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Editorial

Ahmed Al-Mandhari  ¹, Richard Peeperkorn   ², Farah Al-Shorbaji ³, Bisma Akbar    ², Ali Mohamed Kamil    ⁴ and Richard Brennan   ⁵

¹Regional Director, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt. ²Representative, WHO Office for the West Bank and Gaza. ³Technical Officer, Health Emergency Programme, WHO Headquarters, Geneva, Switzerland. ⁴Programme Area Manager, Emergency Operations, Health Emergency Programme, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt. ⁵Regional Emergency Director, Health Emergency Programme, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (Correspondence to Richard Brennan: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

Citation: Al-Mandhari A, Peeperkorn R, Al-Shorbaji F, Akbar B, Kamil AM, Brennan R. Gaza disaster: we need a permanent ceasefire, now! East Mediterr East Mediterr Health J. 2023;29(12):919–920. https://doi.org/10.26719/2023.29.12.919

Copyright: © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

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Another year ends with multiple humanitarian crises ongoing simultaneously across the globe. In the Eastern Mediterranean Region, 9 of the 22 Member States and territory are considered fragile or conflict-affected, with severe health consequences for the population (1).

Over the past 2 months, the world’s attention has focused on the humanitarian catastrophe in Gaza. The Hamas attacks in Israel on 7 October 2023 reportedly caused the death of over 1200 Israelis and injury of over 9000; more than 230 people were taken hostage, including children (2,3). There are also reports of sexual and gender-based violence. Israel subsequently declared war on Hamas, which as of 10 December had reportedly caused the death of over 20 000 Gazans – two-thirds estimated to be women and children – and injury of over 52 000 others (3). Thousands more are reportedly missing under the rubble.

The rapidly accelerating military offensive has forced the repeated displacement of over 1.9 million Palestinians into increasingly smaller areas of southern Gaza (3,8). Gaza was already one of the most densely populated places on earth, heavily reliant on humanitarian aid (4). The drastic reductions of the supply of fuel, electricity, water, food, telecommunications, and other services, and much-needed aid to a besieged civilian population is contributing to a rapidly escalating humanitarian crisis (5).

In addition to the dramatic death toll, the public health risks of the war are grave (6). There are reports of increased numbers of respiratory infections, watery diarrhoea, bloody diarrhoea, acute jaundice, scabies, and head lice (7). In massively overcrowded United Nations Relief and Works Agency for the for the Palestine Refugees in the Near East (UNRWA) shelters, more than 400 people share one toilet (8). An unprecedented 93% of the population in Gaza is facing crisis level of hunger. (9). Winter is approaching; with limited space to shelter safely, Gazans are exposed to the risks of hypothermia and more severe health conditions. The mental health of Gazans has long shown devastating trends, especially among children (10,15). The longer the conflict continues, the more severe these impacts will become.

The health system of Gaza has been massively degraded; only 9 of 36 hospitals are partially functioning (3). The number of hospital beds has plummeted from 3500 to 1500 – nowhere near the estimated need of 5000 (3). Bed occupancy rates are at 200–300% in the main receiving hospitals and 71% of primary healthcare facilities are non-functional. There is dramatic reduction in access to essential health services including emergency obstetric and neonatal care, and treatment of noncommunicable diseases.

As of 21 December 2023, there has been nearly 250 attacks on health facilities and over 300 health workers killed (11), including a key member of the WHO trauma and emergency team, along with her husband, her 6-month-old son, and over 50 family members sheltering in the same house. The toll among humanitarian staff has become unbearable. The current Gaza crisis has been the deadliest for the United Nations, with at least 136 UNRWA staff killed (12).

Gaza cannot afford to lose any more hospitals, hospital beds, or primary healthcare centres. The health system must be protected from further deteriorations to reverse this downward trend and strengthen capacities to meet the soaring needs.

WHO pays tribute to health workers in Gaza who are working heroically under unimaginable conditions. We are working with other United Nations agencies and non-government partners, especially UNRWA and the Palestine Red Crescent Society, to provide and protect health services.

Guided by a comprehensive operational plan (13), WHO is supporting health care services by providing medicines and fuel; leading multiple high-risk, interagency missions to transfer critically ill patients to southern Gaza; and supporting the deployment of emergency medical teams. We are partnering with UNRWA to strengthen disease surveillance, coordinating with health cluster partners to expand primary care services, pursuing options to increase hospital bed capacity, assisting with patient referrals to Egypt, and advocating in the region and globally.

However, the worsening insecurity, grossly insufficient aid flows and increasing desperation among Gazans are placing all humanitarian operations at grave risk. WHO and the United Nations as a whole are committed to stay and deliver for the people of Gaza. Our ability to do so will, however, depend entirely on how security evolves. WHO deeply regrets the failure of the United Nations Security Council to pass a resolution on a ceasefire on December 10.

Tensions and insecurity are also escalating in the occupied West Bank. Over 290 Palestinians have been killed recently by Israeli forces or settlers – 30% of them children (14). Increased use of live ammunition, airstrikes, obstructions at checkpoints, and closure of several communities have prevented entry or exit for patients, health care providers and ambulances on multiple occasions (16).

Health is a human right. More advocacy is needed to secure a ceasefire. This is the only way we can secure unhindered and sustained humanitarian access and ensure the protection of human rights for Gazans and all Palestinians. WHO calls on all those with influence to achieve a permanent ceasefire now. To allow unhindered and sustained humanitarian access to the civilian population of Gaza. To protect the healthcare system from further degradation and attacks. To release the remaining hostages and to ensure that their rights are observed while in detention. And to work towards lasting peace and justice.

References

1. Al Mandhari A. Earthquakes as triggers for public health disasters: WHO and health systems response. East Mediterr Health J 2023;29(3):165–167. https://doi.org/10.26719/2023.29.3.165.
2. France 24. Hamas frees 24 hostages, 39 Palestinians released from Israeli jails. As It Happened, 24 November 2023. https://www.france24.com/en/middle-east/20231124-gaza-truce-begins-friday-ahead-of-first-release-of-hostages.
3. World Health Organization. WHO Director-General’s opening remarks at the Special Session of the Executive Board on the health situation in the occupied Palestinian territory, 10 December 2023. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-special-session-of-the-executive-board-on-the-health-situation-in-the-occupied-palestinian-territory---10-december-2023.
4. UNCTAD. Prior to current crisis, decades-long blockade hollowed Gaza’s economy, leaving 80% of population dependent on international aid. Press Release, 25 October 2023. https://unctad.org/press-material/prior-current-crisis-decades-long-blockade-hollowed-gazas-economy-leaving-80.
5. United Nations. Comment by UN High Commissioner for Human Rights Volker Türk on resumption of hostilities in Gaza. Press Release, 1 December 2023. https://www.ohchr.org/en/press-releases/2023/12/comment-un-high-commissioner-human-rights-volker-turk-resumption-hostilities
6. World Health Organization. Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan, Report by the Director-General to the Seventy-Sixth World Health Assembly, 17 May 2023. https://apps.who.int/gb/ebwha/pdf_files/WHA76/A76_15-en.pdf.
7. Nadeen Ebrahim. Bloody diarrhea, jaundice, hepatitis: Thousands fall ill in war-ravaged Gaza amid spike in infectious diseases. CNN, 12 December 2023. https://edition.cnn.com/2023/12/12/middleeast/gaza-diseases-spread-what-we-know-intl/index.html.
8. UNRWA. The situation in the Gaza Strip and the West Bank, including East Jerusalem. UNRWA Situation Report #50, 12 December 2023, https://www.unrwa.org/resources/reports/unrwa-situation-report-50-situation-gaza-strip-and-west-bank-including-east-Jerusalem.
9. World Food Programme. Gaza food security assessment. Rome: World Food Programme, 2023. https://docs.wfp.org/api/documents/WFP-0000154766/download/?_ga=2.230138905.4420218.1701882982-901052480.1701882982
10. Save the Children. Trapped: The impact of 15 years of blocade on the mental health of Gaza’s children. London: Save the Children, 2022. https://resourcecentre.savethechildren.net/pdf/gaza_blockade_mental_health_palestinian_children_2022.pdf/
11. United Nations Office for the Coordination of Humanitarian Affairs. Hostilities in the Gaza Strip and Israel - reported impact | Day 68. East Jerusalem: United Nations Office for the Coordination of Humanitarian Affairs. https://www.ochaopt.org/content/hostilities-gaza-strip-and-israel-reported-impact-day-68.
12. World Health Organization. WHO staff member killed in Gaza. Press Release, 21 November 2023. https://www.emro.who.int/media/news/who-staff-member-killed-in-gaza.html
13. World Health Organization. WHO Operational Response Plan: Occupied Palestinian Territory. Geneva: World Health Organization, 2023. https://www.emro.who.int/images/stories/palestine/WHO_Operational_Response_Plan_oPt_FINAL_publish.pdf
14. Isabel Debre. With the world’s eyes on Gaza, attacks are on the rise in the West Bank, which faces its own war. The Associated Press, 20 November 2023. https://apnews.com/article/palestinians-israel-west-bank-war-gaza-hamas-settlers-army-raid-militants-c1386ab6a633971cc18b2497169210d3.
15. Wagner G, Glick P, Khamma-sh U, Shaheen M, Brown R, Goutam P, et al. Exposure to violence and its relationship to mental health among young people in Palestine. East Mediterr Health J 2020;26(2):189–197. https://doi.org/10.26719/2020.26.2.189.
16. Bouquet B, Barone-Adesi F, Lafi M, Quanstrom K, Riccardi F, et al. Comparative survival of cancer patients requiring Israeli permits to exit the Gaza Strip for health care: A retrospective cohort study from 2008 to 2017. Plos One 2021;16(6):e0251058. https://doi.org/10.1371/journal.pone.0251058.