George Shand, Wednesday 11th December 2013.

The day of our most recent visit was also the first day of a winter storm that brought chaos to the whole region –howling winds, thunderstorms and torrential rain – with the promise of snowstorms in Jerusalem. (Our journey to the Erez Terminal checkpoint for travel out of Israel into Gaza took longer than we anticipated, and we were very late in arriving.) We were met at the other side by a Hospital mini-bus, which took a very circuitous route into Gaza City and to the Hospital. “We can’t travel directly to the Hospital,” said our driver, Abu George, “because so many of the city centre streets are already flooded.”

It was a very overcast, dark morning. The streets were deserted of pedestrians. However, many businesses seemed to be open, although few had any lighting. “All the schools are closed today. Not just because of the weather, but also because there’s no electricity for heating or lighting.” said Abu George. We noticed a few shops with some limited lighting. “Some shops have their own generators,” said Abu George. “Kerosene powered. Some of these are quite dangerous in the home. The Hospital sees many people with burns.”

At the Hospital we were met by our host Suhaila Tarazi, who has been Director of the Hospital for over 15 years. Suhaila is an orthodox Christian, and was the first woman from Gaza to get a degree in Hospital Management. The Hospital was founded in 1882 by the Church Mission Society (CMS) of the Church of England, and in 1982 was passed over to the management of the Episcopal Diocese of Jerusalem.

We had many questions for Suhaila about Gaza, and about how the Hospital is faring. Our last visit to the Hospital had been in the height of summer, and we had then found Gaza City to be a hive of activity, with lots of construction. But now, there is absolutely nothing positive to report. Suhaila outlined the many restrictions impacting on the Community and the Hospital.
Blockade. The recent blockade from Egypt has meant all the ‘tunnels’ are closed, and so no gasoline or construction materials are entering Gaza that way. About 20,000 workers associated with the tunnels have therefore lost their jobs, and possibly a further 40,000 construction workers are now idle because of the lack of cement and steel and other building materials. From the Israeli side, building materials are only now allowed for some projects under the supervision of international agencies like UNRWA.
New hospital buildingElectricity. At the moment Gaza City has electricity only six hours a day, and there is no timetable of when electricity is available. “Women often rise at midnight to do their laundry and cooking,” said Suhaila, “if that’s when the power is on.” This is a very difficult situation for the Hospital, of course, as it is not possible to predict when there will be power. Most of the time they have to use their own generators. During our visit there was no heating on in the Hospital office. Suhaila, wrapped in a thick coat and a scarf round her neck, said, “The gasoline we buy from Israel, which is all that is now available, is better quality, but it is more than twice as expensive. We have to ensure we don’t waste anything, so that the Hospital can continue to function.” But the continual use of the Hospital generators is quite a drain on their financial resources. And Suhaila shared further, “There is no power at home either. If power is on when I am working, it will not be on when I get home. I worry for large families – to get any light they will need to keep doors open, and of course that also lets the cold in.”
Water. The community faces a similar situation with water. The supply is intermittent. We were told that the water quality is getting even worse. Water tastes salty, and some of it is contaminated now by sewage. The United Nations recently produced a report stating that by 2020 – at the latest – the water supply to Gaza will be unusable, and the Gaza aquifer destroyed for centuries to come.
Sewage. The failure of the Sewage Treatment Works now means that every day 13 million cubic metres of untreated sewage is poured into the sea. This is creating widespread health concerns. Also, because of the restriction imposed on fishermen – currently Gazan boats cannot fish beyond a six mile limit from the shore – there is concern about the impact this will have on the fishing stocks, and also on the quality of the fish caught.
Food. Again, food is in short supply. Reports by the World Food Organisation state that 60% of Gazans are dependent on food support., and 51% are food insecure.
Unemployment. Even before the closure of the tunnels and the knock on effect this has on construction, etc, it was being reported that 52% of the working population were unemployed.
The Health System. This is in a state of prolonged deterioration. Of the World Health Organisation list of essential medicines that should be available to the community, 35% of them are not available to Hospitals. And there are often intermittent supplies of some very important drugs. Suhaila describes the situation for patients on long term courses of medication – for example children on kidney dialysis, or cancer patients receiving chemotherapy. The medication runs out, and their course of treatment is interrupted until new supplies are available. Added to this, at least 20% of patients who need care outside Gaza are denied permits by the Israeli authorities, so cannot get the treatment they need.
Financial support. Suhaila drew a distinction for us between a chronic problem and an emergency problem. This distinction we have heard before from many agencies in the West Bank. The attention of donors is drawn to the emergency situations in Syria, Lebanon, Egypt, and Jordan, and the chronic long-term problems of Gaza receive less support – and the situation simply gets worse and worse.

SOME ISSUES SPECIFIC TO THE HOSPITAL.
The last eighteen months have been a time of significant transition for the Hospital. A change in the priorities of UNRWA, which funds Hospital treatment for all the ‘refugee’ population of Gaza, has meant a withdrawal of funding from the general activities of the Hospital in favour of other local Hospitals where, we are told, the quality of care may not be so high, but the cost per patient to UNRWA is less. The Hospital has responded to this crisis by focusing more on specialisation, and on our visit we had the opportunity to see the new Diagnostic Center building, which will focus on cancer. Donors have funded the new building, which is now complete, and the Hospital is now seeking support to equip the Center.

The Hospital’s work in the broader community continues, and we spent some time with Muhammad El Naqa, who coordinates outreach from the Hospital to villages and refugee camps outside of Gaza City. In many of these places, the poverty situation is extreme. This outreach has three main aspects to it –
Medical Support For Elderly Women (over 50) who have chronic health problems. Their situation is generally overlooked within communities – and families – and the Hospital offers them free healthcare.
Breast cancer screening and education. There has been a significant increase in the breast cancer rates in recent years in Gaza. No study has been undertaken to understand why this is so, but there are many relevant reasons, including lifestyle and war – the effects of contamination reputed to be spread from missile blasts on Gaza. There are many cultural reasons why women are reluctant to undertake breast cancer screening, and the high rate of death from such cancers is because women wait until far too late before seeking medical support. And the high rate of mastectomies is a result of the lack of regular supplies of appropriate treatments. The Hospital offers screening, education and training in self-examination.
Services To Children. The Hospital runs programmes for underweight, or malnourished children, which involves free medical examination and care and treatment for a three month period. The project this year is serving over 750 children. Obviously there are many nutritional issues associated with this extreme poverty. For example, parents with limited resources often give their children bread and a cup of tea for breakfast – sugary tea if the sugar is available. It is filling, but of course, tea, if given to young children, minimises the absorption of iron – and it is estimated that 60% of children in Gaza suffer from iron deficiency. It has also been noted that 45% of lactating mothers suffer from anaemia.

CONCLUSION.

As a visiting group we were again thoroughly depressed by the catalogue of interconnected problems that we hear are facing the Gazan community, and the Hospital we support. Chronic problems, as Suhaila stated, that there is no way out of in the current political climate and conflict.

And the solution to these problems? Suhaila was quite clear. It is not enough to think just about ways to get more food, or medicine, or money to the Hospital. This is all really necessary, of course. But what is crucially important is a sea change in the overall situation, so that chronic problems can be consistently tackled and overcome. And that sea change is PEACE, and JUSTICE. Peace and Justice in the relationship between Palestine and Israel, between Gaza and Israel, is the priority issue on which all else hangs. Without this, the very difficult lives of the 1.7 million people living in the Gaza Strip will continue to deteriorate, day by day.

We commend to your thoughts and your prayers the resilient caring and peace building people we have met in all of our Gaza visits. People who love their community and want the best for all. People who do not see other people as enemy, but as fellow human beings to serve.