'The situation is horrific': Doctors Without Borders coordinator on Gaza's health crisis

Key Concepts

• Medical Aid Delivery: Challenges and impediments in delivering medical supplies and aid to Gaza.
• Humanitarian Aid Worker Protection: Violations of international humanitarian law and the targeting of aid workers.
• Malnutrition and Burns: Severe levels of malnutrition and the inability of burn victims to heal due to lack of resources.
• Health Facility Destruction: The widespread destruction of healthcare infrastructure in Gaza.
• Medical Evacuation: Difficulties and delays in evacuating critically ill patients from Gaza.
• Chronic Conditions: The development and exacerbation of chronic health issues due to the conflict and lack of care.
• International Humanitarian Law (IHL): The legal framework governing armed conflict and the protection of civilians and humanitarian personnel.

Medical Aid Delivery and Access

Claire Mona, Emergency Coordinator for Gaza at Doctors Without Borders (MSF), highlights severe impediments to delivering essential medical aid to Gaza. As of the interview, over 200 tons of medical equipment remain at the border, blocked by Israeli authorities. Only seven international organizations are approved to bring in aid, a number insufficient to meet the massive needs.

• Scale of Need vs. Delivery: Before the conflict, 600 trucks entered Gaza daily. Currently, even this number is not being met, despite over 94% of health facilities being destroyed.
• Impact on Patients:
  • Malnutrition: Levels are extremely high.
  • Burns: Victims of bombings cannot heal, particularly children, who require significant caloric intake for recovery from third-degree burns.
• MSF's Role: MSF receives medical supplies directly, which are then distributed within hospitals. They emphasize that these supplies are for direct medical use and are not diverted to other groups.

Protection of Humanitarian Aid Workers

The situation for humanitarian aid workers in Gaza is described as "terrifying" and "highly dangerous." Despite providing daily location information to Israeli authorities for team safety, MSF has experienced significant losses.

• Targeting of Aid Workers:
  • 15 MSF colleagues have been killed since the start of the war, a clear violation of international humanitarian law.
  • Two colleagues were recently killed by an Israeli strike while clearly marked as humanitarian workers.
• Attacks on Facilities: The hospital where MSF was working was repeatedly targeted, with rockets fired through windows and bombing around the perimeter, preventing safe access.
• Logistical Challenges: Trucks carrying aid are often forced onto unsafe roads in the middle of the night, further complicating delivery and safety.

Gauging Aid Needs and Conflicting Information

MSF gauges aid needs based on the fundamental requirements to sustain medical operations and care for the population.

• Minimum Requirements: Hospitals require a minimum amount of medical supplies to operate theaters and inpatient departments, which house hundreds of beds. These needs are amplified by the large numbers of malnourished and traumatized individuals.
• Separation of Issues: MSF asserts that the delivery of medical supplies is a separate issue from conditions imposed by Hamas. Their focus is on receiving supplies safely for direct medical use.
• Conflicting Accounts: The discrepancy between reported aid entering Gaza and its actual reach to those in need is a significant concern. MSF clarifies that while aid might be entering, it is not reaching the intended recipients due to access and logistical issues.

Motivation and Resilience of Staff

Despite the overwhelming challenges, MSF staff and Palestinian colleagues are driven by a profound commitment to the Palestinian people.

• Resilience of Palestinian Staff: Over a thousand Palestinian staff members come to work daily, even when they are homeless, lack food, and have no safe drinking water.
• Moral Imperative: Mona questions how she or the world can look away when these individuals demonstrate such dedication.

Collaboration and Operational Limits

Humanitarian aid groups in Gaza are banding together for safety in numbers due to the security situation.

• MSF's Approach: MSF is known for being among the first to arrive and the last to leave. However, they acknowledge their limits.
• Withdrawal and Return: MSF had to withdraw from Gaza City when tanks approached within a kilometer of their clinics due to safety concerns. They have since returned and are continuing services.

Emergency Medical Evacuation

Arranging emergency medical evacuations for Gazans who cannot be treated locally remains extremely difficult.

• High Number of Patients Needing Evacuation: Over 15,000 people require medical care outside of Gaza.
• Fatal Delays: In July and August alone, 740 people died waiting for medical evacuation, with one in five being children.
• Constraints:
  • Limited Capacity: Only a certain number of individuals can leave at a time.
  • Bureaucracy and Control: Movements are controlled by Israeli forces, leading to delays in planning safe departures.
  • Paperwork: While not explicitly detailed as a primary constraint, the process of planning safe movements implies administrative hurdles.

Deterioration of Conditions and Chronic Illnesses

The conflict has led to the deterioration of existing conditions and the development of chronic illnesses.

• Physical Trauma and Burns: Patients suffer from physical trauma and burns, with infections becoming rampant due to a lack of clean water and sterile medical bandages. Wounds are described as "rotting away."
• Development of Chronic Conditions: These untreated wounds can develop into chronic conditions.
• Pre-existing Chronic Illnesses: Individuals with cancer and those requiring dialysis also face severe challenges. These chronic conditions necessitate medical evacuation, similar to any other country.

Conclusion

Claire Mona's testimony paints a grim picture of the humanitarian crisis in Gaza, characterized by severe medical supply shortages, the targeting of aid workers, and the devastating impact on the civilian population. The systematic impediments to aid delivery, coupled with the destruction of infrastructure and the inability to evacuate critically ill patients, have led to a catastrophic decline in health outcomes. The resilience of the Palestinian people and the dedication of humanitarian workers like those at MSF are highlighted as beacons of hope amidst immense suffering, yet their efforts are severely hampered by the ongoing conflict and access restrictions. The situation underscores a critical failure to uphold international humanitarian law and ensure the basic right to healthcare for the people of Gaza.