Public Index: MDE 15/002/2009

To: Health Professional Network

From: Health and Human Rights Team

Date: 8 January 2009

Health Professional Action

Health services in Gaza – a worsening situation

Israel/Occupied Palestinian Territories

On 27 December 2008, Israeli forces began a series of airstrikes on Gaza. The stated purpose of these attacks, according to the Israeli government, was “to crush terror”¹. The attacks have led to a large number of deaths and civilian causalities and serious damage to Palestinian infrastructure. They have also severely impeded the ability of the Palestinian health services to treat the large number of Palestinians in need of medical assistance.

The exact number of injured patients is unknown, but as of 7 January 2009 the World Health Organization reported around 2,950, of which 1,134 are children and women. They have also put the number of fatalities at 680, among them 218 children and 85 women².

Amnesty International calls on the Israeli authorities, the Hamas de-facto administration and all other Palestinian armed groups to stop all unlawful attacks that are putting civilian lives in danger.

Effects of the attacks on medical facilities

The worsening conditions in hospitals and other medical facilities in Gaza have led the Palestinian Ministry of Health to declare a state of emergency. Hospitals are operating at full capacity and all medical personnel have been called for duty. Only urgent surgery is being carried out in hospitals and all out-patient clinics are closed, except for those dealing with urgent cases.

Scores of essential drugs and other supplies in Gaza are low. The Central Drug Store reported that “105 drugs and 225 medical supplies of the essential drug and supplies list are still unavailable in Gaza and approximately 20% of ambulances are grounded due to the dearth of spare parts.”³There have been substantial contributions of medical supplies from a number of countries since the air strikes began, though more supplies are urgently needed to deal with the large numbers of injured civilians that continue to flow into hospitals.

There is a severe shortage of other basic materials that are necessary for medical facilities to function, including light bulbs and glass to repair windows broken during bombardments. Electricity failure also means that hospitals are relying on limited fuel supplies for back-up generators. According to the United Nations Office for the Coordination of Humanitarian Affairs, hospitals in the Gaza Strip have been running on back-up generators for five consecutive days and are now running out of fuel reserves⁴. Generators are also at risk of collapse due to lack of spare parts. Electricity shortages are also affecting the availability of water as electricity is needed to pump the water that is used for hygiene purposes in hospitals.

Conditions of sick patients deteriorate

The Israeli attacks are also severely affecting access to medical treatment for chronically ill patients, who are being sent home from hospitals in Gaza to allow the treatment of more urgent cases resulting from the crisis. Physicians for Human Rights – Israel has reported 16 severe medical cases, including cancer patients, whose requests to access treatment outside Gaza have not been answered by the Israeli authorities⁵. These patients remain without access to treatment, which may lead to deterioration of their conditions. Amnesty International has previously appealed for access to health care for seriously ill patients who had been prevented from accessing health care outside Gaza due to the denial or delays of permission to travel into Israel and Egypt.⁶

Attacks on medical personnel

Medical personnel attempting to evacuate injured civilians to hospitals have been victims of Israeli attacks. Several ambulances have been targeted by direct gunfire and medical personnel have been seriously injured or killed. According to Physicians for Human Rights - Israel, an attack by helicopter fire on medical personnel on 31 December 2008 left three people dead, including a doctor and medic: “[I]n Jabal Kashif in northeast Gaza a crew set out to offer assistance. While approaching the bleeding victim on foot, they were hit by helicopter fire. Dr. Ihab Madhun, medic Muhammad Abu Hasireh, as well as the injured victim, were killed.”⁷In another case, an “[a]mbulance belonging to the al awda Hospital was hit by Helicopter fire [on 4 January]. Arfa Abd al Daim, a senior volunteer medic was killed and two other medical personnel were critically injured.”⁸

Air strike on A-Raeiya medical centre and its mobile clinics on 5 January 2009⁹

A-Raeiya medical centre is located near Shifaa hospital in Gaza City, in a residential area. There are no governmental or military installations in its vicinity. On 5 January 2009 at 1am, both the centre and its mobile clinics in the car park were bombed from the air. According to testimony from the head of the executive committee of the medical centre, Raed Sabah (collected by Israeli human rights organization Btselem): "The centre is well known, and everybody knows it only provides medical services. It admits more than 100 patients per day, and bears flags with medical symbols. No warning was received before the air strike". The damage to the centre is estimated to be 800 thousand US dollars. The centre provides expert care for internal diseases, a paediatric clinic, gynaecology and obstetrics services, urology, neurosurgery and emergency services. The three mobile clinics belonging to the centre were donations from Spain. They were completely destroyed in the bombing.

Access into and out of Gaza for patients and humanitarian aid

All crossings into Gaza remain closed with the exception of the Rafah crossing, which has opened on several occasions to evacuate patients and allow supplies into Gaza. Some medical and humanitarian aid is getting through, but not enough to treat the large number of patients and civilians who do not have access to appropriate care, including food and adequate water. The number of injured patients evacuated through the Rafah crossing has been limited, with only 131 patients being referred for treatment in Egypt, Jordan, Saudi Arabia or Libya since 29 December 2008¹⁰(figure as of 7 January 2009).

On 7 January 2008, the Israeli military allowed a three hour opening of a “corridor” to permit the entry of necessary humanitarian materials into Gaza and for civilians to obtain access to supplies. They were reported saying that further three hour periods might be allowed while the conflict continues.

Further information

- Press release: “Military tactics of both sides endangering civilians, says Amnesty International”, 7 January 2009: http://www.amnesty.org/en/for-media/press-releases/gaza-military-tactics-both-sides-endangering-civilians-says-amnesty-inte

- News: “Amnesty International calls for an immediate humanitarian truce in Gaza”, 7 January 2009: http://www.amnesty.org/en/news-and-updates/news/amnesty-international-calls-for-immediate-humanitarian-truce-gaza-20090107

- Press release: “UN Security Council must not fail civilians caught in Gaza conflict”, 5 January 2009: http://www.amnesty.org/en/for-media/press-releases/un-security-council-must-not-fail-civilians-caught-gaza-conflict-2009010

- Press release: “Immediate access to humanitarian workers and observers essential”, 31 December 2008:

http://www.amnesty.org/en/for-media/press-releases/israeloccupied-palestinian-territories-immediate-access-humanitarian-wor

- Press release: “End unlawful attack and meet Gaza's emergency needs”, 29 December 2008: http://www.amnesty.org/en/for-media/press-releases/israeloccupied-palestinian-territories-end-unlawful-attack-and-meet-gaza

- Press release: “Civilians must be protected in Gaza and Southern Israel”, 28 December 2008: http://www.amnesty.org/en/for-media/press-releases/israeloccupied-palestinian-territories-civilians-must-be-protected-gaza-

Recommended action

a) Please write to the Israeli authoritiesbelow:

b) Please write to the Egyptian authoritiesbelow:

Addresses

a) Israeli authorities:

Tzipi Livni (f)

Vice Prime Minister and Minister of Foreign Affairs

Ministry of Foreign Affairs, 9 Yitzhak Rabin Boulevard, Kiryat Ben-Gurion, Jerusalem 91035, Israel

Fax: +972 2 530 3367

Email / website: sar@mfa.gov.il/ www.mfa.gov.il

Salutation: Dear Minister

Major General Yoav Galant

GOC Southern Command

Military Post 02392, Beer Sheva, IDF

Fax: +972 8 990 2655

Salutation: Dear Major General

Yacov Ben Yizri

Minister of Health

Ministry of Health, 2 Ben Tabai Street, PO Box 1176, Jerusalem 91010, Israel

Fax: +972 2 678 7662 / +972 2 623 3026

Email / website: sar@matat.health.gov.il / pniot@moh.health.gov.il / www.health.gov.il

Salutation: Dear Minister

Copies to:

Dr Yoram Blachar

Chair of the Israel Medical Association

PO Box 3566, Ramat-Gan 52136, Israel

Email: malke@ima.org.il

Ambassador James Cunningham

U.S. Ambassador to Israel

U.S. Embassy, Israel, 71 Hayarkon Street, Tel Aviv, Israel

Email: ambtelaviv@state.gov

Fax: +972 3 510 8093

b) Egyptian authorities:

Habib Ibrahim El Adly

Minister of the Interior

Ministry of the Interior, 25 Al-Sheikh Rihan Street, Bab al-Louk, Cairo, Egypt

Fax: +20 22 794 5529

Email: moi@idsc.gov.eg/ center@iscmi.gov.eg

Salutation: Dear Minister

Hatem Al-Gabali

Minister of Health

Ministry of Health, 3 Magles El Shaab Street, Cairo 11467 Egypt

Fax: + 202-7953966 / 7959422

Salutation: Dear Minister

Copies to:

Dr Hamdi Al Sayed

Director of the Egyptian Medical Syndicate
Dar El Hekmah, 42 Kasr El-Eini Street, Cairo, Egypt

Email: alsayed@ems.org.eg, H_nakeeb@yahoo.comand info@ems.org.eg

Please also send copies to diplomatic representatives of Israel and Egypt accredited to your country.

If you receive no reply within six weeks of sending your letter, please send a follow-up letter seeking a response. Please send copies of any letters you receive to the International Secretariat, attention of Health and Human Rights Team, 1 Easton Street, London WC1X 0DW or e-mail: health@amnesty.org