Six months after Israel launched its three-week military operation in Gaza on December 27 2008, Gazans still cannot rebuild their lives, a new report by the International Committee of the Red Cross declared on Monday.
Most people struggle to make ends meet, said the report. Seriously ill patients face difficulty obtaining the treatment they need, many children suffer from deep psychological problems, and civilians whose homes and belongings were destroyed during the conflict are unable to recover.
During the 22 days of the Israeli military operation, nowhere in Gaza was safe for civilians.
Hospitals were overwhelmed with casualties, including small children, women and elderly people.
Medical personnel showed incredible courage and determination, working around the clock to save lives in extremely difficult circumstances.
Many children witnessed violence during the military operation.
Bedwetting, insomnia and agitated behaviour are widespread.
Thousands of children and adults need counselling to deal with emotional scars and post-traumatic stress.
Many people in Gaza lost a child, a parent, another relative or a friend.
Israel’s military operation left thousands of homes partly or totally destroyed.
Whole neighbourhoods were turned into rubble.
Schools, kindergartens, hospitals and fire and ambulance stations were damaged by shelling.
This small coastal strip is cut off from the outside world.
Even before the latest hostilities, drastic restrictions on the movement of people and goods imposed by the Israeli authorities, particularly since October 2007, had led to worsening poverty, rising unemployment and deteriorating public services such as healthcare, water and sanitation.
Insufficient cooperation between the Palestinian Authority in Ramallah and the Hamas administration in Gaza had also hit the provision of essential services.
As a result, the people of Gaza were already experiencing a major crisis affecting all aspects of daily life when hostilities intensified in late December.
Six months later, restrictions on imports are making it impossible for Gazans to rebuild their lives.
The quantities of goods now entering Gaza fall well short of what is required to meet the population’s needs.
In May 2009, only 2,662 truckloads of goods entered Gaza from Israel, a decrease of almost 80 per cent compared to the 11,392 truckloads allowed in during April 2007, before Hamas took over the territory.
Gaza neighbourhoods particularly hard hit by the Israeli strikes will continue to look like the epicentre of a massive earthquake unless vast quantities of cement, steel and other building materials are allowed into the territory for reconstruction.
Until that happens, thousands of families who lost everything will be forced to live in cramped conditions with relatives.
Others will continue to live in tents, as they have nowhere else to go.
Emergency repairs carried out after the military operation have made it possible to restore water and sanitation services, but only to the already unsatisfactory level prevailing before December 2008.
The infrastructure is overloaded and remains subject to breakdown.
Although chlorine is used to disinfect the water, the risk of sewage and other waste matter seeping into the water supply network represents a major threat to public health.
Every day, 69 million litres of partially treated or completely untreated sewage – the equivalent of 28 Olympic-size swimming pools – are pumped directly into the Mediterranean because they cannot be treated.
Thousands of homes only have access to running water on certain days.
Because the water supply network cannot be properly maintained, it is leaking, making it harder to maintain sufficient water pressure.
Even when water is available in the pipes, many homes do not have sufficient power to pump it into rooftop storage tanks.
The taps of tens of thousands of people run dry when Gaza’s municipal water wells break down, which frequently happens because of insufficient supplies of new water pipes, electrical spare parts, pumps and transformers.
The ICRC has occasionally found ways of repairing infrastructure without relying on imports.
For example, it used recycled materials (including used water pipes and concrete segments of the old Rafah border wall destroyed in January 2008) to upgrade a waste-water treatment plant serving 175,000 people in Rafah.
However, on its own this is insufficient.
Other repairs and reconstruction projects are urgently needed to prevent the further deterioration of the water supply system, carry out essential maintenance and stem the steady decline of the water and sanitation system throughout the Gaza Strip.
The fact that water and sanitation services could collapse at any moment raises the spectre of a major public health crisis.
The only way to address this crisis is to lift import restrictions on spare parts, water pipes and building materials such as cement and steel so that homes can be rebuilt and vital infrastructure maintained and upgraded.
Gaza’s healthcare system cannot provide the treatment that many patients suffering from serious illness require.
Tragically, a number of them are not allowed to leave the Strip in time to seek healthcare elsewhere.
Health issues in Gaza are often politicised and patients find themselves caught up in a bureaucratic maze.
The procedures for requesting permission to leave the territory are complicated and involve both the Palestinian and Israeli authorities.
Seriously ill patients sometimes have to wait for months before the relevant authorities allow them to leave the Gaza Strip.
Even when patients do obtain the necessary permits to leave, the transfer through Erez crossing into Israel can be arduous.
Patients on life-support machines have to be removed from ambulances and placed on stretchers, then carried 60-80 metres through the crossing to ambulances waiting on the other side.
Patients who can walk unassisted may face extensive questioning before they are allowed through the crossing for medical treatment – or, as sometimes happens, before they are refused entry into Israel and turned back.
‘I loved to play football with my friends. I told the doctors that I wanted to be able to walk again – they promised that I would,’ said Ghassan, a 14 years old Gaza City boy.
His older brother was killed and he himself was wounded during the military operation.
He is waiting to be fitted with artificial limbs for both legs.
The shortage of basic medicines is a constant problem for Gaza hospitals and health clinics.
They depend on a timely and reliable supply of medicines from the Palestinian Authority’s Ministry of Health in the West Bank, but the supply chain often breaks down.
Cooperation between the health authorities in the West Bank and Gaza is difficult. Complex and lengthy Israeli import procedures also hamper the reliable supply of even the most basic items such as painkillers and X-ray film developers.
As a result, some patients, including people suffering from cancer or kidney failure, do not always get the essential drugs they need.
‘Four of our 14 specialised ventilators for newborn babies are out of order.
‘It is currently impossible to get spare parts into Gaza so that we can have the ventilators fixed.
‘This is a real problem if we have many newborns in the intensive care unit at the same time,’ said Majdia Jouda, head of the neo-natal department at Shifa Hospital.
Most of the very poor have exhausted their coping mechanisms, many have no savings left.
They have sold private belongings such as jewellery and furniture and started to sell productive assets including farm animals, land, fishing boats or cars used as taxis.
They are unable to reduce spending on food any further.
The declining living standards will affect the health and well-being of the population in the long term.
Those worst affected are likely to be children, who make up more than half of Gaza’s population.
Gaza’s alarming poverty is directly linked to the tight closure imposed on the territory.