As healthcare systems in the occupied Palestinian territory struggle to handle COVID-19, new developments such as the normalization deals, Israeli bargaining with Palestinians on vaccines and relief aid, and health guideline breaches in protest of UNRWA’s aid cuts demonstrate how politicized the pandemic response has become. The politicization of Gaza’s healthcare sector is a legacy of occupation that continues to impact Palestinian life, and the current COVID-19 crisis is no exception.
Decades of occupation leaves Gaza without a cohesive healthcare sector; fragmented in terms of decisionmaking, ownership, and financing mechanisms. These effects trickle down, inhibiting its ability to deliver services, plan, and cooperate. 1 The sector suffers from continued dependency on foreign aid—especially through UNRWA—which has left it vulnerable to competing local and international political agendas. The Trump administration’s decision to cease U.S. funding for UNRWA in the West Bank and Gaza affected programs servicing thousands of people. Consequently, UNRWA was left facing unprecedented financial deficits—posing a threat to food distribution for 1 million people and preventing future planning. In light of these challenges to UNRWA’s future resiliency, the organization essential to many Palestinian livelihoods is inhibited by the ongoing struggle to pay its staff salaries and maintain essential services like healthcare. Despite minimal local and international efforts to insulate the Gazan health sector, these endeavors have failed to address the political and economic contexts that contribute to deteriorating situation in Gaza—minimizing their long term efficacy.
Between March and December 2020, Gazan authorities reported a total of 33,594 infections of COVID-19 and 260 deaths. The Hamas government's immediate response centered on the isolation of possible infections as much as possible within the confines of the territory. The imposition of mandatory quarantines for returnees transiting through the Rafah crossing with Egypt or Israel’s Erez crossing, isolation and patrol of high-infection areas, enforcement of lockdowns, and construction of quarantine centers all pointed to leadership’s awareness of the threat posed by the uncontained virus, and a responsibility to use all possible measures to prevent a health catastrophe in Gaza. The Hamas government also reached into delicate social territory to control the virus’ spread. Early closure of legal and educational institutions, prominent disinfection of public spaces, suspension of Friday prayers, empowerment of local production for face masks and PPE, consistent dissemination of public health information, and the promotion of training for nurses and health officials on COVID-19 emergency protocol. Broadly, most Gazans complied with the added movement restrictions, but less so with COVID-19 health guidelines, given the centrality of social rites and rituals to Gazan life. Despite efforts to engage the international community, the government reported frequent shortages in testing kits and requested that the World Health Organization (WHO) and the Palestinian Authority in Ramallah provide necessary assistance. Ultimately, the lack of ability to coordinate a Palestinian national response limited the efficacy of any Hamas government plan to contain the pandemic and its socio-economic repercussions in Gaza.
Though these measures have provided short-term relief, they may not be sufficient for more acute waves of COVID-19 without exacting a high human and developmental costs on Gaza. Such a peak in COVID-19 cases would overwhelm the Gazan healthcare system’s capacity. Limited facilities and expertise, coupled with a lack of ventilators and testing equipment, demonstrate that Gaza’s hospitals are already struggling to handle COVID-19 and other emergent health emergencies. Noncommunicable disease patients—those with chronic lung and heart diseases, cancer, and diabetes—are among the most affected. As overburdened hospitals are unable to accommodate these more commonplace illnesses, patients are resorting to treatments at home under unsuitable conditions. Some patients need treatments, such as chemotherapy or radiotherapy, that require referrals to other countries or to Israeli hospitals. But issuance of medical permits to Israel has decreased by 90 percent, when compared with the pre-COVID-19 standards.
The healthcare sector relies on vital foreign aid. Although international organizations and private donors provided some COVID-19 assistance to Gaza, it remains far below the population's needs. U.S. financial cuts to UNRWA—which offers food, crucial education, and health services for refugees in Gaza—intensified an already difficult situation. The decreased services in Gaza have sparked protests, notably in front of an UNRWA center in Jabalia Camp, emphasizing the indispensable nature of this organization’s contributions to Palestinian subsistence. For Palestinians, not only is the continuation of UNRWA’s support life-saving, but it also legitimizes the protracted refugee status of Palestinians. Gazans worry that UNRWA is trying to solve its financial crisis by withdrawing its responsibility to the Palestinian people rather than working to find long term international mandate to solve its persistent financial challenges and achieve stability in its operations in the coastal enclave. UNRWA’s dramatic programming shifts coupled with the massive burdens of the pandemic leaves families reliant on this relief precariously exposed to further insecurities and politicization.
The pandemic has accelerated the deterioration of the Palestinian political situation in Gaza. Israel and key Arab states used the pandemic as cover to announce annexation and normalization plans, and to contain popular resistance in the territories and at home. Furthermore, Israel extorted the Palestinian people and the Hamas government by conditioning COVID-19 relief aid on the return of the remains of two Israeli soldiers killed in the 2014 war. Palestinians in Gaza attempted to pressure Israel into taking responsibility as occupier of the Gaza Strip to offer the necessary support to handle the health crisis. Although Israel has provided some assistance, including a supply of vaccine doses to Gaza, Israeli support is far from altruistic. A major outbreak in Gaza would be a nightmare for Israel: it could increase global scrutiny of Israeli responsibility for the humanitarian crisis and spread infection to Israelis. But as Gazan hospitals struggled, Israel launched several air attacks on Gaza and blocked the shipment of Russia’s Sputnik V coronavirus vaccines—intended for front-line health workers.
Though political challenges in the Gaza Strip are not triggered by the pandemic alone, competing partisan dilemmas threaten to overwhelm the delicate systems, preventing progress on any of Gaza’s vital objectives. The recent normalization deals break the historical Arab consensus on a “land for peace” arrangement and preserve the occupation. To protect Palestinian legitimacy, and avoid civil unrest against them as ruling parties, the Palestinian National Authority and Hamas governments have started a process of reconciliation by agreeing to organizing the first elections in almost fifteen years. It is uncertain how the agreement will be implemented, and what elections might mean for Hamas and Gaza. And exacerbating the pandemic duress, between May and November 2020, the PA’s political standoff with Israel worsened the financial situation in Gaza—where the unemployment rate is reported at 70 percent. Civil servants continue to suffer salary cuts, and late payments. Furthermore, the COVID-19 crisis has created chaos in the labor market, especially in the agricultural sector. Jobs in the agriculture and fishing sectors decreased by 12 percent from the first to the second quarter of 2020. Prevalent informal employment has left many Gazans without social protection during all crises. Donor transfers to the occupied Palestinian territory from official and private sources are also projected to decline to their lowest point in a decade—aggravating this difficult political and economic situation in Gaza.
Palestinian institutions have been debilitated by both the blockade and the pandemic. Despite efforts to operate these institutions with reduced staff and working hours, the majority struggle from a lack of technological infrastructure and facilities that are inconducive to COVID-19 safety guidelines. The government faces a grave decision: either prioritize the socio-economic crisis or the health crisis. As 74.5 percent of the Gazan population are refugees and most Gazans live in small and overcrowded homes, Gazans will inevitably struggle to overcome the virus’ impacts because of their environmental constraints. This moment forbodes of a decline in literacy, increased inequality, growing mental health problems, and domestic violence—all most severely impacting Gazan disabled and youth.
Generating a global response to support health in Gaza is difficult given the politicization of Palestinians’ right to healthcare. The delay in responding to the COVID-19 emergency in Gaza seems to be a decision made by Israel to weaken the Hamas government, especially as it prepares for the upcoming Palestinian elections. Delaying aid puts the lives of 2 million people in Gaza at risk; a serious violation of universal human rights that would jeopardize the possibility for creating peace for decades. Prioritizing health over politics is the way forward to creating a positive change on the ground. The longer it takes to do so, the more detrimental the impact will be on Gaza.
1 This article is part of an ongoing R4HC-MENA research on the political economy of health in Gaza (https://r4hc-mena.org/).
Dr. Mona Jebril is a Research Fellow at the University of Cambridge Centre for Business Research. She is an interdisciplinary social scientist focused on Gaza and Conflict-affected areas, Follow her on Twitter @Mona_Jebril.