Human rightsgroups have raised concern over the employmentof children in the tunnels. 27

While the tunnels have provided some short-termrelief to the blockade, increasing the availability ofcertain items in the Gazan market place, the tunnelsdo not constitute a long term sustainable alternativeto the resumption of movement of goods throughthe offi cial crossings with Israel. In addition, thetunnels pose high safety risks for those employedin this activity; since June 2007 at least 85 peoplehave died in tunnel accidents, mainly following thecollapse of tunnels and electrocution, and another144 people were injured. 28

Food Insecurity

Graph 2: Total shing catch in tonnes

Preliminary estimates indicate that in the a f ermathof the Israeli o ff ensive 75 percent of Gazaspopulation, or more than 1.1 million people, werefood insecure, up from 56 percent in the rst quarterof 2008 and 53 percent in 2006. 29 Food insecurity

exists when people lack sustainable physical oreconomic access to adequate safe, nutritious andsocially acceptable food to maintain a healthy andproductive life. 30


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The erosion of livelihoods, particularly thedestruction of agricultural land and assetsduring the con ict, is the primary cause for thesharp increase in food insecurity. The impact ofthese factors has been further compounded by the

in ation in food prices, which have made some basic food products una ff ordable for the pooresthouseholds; between May 2007 and May 2009, theConsumer Price Index for food in Gaza increased by 33 percent. This has been triggered by a globalincrease in food prices, and by the ongoing importrestrictions imposed by the Israeli authorities.These restrictions created large gaps in the supplyof certain products in the market, which have beenonly partially mitigated by the transfer of foodproducts through the tunnel system.

Since the imposition of the blockade, foodcommodities have made up over 70 percent of thetruckloads of imports entering Gaza. However,many food products have been restricted duringthat period, leading to sharp price uctuations.Harsh restrictions on the import of livestock, forexample, imposed by Israel since November 2008,led to a steep increase in the price of fresh meat,

from 40 to 60 NIS/kg. Although limited numbers ofcat le and small ruminants have been transferredthrough the tunnels, many of these animals have been diseased causing health risks, made worse bythe inconsistent veterinary vaccinations available inGaza as a result of the blockade. 31

During the past two years, some basic food itemswere totally unavailable due to the closure of thecrossings. For example, during most of the twomonths that preceded Cast Lead, the Israeliauthorities closed the conveyer belt at the Karnicrossing, which is the only available mechanismfor the import of wheat grain. This resulted in thecomplete depletion of wheat stocks and caused thetemporary closure of all six mills in the Gaza Strip;in mid-December 2008, UNRWA was subsequentlyforced to halt its food distribution programme for therest of the month. The lack of wheat our, coupledwith a severe shortage of cooking gas, also caused

many bakeries to gradually shut down and createda shortage of bread that lasted from late Decemberuntil the end of January 2009. People were forced towait in lines for many hours at bakeries during thistime, and bread products were rationed as a result

of the shortage of fuel and wheat.An Israeli government decision adopted on the 22March 2009, to allow the unrestricted entry of foodproducts into Gaza, once the source was cleared by the Israeli authorities, remains unimplemented.As a result, some food items are still not allowedentry, including beverages, certain types of cannedfood, co ff ee, and certain brands of baby formula. Bycontrast, in recent months there has been an increasein the amounts of most staple foods enteringthrough the crossings, alongside a parallel increasein the transfer of food products through the tunnels,increasing the overall availability of these items inthe market.

Approximately 1.1 million people are currentlyreceiving food aid from humanitarianorganizations, primarily UNWRA and the WFP.Due to this ongoing food aid intervention, it iscurrently estimated that overall, the majority of

people consume the recommended daily caloricallowance in their diets. However, a UN surveyfrom 2008 indicated that reducing the quality andvariety of the food consumed was one of the maincoping mechanisms used by most of the populationaff ected by unemployment and poverty; in thiscontext, there has been a gradual shi f in the dietof Gazans from high-cost and protein-rich foodssuch as vegetables and animal products, to low-costand high-carbohydrate foods such as cereals, sugarand oil. 32 This shi f is a possible contributing factor behind the high number of overweight children(15.9 percent) aged 6-16 years old, as recorded in arecent survey, a phenomenon usually triggered bya poor and unbalanced diet. 33 In the future thesechanges in diet are likely to be re ected in increasedrates of micro-nutrient de ciencies, with childrenand women of child-bearing age being the worst-aff ected.


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During the past two years in Gaza there have beenprotracted cycles of violence and a continueddisregard for the basic norms of internationalhumanitarian and human rights law which providefor the protection of civilians and the respect ofcivil liberties. The denial of the right of the peopleliving in Gaza to leave Gaza or to move freelywithin the West Bank as a result of the blockade,particularly when their lives, physical integrity,or basic freedoms are under threat, is another keycomponent of the current human dignity crisis.

While most casualties during the past two years

occurred in the context of the Israeli-Palestiniancon ict, the inter-Palestinian factional con ictconstitutes another continuous source of insecurity.Additionally, a recent UN survey highlighted anincrease in the prevalence of domestic violencefollowing the Cast Lead o ff ensive which hasadded to the overall state of insecurity a ff ecting thepeople of Gaza. 34

The Israeli -Palestinian con ictIsraeli-Palestinian violence has uctuated inintensity over the past two years but has nevercompletely ceased. During the period of the blockade there were two extreme escalations as aresult of Israeli military operations: Operation HotWinter (27 February - 4 March 2008) and Operation

Cast Lead (27 December 2008 - 18 January 2009).There was also one period of relative calm (19 June- 4 November 2008) that occurred in the context ofa cease re brokered by Egypt. Currently there arestill some incidents of sporadic violence: overallhowever there has been a signi cant reduction inIsraeli-Palestinian violence in Gaza and SouthernIsrael since the unilateral cease res declared byIsrael and Hamas on 18 January following the endof Cast Lead.

Overall, in the two years that followed the impositionof the blockade (15 June 2007 - 15 June 2009), a total

of 2,008 Palestinians were killed and approximately6,700 people were injured. In the same period, atotal of 25 Israelis were killed and 586 were injuredinside Gaza and in towns in southern Israel. 35

The Cast Lead o ff ensive, constituted one of themost violent episodes in the recent history of theoccupied Palestinian territory. 36 The reportednumber of Palestinian fatalities during the o ff ensiveranges from 1,116 (IDF spokesperson) to 1,455(Palestinian Ministry of Health in Gaza). Based on

the cross checking of multiple fatality lists, OCHAhas veri ed the records of 1,383 Palestinian deaths(see page 12). Overall Cast Lead accounts fortwo thirds of the Palestinian fatalities and almost80 percent of injuries since June 2007. The almosttotal closure of the borders, coupled with a lack ofearly warning systems or bomb-shelters, denied

Pervasive insecurity and lack of civilian protection

Flash Appeal & Consolidated Appeal: The Gaza Flash Appeal was launched on 2 February 2009, as partof the emergency response to the needs identi ed in Gaza a f er the Cast Lead o ff ensive. The FlashAppeal was subsequently incorporated into the 2009 Consolidated Appeal (CAP). As part of the Mid Yearreview of the CAP, all projects were reviewed and revised a f er subsequent in-depth needs assessmentshad been completed. By the end of April 2009, US $254 million had been pledged for Gaza projects,representing 40 percent of speci ed needs for Gaza in the 2009 CAP. The ongoing blockade has preventedthe implementation of a large number of projects.

The Humanitarian Response Fund (HRF) has approved, since the beginning of 2009, 26 projects in the GazaStrip amounting to US $4.2 million. The capacity of the HRF to meet critical needs was demonstrated in

its quick response to the emergency situation in Gaza.

HUMANITARIAN RESPONSE


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the civilian population any refuge during threeweeks of almost uninterrupted aerial and sea bombardments, artillery shelling, and groundoperations. The reported use by the Israeli militaryof white phosphorus munitions, heavy artillery and eche t e shells in a t acks carried out on denselypopulated areas, increased the level of risk faced bythe civilian population. 40 Military operations alsoseriously impeded the ability of rescue teams toevacuate the wounded, resulting in numerous caseswhere wounded civilians had to wait several daysin the streets or under the rubble of their houses. 41

A signi cant proportion of the Palestinians killedduring the o ff ensive were civilians who did nottake part in the hostilities. However, the precise gure remains disputed. The list of casualtiespublished by the two leading Palestinian humanrights organizations in Gaza indicate that civiliansconstituted between 73 and 83 percent of allfatalities. 42 The IDF spokesperson, however, hasreported that its information shows that the numberof civilians ranged between 25 and 39 percent of allPalestinian deaths. 43

The lives of approximately one million Israelisliving within a range of 40 km from the border ofGaza were disrupted and threatened as a resultof the continuous ring of rockets and mortars byPalestinian armed groups.

In addition to deaths and injuries caused directly bythe recent Israeli military operation, the populationof Gaza is also at risk due to a number of con ict-related factors, including the presence of unexplodedordnance (UXO) and other hazardous materials.UXO remaining a f er the Cast Lead o ff ensivehas posed a high risk to the entire population but

particularly to children, who are more prone to

come in contact with UXO when playing outside ordue to lack of risk awareness. According to UNICEFsince the Cast Lead cease res began on 18 January2009, there have been a total of twelve people killed(average age 17.5 years) from UXO, with 50 percent(six) of these fatalities being children. Twentythree people have been injured four of whomwere children. 44 There has been a continued andconcerted e ff ort by UN agencies and internationalNGOs to clear areas of UXO hazardous material,including training workshops delivered by UNMine Action teams on safety. In addition, the largeamounts of rubble as a result of Cast Leadcouldpotentially contain asbestos or other hazardouschemical substances, such as persistent and/or bio-accumulating carcinogenic substances, constituting

additional environmental and health risks.45

Inter-factional con ictIntra-Palestinian violence is another continuoussource of insecurity, heightening the overallvulnerability of the civilian population in Gaza. 46 In the month that preceded the Hamas take overof Gazas security apparatus (15 May -15 June2007), approximately 190 Palestinians were killedand 850 were injured as a result of inter-factionalviolence and related family feuds; 170 others werekilled and 1,130 were injured in the context of theintra- Palestinian violence in the following two yearperiod (15 June 2007 15 June 2009).

While the frequency of armed clashes betweenHamas forces and various opposition factionssharply decreased a f er the June 2007 take-over,Hamas has reportedly continued exercisingviolence to supress potential challenges to its rulein Gaza. In this context, there have been consistent

allegations made by human rights organizations

Since the beginning of 2005, OCHA oPt has maintained a Protection of Civilians Database, where alldeaths and injuries occuring in the context of the Israeli-Palestinian con ict are systematically veri edand recorded. As part of this ongoing project, based on the cross checking of multiple fatality lists, OCHAhas identi ed the records of 1,383 Palestinians whose death was con rmed by at least two independentsources. 37 These fatalities include 333 children under the age of 18 (including 236 boys and 97 girls),1,029 adults (including 919 men and 110 women) and 21 persons whose age could not be con rmed. 38 According to Israeli o ffi cial sources, 13 Israelis, including three civilians, were killed during the hostilities,and 512, including 182 civilians, were injured. 39

CAST LEAD FATALITY FIGURES: OCHAS DATABASE


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denouncing Hamass arbitrary arrest, ill treatmentand extra judiciary execution of people allegedlyaffi liated with opposition factions. 47 The PalestinianCentre for Human Rights (PCHR) in Gaza, forexample, reported that during the last Israeli

military off

ensive it documented the execution of32 Palestinians accused of collaborating with Israel,17 of whom were prisoners and detainees who edthe Gaza Central Prison a f er it was bombarded bythe Israeli Air Force on 28 December 2008. 48

In July 2008, following a bombing a t ributed toa faction a ffi liated with Fatah, which resulted inthe death of one child and ve Hamas members,Hamas forces raided and closed 210 community based organizations (CBOs), allegedly connected

to Fatah, con scated equipment and arresteddozens of employees. In the course of the followingmonths the majority of these organizations weregradually allowed to reopen; however the closuresof these organizations are estimated to have a ff ectedapproximately 50,000 bene ciaries participatingin various programmes, including psychosocial,special needs, childrens summer games andwomens health. Furthermore, the CBO sector hasfaced increased levels of restriction and monitoring

by the Hamas authorities, which has causedconcern about the overall ability of CBOs in Gazato continue providing independent and impartialcommunity services in Gaza. 49

Family ViolenceIn a recent UN survey conducted a f er Cast Leadmost respondents reported an increase in theprevalence of domestic violence against women, ascompared to before the war, with displaced womenviewed as being at heightened risk of gender basedviolence. Fi f y one (51) percent of men, 52 percent ofwomen and 57 percent of female-headed householdssurveyed also perceived violence against children tohave increased a f er the Cast Lead operation. 50

The survey indicated that violence against men ismore likely to be treated as a public crime, whileviolence against women is most likely to be treatedas a private family problem. Furthermore, concernwas expressed in the survey that there is a criticallack of legal and public mechanisms availableto male and female victims of social and politicalviolence in Gaza and an overall distrust of the legaland public avenues that do exist.

Area destroyed during the Cast Lead offensive, Rafah Refugee Camp. January 2009. P h o t o

b y U N I C E F

, - o P t / 2 0 0 9 / E l B a b a


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The prohibition on the import of constructionmaterials, including cement, gravel, wood,pipes, glass and steel bars is one of the centralcomponents of the blockade regime. Except fora short interval during the cease re brokered byEgypt (July-October 2008), almost no construction

materials were allowed into Gaza through theoffi cial crossings, compared to an average of 7,400truckloads imported every month between Januaryand May 2007. 51 According to the Israeli authorities,these restrictions are implemented against dualuse items, in order to prevent Hamas from usingsuch material for military purposes.

The most visible and urgent unmet need in Gazais the repair and reconstruction of homes damagedduring the last Israeli military o ff ensive. A jointUNRWA and UNDP housing survey showedthat 3,540 homes were totally demolished and afurther 2,870 homes sustained major damage. Inaddition to the 6,400 destroyed orseverely damaged homes, there are52,900 homes that sustained minordamages during the hostilities. Asof mid July 2009, approximately20,000 people previously livingin destroyed homes were still

displaced, and were either rentingapartments or living with relatives;an estimated 100 families wereliving in tents next to their damagedhomes, some of whom continueusing those parts of their homes thatwere less a ff ected. Approximately40 families are still residing in oneof the tent camps that have beenerected in northern Gaza.

The lives of displaced families have been severelydisrupted. Particularly those living in tents, eitherin camps or next to their destroyed homes aredeprived of the most basic facilities which wereavailable prior to their displacement. Anecdotalevidence suggests that children are among the

worst a ff ected by displacement, including manywho were relocated to alternative schools closer totheir place of alternative accommodation.

Shelter needs are not limited to the reconstructionof homes destroyed or damaged during the CastLead o ff ensive, and also includes approximately2,700 housing units that were damaged in previousIsraeli military operations; 1,800 housing units that by June 2007 were under construction by UNRWAand UNDP and could not be completed; and 3,000new housing units needed to replace substandardand unsanitary homes in refugee camps. As a result,the current number of housing units needing repair

Reconstruction of homes prevented; thousands offamilies still displaced

P h o t o

b y : P a t r i c k

Z o

l l ,

House constructed with mud bricks, Rafah. June 2009.

Possible factors behind the increase in domesticviolence include not only the unprecedented levelsof trauma and stress that emerged a f er Cast Lead, but also due to the growing number of male headsof households who lost their jobs as a result of the

blockade. In some instances, women who would nothave traditionally gone to work have been forcedto seek employment as a survival strategy, in orderto ensure the households security, placing addedtension in family relationships.


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A year ago, Manal Shubair, 35, lived in a large house with many rooms and modern conveniences, such as arefrigerator, washing machine and running water. Today, this refugee and mother of two a son aged nine anda 10-month-old daughter live in a small tent, with no running water and only a few blankets, two ma t resses,and some basic cooking utensils.

During the Cast Lead o ff ensive, Mrs. Shubair, the third wifeof a now unemployed blacksmith, le f her home north of GazaCity a f er lea ets were dropped by the Israeli military warningpeople to leave the area. The family took no possessions fromtheir home except white ags that they waved as they walked toan UNWRA school in Beach Camp to seek refuge. At the time, thefamily expected to return home shortly.

Once at the school, Mrs Shubair had to use ip chart paper thatshe found in a classroom as makeshi f blankets to cover her

children: I had nothing for my daughter, who was ve monthsat the time, and I could not keep her warm. The following day, food and blankets were distributed. Asincreasing numbers of people sought refuge at the UNWRA school, Mrs Shubair heard stories of widespreaddamage to houses in her community, and she gradually gave up hope of returning to a house that was stillstanding: We are grateful to UNWRA for providing us with food and water, but the conditions were verycramped and it was not home. We just yearned for home.

As soon as military forces had le f the area, the family returned to their home to nd that it had been at enedto the ground by rubble from a neighboring apartment building that had been directly hit by an Israeli militarystrike. Mrs Shubair husbands blacksmith business and assets were also completely destroyed. As a result, Mrs

Shubair took her children to stay at her sister s house. She registered with the local authorities and, two weeksaf er the cease re agreement, was told that she had been allocated a tent in the new tent camp in Al A t atra,several kilometers from her home.

The Shubair family has received nancial assistance from UNWRA and the local authorities, and continueto reside in the tent camp, in very di ffi cult conditions: The rst tent leaked and it was very cold, it was laterreplaced with a be t er tent, but it gets very hot and is full of ies. The camp has temporary, pre-fabricated bathrooms, one for women and one for men, and water supply is sporadic. Mrs Shubair buys water for herchildren to drink. Three times a week a PRCS team visits the camp. Two times a week an NGO delivers hotmeals of rice and lentils. On the other ve days the family has to make do with cold food, mainly bread andcanned food, which was delivered by humanitarian agencies in the months a f er Cast Lead.

Until the recent summer holiday, Mrs Shubairs nine-year-old son continued a t ending the same school, butthe distance proved a challenge as he had to walk a long distance to reach school each day. Mrs Shubairsson has been a ff ected in a range of other ways. According to Mrs Shubair, her son su ff ers from bedwe t ingand exhibits other psychological problems. His school work has su ff ered, his grades are lower and he isdisconnected from his friends.

Mrs Shubair no longer sees her friends and neighbors. Her social network and support system has brokendown and she believes that she no longer has an existence. My day starts with me hoping it will nish. I amworried and I dont know what the future will bring.

Mrs Shubair and her family are on the UNRWA shelter caseload list to have their house rebuilt. However, dueto the ongoing blockade of construction materials, there has been no reconstruction to date.

A FAMILY DISPLACED WAITING TO REBUILD

Manal Shubair, Al Attara tent camp

P h o t o

b y : C

h r i s t i n a

B l u n t

J u n e

2 0 0 9


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or replacement is 13,900, excluding the repair ofhomes that sustained minor damages.

Limited amounts of construction materials arereportedly being transferred through the tunnelsand are available in the Gazan market. However,the immense gap between current supply and actualneed for building resources has increased prices,making available materials una ff ordable for mostof the population. The current price of one tonne ofcement (3,400 NIS) is nearly ten times higher than theprice in June 2007 (350 NIS), before the imposition ofthe blockade. The shortage of construction materials

has been exacerbated since the Cast Lead o ff ensiveas a result of the damage incurred by constructionsector businesses, causing a 70 percent loss in thesectors capacity. As previously noted, 20 out of 29ready mix concrete factories were damaged in thecourse of the hostilities. 52 As a result of the ongoingshortage of construction materials, several pilotschemes were recently launched using rudimentarymaterials, primarily mud brick building initiatives.

Humanitarian agencies have been assisting

displaced people through the provision of non-food items, including more than 300,000 blankets,2,500 tents, 55,000 ma t resses, 30,000 clothing kits,and 30,000 kitchen sets. 53 In addition, families

whose shelters were destroyed or have su ff ereddamages, including minor damages, are entitled

to cash assistance by UNRWA (for refugees) andUNDP (for non-refugees), with the la t er actingon behalf of the Palestinian Authority. Thisassistance is aimed not only at the rehabilitation orreconstruction of homes, but also to help familiescover the costs of alternative accommodation.To date, USD 20 million of an estimated USD 30million allocated for cash assistance to those wholost or sustained severe damage to their homes has been disbursed. A further USD 20 million of theestimated USD 50 million allocated for the repairof minor damage to homes has been disbursed.USD 30 million dollars are outstanding due to lackof liquidity in the banks in Gaza. 54

Despite these di ffi cult circumstances, a number oforganizations, including UN agencies, are activelyseeking ways to initiate reconstruction. The UNSpecial Coordinator for the oPt has presented tothe Israeli Defense Minister a proposal to kick-startearly recovery in Gaza by opening the crossingsfor materials to complete UN construction work on

housing, health and education facilities suspendedsince June 2007. Intensive consultations with theIsraeli government have taken place and the UNawaits Israels response to the proposal.

9,057

7,778

5,978

8,195

6,002

2,341

59 0 0 0 0 129 0 3 86 3 17 2

2,256

903

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700

3 0 0 0 3 0 3 18 20

1,000

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Jan-07

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Dec-08

Jan-09

Feb-09

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Apr-09

May-09

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T r u c

k l o a

d s

Graph3: Number of imported truckloads with construction material


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In November 2007, following the declaration of theGaza Strip as a hostile entity, the government ofIsrael decided to reduce the amount of all types of

fuel allowed into Gaza, including benzene, diesel,cooking gas, and industrial fuel. This reductioncreated a protracted energy crisis, with negativeimplications on the provision of key services, as wellas on the ability of Gazans to run their households.

The main component of this energy crisis is theelectricity de cit created by the reduction in theproduction levels of Gazas sole power plant.Production levels have been previously reduced ina drastic manner, following the destruction of sixelectric transformers by the Israeli air force in June2006, immediately a f er the capture of Israeli soldierGilad Shalit.

The electricity demand in the Gaza Strip uctuates between 230 and 250MW (megawa t ), dependingmainly on the weather conditions. Approximatelyhalf of this demand, 122MW, is met through thepurchase of electricity from Israel and another17MW are supplied by Egypt to the Rafah area.Gazas sole power plant can potentially produce, atfull capacity, approximately 80MW. However, dueto the cut in the amounts of industrial fuel importedfrom Israel, compounded by the recurrent lack ofmaterials and spare parts, the plant is currently ableto produce only 55-60 MW, or approximately threequarters of its capacity, creating an electricity de citof 15-20 percent. 55 In the past two years the powerplant has been forced to shut down completely forseveral days at a time due to lack of fuel, which has

Following the end of hostilities in Gaza, the Humanitarian Country Team developed a Framework forthe Provision of Minimum Humanitarian Assistance in Gaza. Recognizing the challenges presented froman operational perspective, the Framework describes how the basic humanitarian principles must beoperated in order to facilitate an adequate and principled humanitarian response, including the swi f implementation of the projects included in the Consolidated Appeal. The Framework also provides atool to strengthen humanitarian programming internally. Speci cally, it supports internal monitoringand evaluation to ensure the distribution of aid according to need and addresses concerns related to thepossible diversion and misuse of assistance. Based on this Framework, regular reporting will commencein August 2009.

FRAMEWORK FOR THE PROVISION OF MINIMUM HUMANITARIAN ASSISTANCE

resulted in power cuts across the Gaza Strip lastingup to sixteen hours a day during these times.

In addition, currently 10 percent of the population hasno electricity supply because of the lack of available building resources to maintain and repair thesystem. There are 150 electricity-related materials(e.g. high voltage cables, transformers, wires andswitches) at zero stock level and approximately 400others in short supply as a result of the blockade.

Most of the remaining 90 percent of the populationexperience scheduled electricity cuts of 4 to 8 hoursa day. 56 The Rafah area, which receives electricitydirectly from Egypt, experiences power cuts of 4hours a day two times a week. With the extremesummer heat, these electricity cuts are directlyaff ecting refrigerated foods and air conditioningsupply in individual households, as well as onthe provision of essential services like water andsanitation, health care, medicine storage andwaste disposal. As a result, public institutions areforced to rely extensively on backup generatorsand other alternative devices, which are extremelyvulnerable due to the inconsistent supply of spareparts (see Health Section).

Since the beginning of November 2008 and untilrecently Israel suspended the import of benzeneand diesel except for small quantities supplied tohumanitarian agencies and hospitals, and reducedthe quantities of cooking gas allowed entry.However according to the Gas Stations OwnersAssociation (GSOA), in parallel to the tightening

A protracted energy crisis


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of the restrictions, there has been an increase inthe transfer of such fuels through the tunnels,making them available on the open market inGaza at relatively low prices. Since late July 2009,the Israeli authorities have authorized the import

of limited quantities of benzene and diesel forcommercial use, however given the lower pricesof the Egyptian fuel entering through the tunnelssystem, the scope of the current demand for theIsraeli fuel remains unclear.

A challenged health system

Boy injured in an UXO incident. April 2009.

P h o t o

b y J C T o r d a i .

The blockade, the internal Palestinian division, andthe Cast Lead o ff ensive, have all underminedthe ability of the health system in Gaza to functionproperly, resulting in an overall decline in the qualityof health services provided to the population.

Pervasive shortages: facilities, electricity,drugs and equipment

As in other sectors, the shortage of building materialshas prevented the expansion of health facilitiesrequired to meet the needs of a growing population.The completion of the new surgical wing of Gazas

largest hospital (Shifa) for example, has been frozenas a result of the continued shortages of constructionmaterials.

The impact of the shortage of space and facilities has been further compounded by the recurrent powercuts triggered by the ongoing reduction in thesupply of industrial fuel to the Gaza power plant.These cuts have forced hospitals and clinics to relyextensively on the use of back-up generators, whichare not designed to function for prolonged periodsof time and are o f en damaged as a result, withreplacement parts needed to repair them frequently


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unavailable. During the peaks of the electricity crisisand the most prolonged power cuts, many hospitalshave suspended or postponed elective surgery toreduce the risk to patients.

Given the limited reliability of generators, hospitalsalso use UPS (Uninterruptible Power Supply)devices to minimize the damage of power cutsand uctuations in power to sensitive medicalequipment. However, the e ff ectiveness of thissolution has been undermined due to therestrictions and delays by the Israeli authoritiesin regard to the import of the ba t eries needed tooperate these devices. There are currently hundredsof UPS units out of use because of dead ba t eries. 57

Repeated denials and prolonged delays of theneeded import clearance at the crossings havesigni cantly reduced the availability of imagediagnostic devices, including x-ray equipment.Similar to the UPS ba t eries, these devices areconsidered by the Israeli authorities as dual-useitems, which may serve military purposes, andtherefore remain severely restricted. 58

The optimum functioning of medical equipment has

been undermined also by the restrictions and delaysat the crossings. Export restrictions have impededthe regular recalibration of key medical machinesand instruments, which should be performed bythe manufacturer or by specialized companies,some on a strict six month basis to maintain theireffi ciency and safety. The Gaza branch of the St. John

Ophthalmological Hospital, for example, has had aretinal laser unit for eye surgery out of order for morethan two months, as it is awaiting export to Germanyfor recalibration. 59 The inability of maintenancestaff to leave Gaza to gain the training necessary to

maintain medical equipment, the restrictions on theentry to Gaza of medical technicians to undertakevital equipment maintenance, and the extreme lackof spare parts, have directly prevented the repair ofvital equipment with negative health implicationsfor patients.

The provision of adequate medical services hasalso been challenged by recurrent shortagesof pharmaceuticals and consumables. While

the clearance procedures at the crossings haveoccasionally caused delays in their supply, theseshortages occur mainly due to poor managementand distribution of available supplies, unreliabilityof estimated needs, ine ffi ciencies in the procurementprocess and funding shortfalls. The large in ux ofdrug donations during the Cast Lead o ff ensivehas had only a moderate impact in the current stocklevels, mainly due to a lack of coordination whichresulted in the delivery of massive amounts of non-

essential items, much of them with short expirydates. As a result these items have not been able to be utilized and have caused a signi cant problemrelating to storage and disposal of unused drugs andmedical equipment and has resulted in increasedstorage costs and disposal costs. As of July 2009,there were 77 essential drugs (or 15 percent of the

976

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Total No. of applications

Applicationsrejected or delayed

Graph 4: Patients applications for permits to leave Gaza through Israel


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essential drug list) and 140 disposable items (or 20percent of the essential list) out of stock.

Patients and staff prevented fromleaving Gaza

The lack of adequate investment that has a ff ectedthe health system in Gaza for decades, compounded by the ongoing blockade, has created signi cantgaps in the provision of medical services. 60 Thesegaps have created the need to refer patients tohospitals outside Gaza, mainly in the West Bank(including East Jerusalem), Jordan, and Egypt forspecialized medical treatment. The process thatpatients are required to undertake in order to obtainthe necessary documents to leave Gaza is timeconsuming, arduous and uncertain, thus addingsigni cant anguish and stress to people alreadyvulnerable due to illness.

The rst step in this process is the approval of thepatients application by the Palestinian ReferralAbroad Department (RAD), which ensures thatthe required treatment will be funded by the PAsMinistry of Health. While this step currently takesup to one week, in March 2009 the approval of new

applications were halted for more than a month,following the take over of the RAD by the Hamasauthorities. 61 According to the Palestinian Centrefor Human Rights (PCHR), ten patients died duringthis period while waiting for the approval of theirapplications. 62

Once the RAD approves an application, patientsreferred to the West Bank, Jordan, or Israel mustmake an appointment with the relevant hospital,and then apply for a permit from the Israeliauthorities that allows them to leave Gaza throughthe Erez Crossing. Between January 2008 and June2009, 40 percent of the applications for permitssubmi t ed to the Israeli authorities were eitherrejected (three percent) or delayed (37 percent),compared to 10 percent of the applications rejectedor delayed during 2006. 63 Having the applicationdelayed means that no reply was received by thepatient from the Israeli authorities by the day of the

planned travel, resulting in a loss of the pre arrangedappointment at the relevant hospital. When this

occurs, the patient must seek a new appointment andsubsequently submit an entirely new applicationfor another permit, thus signi cantly prolongingthe waiting period before the patient can receive thenecessary medical treatment.

Patients referred to Egyptian hospitals must registerwith the Hamas authorities Ministry of Interior, whosubmits a request for a permit from the Egyptianauthorities. While virtually all of these requests areapproved, the sporadic and unpredictable openingsof the Rafah Crossing, usually no more than threedays a month, generate prolonged and uncertainwaiting periods.

In addition, the ongoing discord and lack of

coordination between the Palestinian Authority(PA) in Ramallah and the Hamas authorities inGaza has prevented patients from leaving Gazafor medical treatment, or delayed their travel, dueto the limited number of passports issued by thePA to Gaza residents. The Ministry of Interior inGaza estimates that there are currently hundredspatients prevented from traveling due to the lackof a passport.

The almost total ban on the movement of non-humanitarian cases through the Erez crossingand the erratic and unpredictable opening of theRafah crossing have prevented medical sta ff fromupgrading their knowledge and skills through theirparticipation in vocational training outside Gaza.The impact of such a learning freeze in a dynamicand constantly evolving discipline such as medicinecannot be underestimated.

Dealing with the Cast Lead legacyDuring the 22-day-long Israeli o ff ensive, medicalteams in Gaza demonstrated outstanding courageand professional ability, working around the clockin very dangerous conditions managing masscasualties, particularly in the rst three days ofCast Lead when hundreds of people presentedto hospitals for treatment. The scope of the injuries,and the widespread trauma and destruction caused

during the off

ensive created an extreme challengeto Gazas entire health system.


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According to the Palestinian Ministry of Healthin Gaza, 5,303 people were injured, includingover 1,815 children, 785 women and 2,703 men,many sustaining multiple and complex injuries. Inaddition, it is estimated that 40 percent of patients

with chronic illnesses did not receive essential inmedical treatment during the military o ff ensive aspriority was given to those with life-threateninginjuries. This has negative long-term healthrami cations for those chronically ill patients whohad their treatment interrupted. The provision offollow-up treatment to those su ff ering from complexinjuries and permanent disabilities has added anenormous burden to an already weakened healthsystem, thus widening the health gaps in Gaza. 64

Of equal concern is the mental health impact of thewidespread trauma, human loss and high levelsof violence witnessed by the population in Gazaduring the military operation. The lack of any safe

haven against the almost continual bombardment,coupled with the continued sealing of the bordersduring the con ict placed the civilian populationin an extremely vulnerable position. People losteven the most basic sense of security, which is one

of the foundations of overall psychosocial well- being. WHO has estimated that between 20,000and 50,000 people will continue to su ff er long-term mental health issues as a result of the CastLead o ff ensive. 65 According to a householdsurvey carried out in March 2009, approximatelyone percent of the population su ff ered from severeacute psychological distress as a result of the war;13 percent from sleeping problems; 34 percentreported frequent loss of appetite and di ffi cultiesconcentrating; 9 percent of adults said that they

were totally unable to carry out normal activitiessuch as ge t ing dressed, washing, household chores,going to work; and 23 percent of children aged 5-14had a bed-we t ing problem. 66

The widespread loss of life, the destruction of homes, and the lack of available protective mechanisms

during the con ict have had an extremely negative e ff ect on Gazan women, particularly among thedisplaced and those disabled due to injuries sustained. The inability of women to carry out their normalcaretaking roles signi cantly contributed to their psychological su ff ering. A UN survey reported thatduring the con ict women feared disability and dependency more than their own death. 67 Accordingto UNFPA, 68 pregnant women were particularly a ff ected: during the o ff ensive there was a 31 percent 69 increase in the number of miscarriages; an increase in neonatal death by 50 percent; 70 an increase in thenumber of premature births 71 and obstetric complications, which necessitated an increased number ofCaesarean sections 72 undertaken in the surveyed hospitals during the con ict. Women, who gave birthduring the con ict, were usually discharged 30 minutes a f er delivery as a result of the need to free beds for the critically injured, increasing risk and trauma to mothers and the newborn due, in part, to

the precarious levels of risk faced during the con ict. Many women did not a t end their rst post-natalcheckup as a result.

THE EFFECTS OF CAST LEAD ON WOMEN


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The limited availability of building resources, spareparts, and fuel has prevented the adequate operationand maintenance of the water and sanitationinfrastructure in Gaza, creating a signi cant publichealth and environmental hazard. While somesupplies, including plastic pipes, plumbing spareparts, and power generators have been sporadicallyallowed entry enabling the performance of certainurgent works, these imports remain insigni cantwhen compared to the current existing needs ofinfrastructure repair in Gaza. 73 Following therecent completion of some rehabilitation projects,the number of people not connected to the waternetwork has decreased to 10,000 people, residing inNorthern Gaza and the Az Zaitoun area, southeastof Gaza city.

The decline of the system is re ected at multiplelevels, including the current inability of Gazaswastewater utility to properly treat the volumeof sewage produced. Consequently, every dayapproximately 80 million liters of untreated

and partially-treated wastewater are beingdischarged into the environment. In the MiddleArea, for example, about 10 million liters of raw,undiluted,sewage ows every day into the GazaStream (Wadi) and into the Mediterranean Sea.Even though the damage incurred to the core

infrastructure (e.g. water wells, pumping stationsand treatment plants) during the last Israelioff ensive was relatively limited, the widespreaddestruction of buildings previously connected tothe wastewater network has led to the release ofadditional quantities of untreated sewage into theenvironment.

The Gaza wastewater treatment plant,whichcurrently treats 50 million liters of sewage a day wasoriginally designed to treat only 32 million litersper day. As a result, the wastewater discharged into

the sea contains twice the safe standard amount of biological pollution and suspended solids. 74 Anexisting project aimed at upgrading the plantscapacity to 70 million liters a day is still in an earlyplanning stage as a result of being delayed for anextended period of time due to the blockade and theongoing internal Palestinian con ict.

The emerging public health concerns due to theinability of the current system to properly treat the

current volume of sewage produced in Gaza aresigni cant. Microbiologically contaminated seawaterfound along the Gaza Strip coast poses a serioushealth hazard not only to people using beaches forrecreation, but also to the entire population, throughpotentially contaminated sea food.

Water and sanitation infrastructure: a health andenvironmental hazard

Sewage outlet, Rafah beach. April 2009

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Of equal concern are the potential health impactof the sewage in ltration into the coastal aquiferand the resulting contamination of the aquifer, thesole fresh water resource in Gaza. The aquifer hasundergone a gradual process of salinization and

pollution over the past decades, exacerbated by theongoing sewage in ltration. 75 Currently, only 5-10percent of the extracted water is considered drinkablewhen compared to WHO safety standards. 76

In Khan Younis governate, one of the worst a ff ectedareas, the average levels of nitrates detected during2008 in the water wells was more than three

times (169 mg/L) the safe WHO level (50 mg/L).Consumption of water with high concentration ofnitrates compromises the transmission of oxygenin the blood and could cause an increase of thepotentially lethal blue-baby syndrome among

infants in the Gaza Strip. 77 The deterioration of thesanitation services is likely to have also contributedto a recent increase in the prevalence of waterydiarrheal disease (WDD) among children aged 9-12months as reported by UNRWA in March 2009. Forexample in comparison to 2008 gures there wasa major increase of (WDD) in Khan Younis by 88percent and in north Gaza by 77 percent.

Education underminedThe restrictions on the movement of goods andpeople across Gazas borders have constrainedthe functioning of the education system in Gaza,negatively impacting the quality of the educationprovided to Gazas students.

The lack of building materials needed to expandexisting educational facilities has resulted inan overcrowding of schools and kindergartens.The problem has been compounded followingthe damage incurred to the existing educationfacilities during Cast Lead. According to arapid assessment of the Education Sector, at least280 schools and kindergartens were damaged,including 18 facilities totally destroyed (eightgovernmental schools, two private schools and eightkindergartens). By the end of the last academicyear, some 88 percent of UNRWA schools and 82percent of governmental schools were operating ona shi f system to accommodate the growing numberof students. Approximately 1,200 secondarystudents in governmental schools in north Gaza,which was the worst a ff ected area during the CastLead o ff ensive, are currently at risk of not havinga local school to a t end due to a lack of alternativepremises for the schools to operate from.

In addition the recurrent electricity power cuts,created by the restrictions on the import of

industrial fuel, have disrupted the functioning

of schools in most areas of education provision.In the course of the past two years, some of themost basic educational items including paper,text books, computers, and educational kits have been systematically denied entry or delayed forprolonged periods by the Israeli authorities. Inthe past two months, however, there has beena signi cant and positive improvement in the

clearance of educational items allowed entry intoGaza, with the majority of items previously onhold currently being allowed in.

The combined impact of the di ff erent shortages(space, materials, electricity) is re ected in thedecline in school a t endance and performance. Inthe rst semester of the 2007-2008 school year, forexample, only 20 percent of 16,000 sixth graders inGaza passed standardized exams in maths, science,English and Arabic. 78

Access to higher education was also drasticallycurtailed due to the blockade. 79 The tertiaryeducation system available in Gaza includes ve universities, which o ff er a limited selectionof undergraduate disciplines and an even morelimited choice of post-graduate programmes. In January 2008, Israel announced that it would notallow any student to exit the Gaza Strip to pursuetertiary education.


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Following a public outcry when seven Fulbrightscholarship recipients from Gaza were not grantedpermission to leave so as to a t end their studies inthe United States, the Israeli authorities decidedto allow a limited number of students to travel

abroad subject to strict criteria: the student musthave a scholarship with a recognized university(although no such list has been produced by theIsraeli authorities) and a diplomat from the countrythat awarded the scholarship must accompany thestudent from the Erez Crossing, across Israel andthe West Bank, until the student reaches the bordercrossing between Israel and Jordan.

Between July and September 2008, prior to the beginning of the last academic year, only 70students were permi t ed to leave the Gaza Stripthrough Israel. Hundreds of other students whowere not awarded scholarships, or who could notsecure diplomatic escort (including those bound forcountries that do not have a diplomatic presencein Israel) were denied exit. While some studentsmanaged to leave Gaza through the Rafah Crossing,the number of such cases has been limited by therare and sporadic openings of this crossing.

School in Beit Lahia destroyed during the Cast Lead offensive. April 2009 P h o t o

b y J C T o r d a i


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ConclusionFor more than two years the blockade of the Gaza Strip has caused a protracted human dignity crisis thatis re ected in almost every aspect of daily life: over 140,000 people, willing and able to work, are currentlyunemployed with over a million living in poverty and reliant on food aid; most of the 6,420 families whose

homes were destroyed or severely damaged during the last military o ff ensive are still displaced due to theongoing ban on the entry of construction materials; in the extreme summer heat in Gaza, almost no one hascontinuous electricity supply to operate refrigerators or air conditioning, and some people still have no accesselectricity at all; patients requiring specialized medical treatment unavailable in Gaza must overcome a longand arduous permit processing system, resulting in unnecessary anguish and stress. These are but a fewexamples of the daily challenges that deprive 1.5 million people in Gaza of a normal, digni ed life as a resultof the blockade.

The distress experienced by the population has grown as the months have passed since the blockade beganin 2007. Many people report a growing sense of being trapped; physically, intellectually and emotionally.Levels of anguish and concern regarding day-to-day survival and prospects for the future have increased asthe coping mechanisms available to people in Gaza have gradually been exhausted.

The continuation of the blockade on Gaza has been linked to various political factors and it is currently unclearwhat conditions may lead to a li f ing of the blockade. The UNs most senior humanitarian o ffi cial, John Holmes,has stressed that protection, food, water, healthcare, and shelter are basic human needs, not bargaining chips.This fact must be recognized by all parties responsible for the immense su ff ering in Gaza. 80

This blockade is collectively punishing the entire Gazan population. The UN, the ICRC, many states andhumanitarian organizations, have repeatedly urged the Government of Israel to remove the restrictions onGazas borders as well as to allow free access to agricultural areas within Gaza and to shing areas in Gazas

territorial waters. These are the urgent rst steps needed to start the reconstruction of homes and infrastructure,the revival of the economy, and the restoration of human dignity in Gaza.


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End notesThe blockade marked the peak of a gradual1.process of isolation of the Gaza Strip thatstarted in the early 1990s with the imposition ofa general closure which forced Gazans to obtainspecial permits to travel to the West Bank; in1995, Israel built a perimeter fence encirclingthe Gaza Strip and separating it from Israel;for most of the time since the beginning of thesecond Intifada in September 2000, permitsto enter or leave Gaza were limited mainly tohumanitarian cases; following the victoryof Hamas in the January 2006 elections, theinternational community impose an embargoon the Palestinian Authority and suspendeddevelopment projects in the West Bank andGaza Strip.

John Holmes,2. Brie ng to the UN Security Councilon the situation in the Middle East, including thePalestinian question , 27 January 2009.

See for example, Quartet Statement, Trieste,3.26 June 2009, paragraph. 6; ICRC, Gaza - 1.5million people trapped in despair , June 2009; Joint statement on 2nd anniversary of theGaza blockade issued by 38 humanitarianorganizations, including three UN agencies, 17 June 2009.

Food insecurity exists when people lack4.sustainable physical or economic access toenough safe, nutritious, and socially acceptablefood for a healthy and productive life.

Palestinian Central Bureau of Statistics (PCBS),5.Labor Survey Results , relaxed de nition. The ILOde nition of unemployment includes persons(15 years old and above) who do not workand are actively seeking a job. PCBSs relaxedde nition adds to the ILO de nition peoplewilling to work but currently not engaged inactive job search (known as the discouraged).

Ibid, ILO unemployment de nition.6.

Palestine Trade Center,7. Gaza Strip Two Yearsthrough Siege , Special Report, 7 July 2009.

ICRC,8. Gaza - 1.5 million people trapped in despair , June 2009.

OCHA, Crossings Database.9.

Palestine Trade Center, see footnote 7.10.

PalTrade, Ibid.11.

FAO/WFP,12. Report of the Rapid Qualitative

Emergency Food Security Assessment (EFSA) GazaStrip , 24 February 2009, p. 12.

According to WFP and FAO, agricultural items13.urgently needed include nursery equipment,seeds, seedlings, fertilizers and greenhouse and

irrigation rehabilitation materials. Strawberryfarmers are unable to access strawberry motherplant seedlings, which are traditionallyimported from Israel and cultivated ingreenhouses from mid-April onwards toproduce the o ff shoots for the next strawberryseason. See, WFP/FAO, Update on Food SecurityIssues , 20 April, 2009.

FAO/WFP, footnote 12.14.

On 29 April 2009, the Ministry of Agriculture15.(MoA) in Gaza instructed farmers not to plantexport crops, in particular those in need ofsizeable investment inputs, such as cut owersand strawberries. According to the MoA, thisinstruction was given to protect farmers in Gazafrom losing huge investments and to preservewater reserves. Instructions to farmers werealso to direct crop production to service localGaza market needs only.

Private Sector Coordination Council16. GazaGovernorates, Gaza Private Sector, Post-War Statusand Needs , February 2009.

World Bank.17. Palestinian Economic Prospects:Gaza Recovery and West Bank Revival. EconomicMonitoring Report to the Ad Hoc LiaisonCommi t ee. June 8th 2009. Available at www.worldbank.org/ps.

Private Sector Coordination Council-18. GazaGovernates: Gaza Private sector Post War Statusand Needs. Gaza City. 2009.

Agricultural Sector Report 19. Impact of GazaCrisis , March 2009.

An exception to this de nition is an area along20. the northern border of Gaza the past locationof three Israeli se t lements where the no-go areais signi cantly larger.

The only types of sh found in the market are21.Asafeer, Ghobos and very small quantitiesof sardines and Dennis imported from Israel(20-35 NIS/kg). See WFP/FAO, Update on FoodSecurity Issues , 16 March, 2009.

The current sea blockade of 3 nm is one quarter22.of the area to which Israel commi t ed to allow shing under the Bertini commitments in 2002(12 nm) and is one sixth the area as de ned


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under the Oslo Agreement (20 nm).

WFP/FAO,23. Update on Food Security Issues, May2009.

Ibid.24.

This section relies entirely on The World Bank,25.Palestinian Economic Prospects: Gaza Recovery andWest Bank Revival , Economic Monitoring Reportto the Ad Hoc Liaison Commi t ee, June 8th 2009,p. 24. Available at www.worldbank.org/ps.

OCHA interviews with sources in Gaza and26. journalists covering this issue.

Palestinian Centre for Democracy and Con ict27.Resolution, Children of tunnels, death mixed withsand avor , July 2009. Available in Arabic at:

ht

p://www.pcdcr.org/Arabic/index.php?page=NewsDetails&NewsID=283&CatID=1

OCHAs Protection of Civilians Database, 1528. June 2007 28 July 2009.

29. Mid Year Review of the CAP , July 2009, p. 21.For previous gures see, WFP/UNRWA/FAO, Joint rapid food security survey in the occupiedPalestinian territory , May 2008.

In the WFP/UNRWA/FAO survey households30.suff ering from food insecurity included thosewith and income and consumption below 1.9US$/per capita/day and showing a decrease intotal food and non-food expenditures.

WFP/FAO,31. Update on food security issues in Gaza ,May 2009. Source of concern is particularlyrelated to common livestock diseases like PPR(peste des petis ruminants), enterotoxaemia,sheep pox, and brucellosis.

WFP/UNRWA/FAO,32. Joint rapid security surveyin the occupied Palestinian territory , May 2008.

Overweight among girls is ve times higher33.than among boys (24.6 compared to 5.4 percent),possibly due to the increased lack of physicalactivity among them. Data collected by the PAMinistry of Health between September 2007 and June 2008. See WHO, Gaza Health Assessment , July 2009, p. 7.

UNIFEM,34. Voicing the Needs of Women and Menin Gaza. Beyond the A f ermath of the 23 day Israeli Military Operation s, 2009.

Unless it is otherwise speci ed, the source for35.all casualties gures is OCHAs Protection ofCivilians Database. The source for Palestinian

injuries during the Cast Lead operation onlyis the Palestinian Ministry of Health in Gaza.The source for Israeli civilian casualties duringCast Lead is the Magen David Adom (thenational society of the International Red CrossMovement in Israel), while gures regarding

IDF soldiers are based on the Israeli Ministry ofForeign A ff airs information.

For example, more Palestinians were killed36.in Gaza during the three weeks of Israelsmilitary operation than during the entire rstIntifada (December 1987 - September 1993). SeeBTselems statistics: h t p://www.btselem.org/English/Statistics /First_Intifada_Tables.asp.

This gure excludes Palestinians killed by inter-3

ocha gaza impact of two years of blockade

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