physicians for human rights-israel: the gaza strip - state of disaster - september 2006

8/8/2019 Physicians for Human Rights-Israel: The Gaza Strip - State of Disaster - September 2006

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The Gaza Strip State of Disaster

September 2006

"Decent folks must be allowed to sleep easy o'nights, mustn't

they? Really it would be shockingly bad taste to linger on such

details, that's common knowledge. But personally I've never been

able to sleep well since then. The bad taste remained in my mouth

and I've kept lingering on the detail, brooding over them."

Albert Camus, The Plague (1947).

[This report contains photographs that may be difficult for

some audiences to view. Your discretion is advised.]

Introduction:

Over the past several months, changes have taken place in the management

of the occupation by the Israeli government and the Israeli army.

Since the secondIntifada, Israel has exercised its power over the Palestinian

population in the Occupied Territories through nearly absolute control over

day-to-day life. This is expressed most prominently in Israeli control over

Palestinians' movement, through a system of sieges, roadblocks, closures,

and an arbitrary permit regime. Direct violence, e.g., Operation "Defensive

Shield" and the policy of assassinations and arrests, comprises a substantial

part, but not all of the means through which Israel perpetuates the regime of

occupation.

The illusion of unilateral moves in order to get rid of the Israeli-Palestinian

conflict - the self deception which promoted the belief that the removal of

Israeli settlements in the Gaza Strip is equivalent to the end of the occupation-

the firing of Qassam rockets on the Israeli towns near the Gaza border andthe capture of Gilad Shalit, are amongst the circumstances that led in the


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recent period to a change in the management of the occupation. Now more

than ever, emphasis is placed on control by means of killing and destruction.

In recent months, more than 200 people have been killed, half of them

civilians and one-quarter of them children. The numbers bear clear witness

that the entire Palestinian population is a target for Israeli army strikes.

Intentional destruction of civilian infrastructures, as in the case of the bombing

of electric turbines; indifference regarding the ability of essential civil systems,

such as the health care system, to function; the fatal blow dealt to the

Palestinian economy, inevitably resulting in poverty and malnutrition, all

indicate an escalation in the inclination to use violence as a means to

perpetuate the occupation. This policy has not resulted in "the unconditional

release of Gilad Shalit". Rather, its result, whether conscious or unintended,

is the elimination of any option for a just, agreed-upon solution to the Israeli-

Palestinian conflict. We are ourselves fulfilling the prophecy that we shall

forever live by the sword.

The policy of wreaking havoc necessarily brings the occupation's internal logic

to an end. Past illusions about an enlightened occupation have been replaced

by routine killing and destruction, to the almost utter indifference of Israeli

society. Whereas in the past, many sectors within Israeli society have

opposed and protested the oppression of the Palestinians, in recent months

the Israeli public has become indifferent at best, and supportive, at worst.

The media is silent on these cases; the public chooses to remain ignorant, as

though the killing is caused by some natural disaster out of anyone's control,

rather than by government and military policy.

In this report, a PHR-Israel delegation of physicians presents findings from its

visit to the Gaza Strip, where it met with health care and non-governmental

organization personnel. The report's text and photos paint a harsh picture, for

which we, the Israeli public, carry responsibility. We submit this report in the

hopes that it may contribute towards producing a wave of opposition to

current policy, that will make clear to the government and senior military ranks


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that they are not acting in our name. This report serves as a mirror that

reflects the occupation's ugly face. The desire to perpetuate the occupation

will only increase the intensity of the killing and the destruction. We must

understand that only ending the occupation will allow us and our daughters

and sons, and the sons and daughters of our daughters and sons, to live in a

worthy society. Only negotiation will return Gilad Shalit to his loved ones. Only

negotiation that ends the occupation and creates a peace agreement based

on justice, will offer both peoples a chance for a future.

Dr. Dani Filc, Chairperson, Physicians for Human Rights-Israel

On September 1st and 2nd, 2006, a delegation of physicians from PHR-

Israel visited the Gaza Strip. This undertaking was finally permitted, after

the Israeli government had prohibited the entry of PHR-Israel's Jewish

members for the past six years. The purpose of the visit was to assess

the critical medical and economic situation reported by various sources

from the Gaza Strip and abroad, and to investigate recurring claims

regarding Israel's use of an unknown, particularly violent kind of

weapon.

On June 26, 2006, Israeli soldier Gilad Shalit was abducted. From the

moment of his abduction, pressure was put on the Palestinian civilian

population and political system to facilitate his release, by barraging the Gaza

Strip day and night and flying in the skies of the Strip, producing sonic booms.

Israeli infantry has carried out massive house demolitions in a series of

incursions, where civilian homes have been taken over and their inhabitants

jailed in for hours, not unlike the practice long seen in the West Bank.


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In the course of this activity, Israeli forces have killed 226 people, including

114 civilians,

46 of them are children.

Testimony from various sources reports the use of an unknown, particularly

malevolent weapon against the civilian population. Physicians in Gaza

hospitals report obstacles to treating and saving lives of the wounded.

The Israeli air force has bombarded central bridges and major roads, and has

destroyed six electric turbines that provided 40% of the Gaza Strip's power

supply. As a result, the power supply to residents and essential institutions

such as hospitals has been severely disrupted. Moreover, Israel's closure of

Nahal Oz passage has cut off the supply of gasoline to the Strip and impaired

the ability to operate alternative power systems, such as generators, that use

gas and diesel fuel.

Economic assault: In March, Hamas was democratically elected to control the

Palestinian Authority. Immediately afterwards, Israel froze the transfer of tax

revenues to the PA; following pressure by Israel and the US, other states and

international donors stopped transferring fonds to the PA as well. The

economic crisis ensued. PA employees constitute as much as 57% of the

Palestinian health workers and supply 64% of health needs: especially

advanced secondary and tertiary treatment. These workers have not received

their salaries for the past six months, and the various systems are only

partially functioning. The Palestinian Health Ministry, nearly 100% of whose

current operating budget (not including salaries) depends upon donations and

revenues from taxes imposed by Israel, found itself in an impossible position:

its employees are not being paid, and the empty treasury does not allow for

the buying of medications and perishables. As a result, all elective surgeries

have been postponed. Cancer patients who require expensive medications

have not received them for months, and patient referrals are no longer made

to Israel and to other service providers for expensive treatmentsthat are


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unavailable in the Palestinian system, such as bone marrow transplants

amongst others.

Restriction on movement: Moreover, Israel has hermetically sealed off the

Gaza Strip, prohibiting the opening of Rafah crossing, which is Strip residents'

only gate to the rest of the world. Karni passage, through which goods,

including all medical equipment, enter and exit the Gaza Strip, is also closed

for long periods of time, operating on a very limited basis. Karni passage

opens for a limited number of hours at a time, on an irregular basis. A

shortage of cancer drugs and medications for chronic illnesses in the Gaza

Strip has resulted.

PHR-Israel delegation's visit:

Northern Gaza Strip

Since June 26, 2006, 95 civilians have been killed in the northern Gaza Strip;

30% of those injured and killed are minors under 18.

Kamal Adwan hospital serves the 30,000 residents of Beit Lahia and the

northern Gaza Strip. The Beit Lahia area, from which Qassam rockets are

fired on adjacent Israeli towns, has been heavily barraged. Since Gilad

Shalit's capture, the area has been hit even harder, by air, ground and artillery

strikes.

Hospital director, Dr. Mahmoud al-Asali:

The hospital carries out an average of 170 surgeries per month. Some 300

patients are seen in its out-patient clinics daily. Since June 26, 2006, the

hospital has received some 260 injured, 60% via emergency transfer, some

critically injured. In recent months, the hospital has been forced to deal with a

large number of injured who require immediate surgical procedures (at times

20 patients concurrently), with only two operating rooms in the facility.


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Dr. Muhammad Sultan, a senior physician at the hospital:

In many cases, the bodies arrive naked, with injuries of about 5 cm in

diameter surrounded by a burn of about 10 cm in diameter. In some cases,

no shrapnel or metal shards have been found on or in the bodies. The means

of fatal injury that caused the death is unclear.

Sheja'ieh neighborhood: Ground incursion killing and house

demolition

The delegation observed the serious damage caused by Israeli tanks

throughout the neighborhood. Armored corps and infantry forces retreated

from the neighborhood two days before our visit. On the main street leading to

the neighborhood, four four-story homes were demolished and the area was

completely flattened. After the forces' withdrawal, 25 Palestinian fatalities

were reported by the Israeli army.

Ruins of a home in Sheja'ieh, Photo: Ibrahim Habib

Destruction of civilian infrastructure: electric power and bridges


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On June 26, 2006, the Israeli air force bombed the six electric turbines,

bringing Gaza's only electric power station to a standstill

Electric power only twelve hours a day: The Gazan electric power station,

which was constructed with Norwegian funding, began operation a year and a

half ago, with the goal of supplying power to the entire Strip and minimizing

dependence on Israeli electric power. Until its destruction, this station

supplied 40% of the Strip's power supply. Its destruction severely disrupted

the power supply, as Israel provides only 60% of the power required.

Implications of disruption of the power supply

-The supply of running water to homes is disrupted, because the water is

pumped onto containers on the roofs.

-As it cannot be stored in refrigerators, food spoils in the severe heat of the

season, as do medications requiring refrigeration such as insulin, milk for

infants, special foods for ill persons, etc.

-Operation of home medical equipment, such as inhalers, is disrupted,

causing some patients to become hospitalized. In hospitals, equipment is

operated via generators during stoppages in the power supply.

The hospitals operate 12 hours a day via generators. During closure of the

Nahal Oz Crossing, supply of gas and diesel oil was disrupted and a real

concern arose that the existing supply would be depleted. Consequently, all

non-emergency medical procedures and elective surgeries were canceled. At

Kamal Adwan Hospital, surgeries are hurried due to the concern that oxygen

and resuscitation systems may be disrupted during the procedures.


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Four destroyed electric turbines. Photo: Ibrahim Habib

Restrictions on movement - Bombing of bridges: The Israeli air force

destroyed three bridges over Gaza Stream that connected the northern and

southern sections of the strip, paralyzing movement on the strip's central

Salah a-Din road. Security forces claimed that the bombing of the central

bridge was intended to prevent the transfer of Gilad Shalit, but in fact

residents reverted to using the alternate road at the foot of the bridge.

However, during the rainy season, the stream will overflow and traffic on the

road will be restricted. While the bombing of the bridge did not achieve its

declared end, that is, impeding travel between parts of the Strip, it is collective

punishment of the population, destruction of infrastructure that costs millions

of dollars.

Destroyed main bridge on Salah a-Din road, Photo: REUTERS/Mohammed

Salem.

Hunger in Gaza

The Ard el-Insan organization operates four clinics for women and children

throughout Gaza Strip. The organization's director, A'Ihtidal Khatib, and Dr.

'Adnan Alwahidi, described to PHR-Israel's delegation the state of affairs in


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their center: :We see the weakest population, the poorest and most needy.

The situation is getting worse and worse. Women are unable to pay for their

clinic visit, and we have to give them money for transportation to get here. Our

patients suffer from dire hunger and subsist mainly on tea and sugar. Women

refuse to take their babies home from here because they have no food to give

them at home. The women themselves also suffer. They are last to eat.

There are women who eat one small meal a day, and even this is the most

meager, poor meal you can imagine. There are families in which five children

are all suffering from malnutrition and women suffer malnutrition and anemia.

Children who complete our feeding program return shortly afterwards,

suffering from diarrhea and malnutrition. The situation is very grave, and we

cannot respond adequately to the growing need."

Shifa Hospital, Gaza

"We can no longer save the injured"

Shifa Hospital is the Strip's main governmental hospital, with 600 beds and

1400 employees. The delegation met with the hospital's senior staff, including

Dr. Jumaa`Al-Saqqa, Dr. Hassan Abu Tawila, Dr. Subhi Al-Skeik and other

senior physicians.

The hospital's physicians reported the difficulties they encounter in treating

the seriously injured patients who are arriving following the recent wave of

shelling. The medical staff is experienced in treating injuries from gunfire and

bombardment, but is struggling to treat injuries of an unfamiliar type, where

conventional treatment methods fail. The staff presented the delegation with

photos that illustrated some of the claims:

-More than the usual number of injured arriving with amputated upper and

lower extremities.

-Injured people burst into flames even after the fire has been extinguished.

-Totally burned, unidentifiable bodies, at times charred remains.

-Bodies appearing as if they have "melted".


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-Some of the bodies have no visible exterior injury, but upon abdominal

exploration, the internal organs appear to be completely crushed in a manner

that does not correspond with conventional blast wounds.

-Similar cases, but in which the internal inner organs appear burnt and

crumbled.

-Some of the injured are operated on and stabilized, only to pass away two

days later for no clear reason.

-Imaging tests do not detect fragments; nonetheless the patient dies.

-In some cases, instead of metal pieces, fragments that appear to be plastic,

undetectable by x-ray, are found.

-Patients with a gangrenous organ which is removed surgically then develop

advanced gangrene at the site of removal. Even after the area is removed,

gangrene continues to develop.

Remains of a man killed by Israeli bombardment. Photo: Palestinian MoH

Obstacles to saving lives

Also present at the meeting at the hospital was director of emergency medical

services in Gaza Strip, Mr. Marwan Baker. He and his colleagues reported

that in many cases the army delays ambulances' access to the injured,

sometimes for two hours. These delays may cause a decline in the injured's

condition, and at times, their death. Medical staff have also been the target of

the army's fire: Red Crescent ambulance driver Anwar Abu Holi lost his leg

after being shot during evacuation of patients in the al-Maghazi refugee camp.


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Lack of basic medical services

Dr. Al-Saqqa gave a detailed survey of the hospital's departments and the

services it provides. He described the services that Shifa and other Gazan

hospitals cannot provide for Gaza Strip residents, which include radiation

therapy for cancer patients, imaging tests, catheterization, bypass and heart

surgery.

The delegation toured the hospital's departments and was impressed with the

level of care and quality of medical treatment provided under such difficult

conditions. Professor Zvi Bentwich examined two seriously ill patients who

were denied entry into Israel for medical treatment:

1. An AIDS patient whose request to receive treatment in Israel was denied

by the security services as well as by the Israeli High Court of Justice.

2. A patient with serious gall bladder disease. Her entry into Israel was

denied on security grounds, but a day following Professor Bentwich's

assessment and another request on her behalf by PHR-Israel, backed up by

the results of his examination, she entered Israel for medical treatment.

The Palestinian Health Ministry's central medication warehouse:

Working under conditions of uncertainty and shortage

The Health Ministry's head pharmacist Dr. Ziad Shaath and the ministry's

staff, met with PHR-Israel's delegation. Dr. Shaath reported that the ministry

required an annual medication budget of 26 million dollars, but that due to the

budget crisis, it is entirely dependent upon donations, of which only 2 million

dollars has arrived this year. He also told of pledges by international donors

for emergency assistance that have not yet been realized.

Lacking a regular, guaranteed budget, a yearly, or even weekly program

cannot be created in order to operate the eight governmental hospitals and

fifty Health Ministry clinics and pharmacies in the Gaza Strip.


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The PHR-Israel delegation returned from the visit in the Gaza Strip shocked

by the grave humanitarian, medical and economic situation it witnessed.

Taking advantage of the Israeli public's indifference, Israel is waging a harsh

battle, bringing the Gaza Strip to the brink of a humanitarian crisis. Human

injury, a bleak economic situation which critically harms the weakest people,

intensifying the military attacks in parallel to militarization of the Gaza Strip ,

the governmental anarchy, the hatred and frustration- these will all ultimately

destroy both the Palestinian and Israeli societies.

Today, a year after the unilateral disengagement, the violence on both sides

is intensifying. Qassam barrages on the one side, and wanton killing and

destruction on the other, allow nearly no room for building a non-violent

alternative. Indeed, Israel is obligated to defend its citizens, but its response

to the firing of Qassam rockets is not only reckless violence, but also harms

its own citizens as it willingly forfeits any moral inhibition. Israel's claims that it

attempts to prevent civilian casualties are shattered in the face of the large

number of civilians who have lost their lives. When 46 children die violent

deaths as a matter of routine, it is clear that the crimes which lead to this,

must be stopped.

Being that Isarel is the occupying power in the Gaza Strip and the West Bank,

the state has obligations towards the civilian population in the Occupied

Territories according to international law and basic moral codes. Therefore,

Physicians for Human Rights-Israel demands that Israel:

Open the borders of the Gaza Strip immediately;allow without delay the entry

of goods, especially medications; and

facilitate provision of civilian services that the Palestinian Authority is unable

to provide due to the economic crisis, which is caused among other factors by

the freezing of tax revenues.

"The day after. Keep in mind that every war is temporary and ends at

some point. Therefore, it is wise to consider the stage after the end of

hostilities []acts of cruelty during war are engraved in the victims'


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memories, perpetuating the conflict and making it difficult to conduct a

peace process"

From the Laws of War on the Battlefield, published by the Israeli JAG

Command and School of Martial Law.

Photo: Remains of a child killed by Israeli bombing. Photo: Palestinian MoH

www.phr.org.il [email protected]

physicians for human rights-israel: the gaza strip - state of disaster - september 2006

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