The coronavirus pandemic has crippled countries across the globe, infecting over 600,000 people and killing over 28,000. As the toll continues to climb, the world has turned inward to try to curb the spread of infection. Social life has been restricted in unprecedented ways. Economies have ground to a halt. Borders have all but sealed. Travel has become nearly impossible. People everywhere suddenly find themselves isolated and alienated.
In the Gaza Strip, such conditions of estrangement have been the status quo for nearly a decade and a half. The measures now being used to quarantine populations around the world have been imposed on Gaza in various ways for years. Since 2007, a crippling blockade enforced by Israel, as well as Egypt, has stifled nearly every aspect of daily life for Palestinians in the enclave. It is why Gaza is often described as the world’s largest open-air prison.
The siege and suffocating restrictions on movement may have delayed the spread of the virus to Gaza, with the first cases only discovered last week. But now that the disease has arrived, Gaza finds itself in a uniquely vulnerable position for dealing with the potentially devastating effects of an outbreak.
Thirteen years of siege, three major military assaults, and two years of near-continuous protests have created the ideal conditions for the pandemic to wreak havoc: a potentially deadly combination of deep poverty, crumbling infrastructure, high population density, extreme power shortages, restrictions on basic supplies, and a health care system on the verge of collapse.
“Nobody is going to be spared this pandemic in the whole world,” says Tarek Loubani, an emergency physician who works in Gaza’s Shifa Hospital and in the London Health Sciences Center in Ontario, Canada. “But the occupation and its systematic degradation is going to make this much, much worse in Gaza.”
The number of confirmed coronavirus cases in Gaza is still low, with nine people officially declared to have tested positive, according to Gaza’s Health Ministry. Meanwhile, the Hamas government has taken measures to try to curb the spread of the pandemic.
Since March 15, all incoming travelers from Egypt and Israel have been put in isolation for 14 days in one of 23 compulsory quarantine facilities set up in health facilities, schools, and hotels across the Strip, with over 1,600 currently quarantined. An additional 1,200 people who entered Gaza prior to March 15 were under home quarantine but have since been cleared .
Educational institutions were closed on March 6, but other aspects of daily life continued as normal until the first cases were discovered on March 22, which prompted authorities to order the closure of all wedding halls, weekly markets, restaurants and cafes, and to place restrictions on public events and Friday prayers.
After the first two cases were confirmed, a field hospital was established in Rafah to isolate and treat cases. The additional seven cases announced on Wednesday were all security officials quarantined in that facility, the health ministry said.
“People are panicking. In the beginning they took it lightly, but now no. The streets are nearly deserted. People are generally staying at home,” says Dr. Mona El-Farra, the former chair of the Red Crescent Society in Gaza and the director of the Middle East Children’s Alliance in Gaza. “And there is great social solidarity in Gaza. Volunteers are going around sweeping streets, delivering hygiene kits, distributing leaflets. It reminded me of the first intifada.”
Yet doctors and health professionals fear that the pandemic will be almost impossible to contain.
Israel has sent just a few hundred test kits to Gaza and the health ministry says it has tested 339 so far, even as hundreds of Palestinians have returned to the territory over the past few weeks.
Gaza is one of the world’s most densely populated areas, with over two million people living on a 360-square-kilometer stretch of land, making the notion of proper quarantine, let alone social distancing, a daunting prospect.
“We don’t have enough places for these people, we are sending them to schools and hotels. It’s a big problem,” Farra says. “How do we feed them and stop them from infecting each other? We have up to eight people in one room.”
The problems Gaza faces with the coronavirus pandemic are exacerbated by the crumbling healthcare system.
Hospitals have severe shortages of supplies and equipment, including roughly 40 percent of the basic medications they need, and there are a grand total of 56 ventilators and 40 functioning ICU beds for adults, according to Farra — all equipment that is essential to treating patients suffering from COVID-19.
“This is a very, very small number compared to the situation we are going to face,” she says. “We are still in the beginning but the difficult time is coming.”
There is also a severe shortage of basic protective gear for healthcare workers, including gloves and masks. According to the United Nations Office for the Coordination of Humanitarian Affairs, “A significant proportion of medical staff are at risk of contamination, and if health workers are infected, this has a knock-on impact for the entire health response. In the Gaza Strip, only 700 Personal Protective Equipment kits are currently available.”
On Thursday, the Health Ministry issued an urgent appeal to the international community for $23 million in aid for ventilators, ICU equipment, medicines, laboratory supplies and testing kits. “The Israeli occupation practices systemic racism against our people and puts the lives of 2 million citizens in the Gaza Strip at risk in the face of the coronavirus pandemic,” Dr. Ashraf al-Qidra, the Health Ministry spokesperson, said in a statement.
In addition to lacking basic supplies, the healthcare system has also borne the brunt of three devastating military assaults on Gaza and two years of the Great March of Return protests during which thousands of Palestinians have been wounded by Israeli snipers. Meanwhile, severe electricity shortages as a result of the Israeli siege compunded by sanctions imposed by the Palestinian Authority to put pressure on Hamas mean that hospitals have to rely on overused generators for power.
“The health system has not recovered after each successive military operation and two years of demonstrations,” says Suhair Zakkout, the spokesperson for the International Committee of the Red Cross in Gaza. “It is already stretched and fragile and any extra burden on it will have substantial consequences on the population.”
Meanwhile, doctors in Gaza lack sufficient training and expertise to deal with the pandemic.
“There is no way that any country would be able to train doctors to meet even basic standards of care given the restrictions that exist in Gaza,” Loubani says. “And this is not a basic situation. This is a really intense situation that tests the healthcare system to the absolute maximum.”
According to Loubani, any pandemic response relies on three main pillars: diagnostics, protection of health care workers from infection, and treatment. “In Gaza none of these three pillars work, they’ve been degraded systematically over years,” he says.
Loubani is a founding member of Glia, a project to create open-source medical devices. Glia is currently working to mitigate the shortage of protective equipment for Gaza doctors by gearing up to produce face shields using 3-D printing technology. They hope to be able to produce up to 500 a day, though Loubani says 10,000 are probably needed at a bare minimum.
“To say that Gaza’s healthcare system does not have the capacity to deal with an outbreak is like saying that a nuclear bomb is just an explosion,” Loubani says. “I know it might sound hyperbolic but it won’t sound so hyperbolic in about 30 days. That’s why everybody in the medical world is panicked right now in Gaza. Because we see this powder keg, where the gunpowder has been poured on over the last decade and a half. And now we see sparks flying in.”
The dire economic situation in Gaza as a result of the Israeli blockade — with unemployment at 43 percent, youth unemployment at 64 percent, and over half the population living below the poverty line, according to the UN — also has direct consequences on how quickly the virus could spread, as basic hygiene becomes more difficult.
“In terms of clean water, in terms of the ability of people to buy hand sanitizers, to buy masks, to buy sufficient food if there is a lockdown — all of this makes it much harder to contain the virus, even if there is self-isolation. I’ve been talking to people who tell me that one mask is shared by different family members because they can’t afford more,” says Tareq Baconi, the Israel/Palestine analyst for the International Crisis Group. “A very poor health sector coupled with major poverty and an absence of medical supplies makes for a pretty disastrous combination. The fate of Gaza is similar to vulnerable communities elsewhere — refugee camps, stateless people, prisoners — they are going to bear the brunt of this.”