March 11, 2009

Gaza 2009 © Mustafa Hassona

A man runs with an injured child to Al Shifa hospital in Gaza City.

Editor's Note

To our Supporters:

It has been brought to our attention that a number of our supporters were upset by the article, "Gaza: A Devastating Disregard for Civilians," on the Israeli-Palestinian conflict published in the spring 2009 edition of the Alert newsletter.

At Doctors Without Borders/Médecins Sans Frontières (MSF), we pride ourselves on transparency and accountability to our donors and to an open and constructive dialogue with those who believe in supporting the principles of providing assistance to victims of violence and disease regardless of political, religious, or economic affiliations.

Upon further reflection, we recognize the legitimacy of the concerns expressed that the Alert article was too one-sided in its presentation of the Gaza conflict. The article, as it was written, did not sufficiently contextualize the Israeli incursion into Gaza as a response to the longstanding and indiscriminate rocket attacks being launched by Hamas from the Strip into Israel. In no way was the omission of the broader context intended to diminish the suffering caused by these attacks on Israel. Human suffering is deplorable in all its magnitudes.

As MSF, we pride ourselves on a constant reflection of our medical humanitarian action and speaking out. This is a daily engagement playing out in our headquarters and among our field teams around the world. As our supporters, you are a vital part of this reflection. Just as MSF is an association composed of medical and non-medical field staff from across the globe, bound by independent, impartial, and neutral medical action, we are a movement supported by millions of individuals like you.

We thank you for the vitality of your engagement in our collective endeavors, and in difficult economic times need your continued support more than ever. Please continue to challenge us, in all aspects of our work, in the days ahead.

Attacks on the Gaza Strip by the Israeli army during three weeks in December 2008 and January 2009 made medical action extremely difficult. The vulnerability of civilians sparked humanitarian outrage and widespread criticism.

Doctors Without Borders/Médecins Sans Frontières (MSF) works in some of the most conflict-ridden areas of the world, but in most cases, civilians have the ability to flee to safer areas. Inside the locked-down borders of Gaza, one of the world’s most densely populated areas, there was no way out. From December 27 to January 19, the number of wounded people grew to 5,450 and the dead totaled 1,300, according to the UN agency for Palestinian Refugees (UNRWA). Shelling destroyed an estimated 17,000 homes and reports spread about bombing of locations considered safe zones and used for shelter by civilians.

Al Shifa hospital, the main referral facility in the Gaza Strip, received 500 wounded people in the first 24 hours of the army’s bombings—as well as 180 dead bodies. These were men, women, children, and elderly, said Dr. A, a Palestinian doctor working with MSF who requested anonymity.

On January 15, Jessica Pourraz, MSF field coordinator in Gaza, and her team were hunkered down in an MSF building a mile and half away from fighting in the Tal El-Hawa section of Gaza City. She described the situation of civilians: “An International Committee of the Red Cross (ICRC) building and a UN compound are very close to Tal El-Hawa and the families and people who escaped have gone to these buildings because they think they will be safe there. But, this morning three rockets were fired at the compound, so, as you see and as we’ve said, there is no safe place in Gaza anymore, and we are all very worried about that.”

Gaza 2009 © Frederic Sautereau/Oeil Public

MSF staff treats a child with a burn wound.

Trying to Bring Treatment

MSF has been working in Gaza since 1999 and before the assaults ran a post-operative care clinic in Gaza City and one in Khan Younis in the south, as well as a pediatric care clinic in Beit Lahia, in the northern Gaza Strip. After the initial closure of MSF facilities due to violence, the staff tried to reopen them to take the pressure off overcrowded hospitals. But access to the wounded and security for medical personnel amid the bombing campaign were severely limited.

“Despite official statements from the Israeli government, there are serious obstacles to providing humanitarian aid and, specifically, medical aid. Bombs and bullets do not spare ambulances, hospitals, or health workers,” said Dr. Marie Pierre Allie, president, MSF France, during a January 16 press conference. MSF attempted several times to reopen its pediatric clinic in Beit Lahia to relieve Kamel Edwan Hospital. But each time, the attempt was cut short; a January 1 bomb attack forced the MSF team to suspend its work only two hours after starting. Two MSF clinics for post-operative care, where patients from Al Shifa hospital are usually referred, were empty: patients in Gaza City could not reach the clinic, and no one could enter the south of the territory from the north after the Israeli army effectively cut the 140-square-mile Gaza Strip in two.

Palestinian MSF doctors, nurses, and physiotherapists began taking emergency medical kits into their own neighborhoods to meet the immediate needs of people living near them. By January 7 about 20 MSF staff werevisiting nearly 40 people every day. But even this was extremely risky—the World Health Organization (WHO) estimated that 16 health personnel were killed and 22 injured while working in Gaza since the start of the conflict.

The safety of medical facilities, protected under humanitarian law, was not respected, according to Dr. A: “Buildings near Al Shifa hospital were hit with missiles. And when a building is bombed, the neighbors are immediately affected. The hospital windows that were broken in the explosions caused cuts and wounds, mainly to the children who were sleeping.” Over three weeks, 34 facilities were destroyed or damaged, including 8 hospitals, according to the WHO.

Meanwhile, hospitals were also dealing with electricity cuts and severe lack of medical supplies. Al Shifa hospital had to be powered entirely from generators. MSF made donations of drugs, burn kits, and other items to six hospitals in Gaza and kept in constant contact with doctors, pharmacists, and administrators. But insecurity made deliveries extremely difficult.

A Lull in the Bombing

Starting January 7, the Israeli army announced a daily, three-hour pause in fighting so humanitarian aid, including food, water, and medical treatment, could be delivered. MSF, along with the ICRC and the UNRWA, were trying to provide aid and medical treatment to civilians, but this limited window of opportunity was restricted to Gaza City and it was insufficient to make any major progress.

“Don’t be deceived—the lull in bombing is not helping humanitarian aid workers to do their jobs or helping people reach the hospitals,” said Jessica Pourraz on January 9. “We are in Gaza, in the middle of everything, but we can neither reach patients nor do our work properly.”

While emergency wards in Gaza hospitals were short on surgical staff, as well as supplies, a five-person MSF surgical team was ready in Jerusalem but could not get the security guarantees needed to pass through the Erez Crossing.

“Their emergency departments and intensive care units are overwhelmed by the inflow of sick and wounded patients, especially at night,” said Cécile Barbou, medical coordinator for MSF’s programs in Gaza. “Surgical departments are working around the clock. Sometimes two operations are performed simultaneously in the same operating room. Hospital staff are exhausted.”

After 10 days, the MSF surgical team entered Gaza. A 21-ton MSF shipment of medical materials was admitted after waiting four days for clearance.

MSF "Outraged"

MSF expressed strong criticism of the Israeli army’s assault on Gaza and of the international community for standing by while the incursion continued for 22 days.

“How far can the Israeli army go before the international community mobilizes to stop it?” asked Cécile Barbou during a press conference on January 16. “It’s hell here. Even people carrying white flags are being shot at. It’s high time for the international community to organize, position itself, make decisions, and take the measures required to stop this conflict. This passive stance is unbearable, intolerable! This has got to stop. We are outraged.”

Gaza 2009 © Mustafa Hassona

MSF staff treat an injured child.

After ceasefires were separately agreed on January 17 and 18, MSF and other aid agencies were able to slowly bring more aid to civilians in Gaza. MSF logistics staff set up two inflatable medical tents that housed operating rooms and a 12-bed intensive care unit for the MSF surgical team in Gaza City.

The MSF team in Gaza, made up of 70 Palestinian staff and 12 international staff, resumed its full range of activities, including the post-operative clinics in Gaza City and Khan Younis and the pediatric clinic in Beit Lahia.

In addition to medical assistance, MSF tried to bring more attention to the situation of civilians in Gaza by speaking out. MSF often speaks out publicly when it sees atrocities committed that have gone unreported. These atrocities were widely televised but nevertheless prompted little interference.

“Today, 1.5 million Palestinians in the Gaza Strip—almost half of them children—are the victims of incessant shooting and bombing,” said MSF head of mission Franck Joncret. “How can anyone believe that such a steamroller attack would spare civilians, who are prevented from fleeing and are crowded in a densely-populated enclave?”