18 December 2020
[Updated with latest COVID-19 data on 18/12/20]
The current spike in COVID-19 cases is stretching the capacity of Gaza’s beleaguered health system to breaking point. Over the past three weeks, cases of COVID-19 in Gaza have increased by over 65%, with more than 31,000 total cases recorded compared to 15,000 on 23 November.
Our team in Gaza are warning of very urgent shortages to essential materials for treating cases, and a growing crisis in child malnutrition. Amid this crisis, Medical Aid for Palestinians (MAP) has issued an emergency COVID-19 briefing, calling on the UK Government to help Gaza breathe as oxygen supplies dwindle.
You can read our briefing below, and find the document here as a pdf.
The humanitarian situation in Gaza was critical long before the arrival of COVID-19 earlier this year. Two million people, 70% of whom are refugees, live in approximately 365km2, making Gaza one of the most densely populated areas of the world. Israel has imposed an illegal closure and blockade on Gaza since 2007 which, combined with repeated military offensives and the significant injury and death toll of Israel’s use of force against the ‘Great March of Return’ protests of 2018-19, has led to economic de-development, crumbling infrastructure, and massive pressure on essential services.
The World Bank described Gaza’s economy as being in ‘freefall’ with rapidly worsening socio-economic indicators: unemployment is at 55%, more than half of families (57%) live below the poverty line, and 68% are food insecure. UN OCHA has described the situation as a chronic emergency and a protracted human dignity crisis. Meanwhile, international funding has dramatically decreased due to donor fatigue and changing priorities. Limited funding, blockade and more than 50 years of occupation have left Gaza’s health system woefully unprepared for the challenge presented by COVID-19.
The current spike in COVID-19 cases is stretching the capacity of Gaza’s beleaguered health system. Over the past three weeks, cases of COVID-19 in Gaza have increased by over 65%, with more than 31,000 total cases recorded compared to 15,000 on 23 November. With testing capacity limited to around 2,000 tests per day, the positivity rate has increased from 19% to 29% in three weeks. High population density and pervasive poverty mean that the rate of infections and hospitalisations continues to increase despite nightly curfews and the closure of schools, universities and mosques.
The World Health Organization (WHO) has warned that the risk remains high that Gaza’s health system may reach capacity and become overwhelmed. Health facilities lack adequate infrastructure, human resources, essential equipment, medicines and supplies needed to manage a widespread outbreak of the virus. Half of all essential drugs and a third of all essential medical consumables are permanently at zero-stock (less than a one-month supply at Gaza’s Central Drug Store), and the diversion of precious resources to the COVID-19 response greatly exacerbates this ongoing crisis.
On Monday 8 November, the Ministry of Health had to stop all COVID-19 testing due to zero stock in lab reagents and testing kits. The WHO has since supplied an emergency shipment of testing kits, but health officials have warned this will only be enough for just over one week’s supply. 88% of intensive care unit (ICU) and high dependency unit (HDU) beds are now occupied. The Ministry of Health reports that it needs an additional 250 hospital beds dedicated to COVID-19 cases.
MAP’s Senior Manager in Gaza, Mahmoud Shalabi, reports: “The health system will not be able to cope with the continued increase in COVID-19 cases. It is of extreme importance that the health system is enabled to operate to meet the demands, but there are huge shortages in PPE, drugs, disposables, infection control supplies, ICU equipment, respiratory devices and oxygen urgently needed for COVID-19 patients. This all adds to the grim reality of Gaza’s beleaguered health system, and the fact that imposing a strict lockdown is almost impossible in one of the world’s most overcrowded places.”
With rising unemployment and higher levels of poverty and food insecurity, COVID-19 has triggered a surge in childhood malnutrition. MAP expects this situation to worsen over the winter. A recent needs assessment surveying over 600 households in Gaza to look at the impact of COVID-19 on vulnerable children and their families, found that 90% of surveyed households did not have enough food.
While daily cases and hospitalisations continue to rise significantly, there is a critical gap in local capacity to generate oxygen to treat COVID-19 patients. Gaza’s main dedicated COVID-19 hospital, the European Gaza Hospital (EGH), only has the capacity to produce 2,200 litres per minute of oxygen, but its intensive care units alone needs 3,000 LPM. Three additional oxygen plants due to arrive in Gaza in the next few weeks (two from MAP, one from NORWAC) will only provide an extra 1,400 LPM.
The Ministry of Health has had to deploy oxygen generators from other hospitals and health facilities to cover current needs. Costing approximately $130,000 each, additional oxygen plants are beyond the buying capabilities of the Ministry of Health in Gaza. The only factory in Gaza able to produce liquid oxygen has been unable to address needs, and it is estimated that it would cost the factory $100,000 monthly to provide the supply needed by EGH.
If COVID-19 cases continue to rise in Gaza, the capacity of the health system to treat critically ill patients will soon be surpassed and lives will be avoidably lost. The international community must urgently increase its aid to the Palestinian people and humanitarian organisations responding on the ground, in order to give them a fighting chance to avert catastrophe in Gaza.
MAP is calling on international donors, including the UK government, to immediately boost funding to the Palestinian health system, prioritising provision of supplies necessary to fight the pandemic and addressing oxygen production capacity gaps and food insecurity. Long-term action is also needed to support the sustainable re-development of Gaza’s health system, and to address Israel’s illegal closure and blockade of Gaza that has long undermined local healthcare capacity and the social determinants of health.
Medical Aid for Palestinians (MAP) is working tirelessly to provide vital equipment, medical supplies and training to support infection control efforts and help health workers treat patients in the occupied Palestinian territory.
MAP is providing Continuous Positive Airway Pressure (CPAP) respirators, oxygen plants and essential medicines and disposables to Gaza’s hospitals, to treat COVID-19 patients with severe breathing difficulties. We have also provided hygiene kits to quarantined families, Personal Protective Equipment (PPE) for health workers, COVID-19 PCR testing kits and antiseptics/disinfectants to help prevent further spread of the disease.
Further details of our emergency response are available here and our latest COVID-19 situation updates are on our website here.
