Gaza’s other dead: Destruction of health services and lack of aid kill despite ceasefire

The ceasefire between Hamas and Israel in Gaza came too late for Sami Mushtaha. The 76-year-old man had survived a missile that killed three of his grandchildren in his home in the Gazan capital in November 2023. Seriously injured, both of his legs had to be amputated, but the death he escaped in the midst of the war came to him on January 22, three days after the truce agreement came into effect. The old man had suffered a heart attack days earlier; it was not fatal, but in the practically destroyed Al Shifa hospital they were unable to perform the urgent operation that might have saved his life, explains his daughter-in-law from Granada, Spain, who only introduces herself by her first name, Malak.

Like him, other Palestinians have continued to die due to lack of available treatment during the fragile ceasefire in Gaza, a place turned into a scorched earth by 16 months of air strikes, military invasion, and blockades of food, water, fuel, and medicine. Those deaths now threaten to increase after Israel decided last Sunday to reimpose the blockade on the entry of humanitarian aid into the Strip to pressure Hamas to accept changes that were not included in the roadmap for the truce agreed in January.

Doctors Without Borders (MSF) calls these people the “silent dead”; those who die “not directly from the conflict, but from its impact,” explains Ruth Conde — the organization’s medical director, who returned from her second mission in the Strip in January — by telephone. As if they were invisible, these victims are not included on the list of more than 48,000 people killed by military actions in the war maintained by the authorities of the territory governed by Hamas.

Palestinians like two-month-old Sham Shambari, who died on February 26 of hypothermia in the sea of makeshift tents in Al Mawasi, in southern Khan Younis. Or the other six children who have died in recent days for the same reason, according to medical sources, without walls to protect them from the cold snap that hit the occupied Palestinian territory last week. A study published last July by The Lancet calculated that for every death in an Israeli attack in Gaza, another four people may have died indirectly. The publication stated that a “not implausible” figure based on a “conservative” estimate of deaths could already be as high as 186,000, out of a total population of 2.3 million.

An “impossible” survival

Palestinian doctor Umaiyeh Khammash, founder of the NGO Juzoor — which also works in Gaza — said via WhatsApp from Ramallah (West Bank) that, “for many Gazans, the absence of health care for weeks or even months, coupled with severe shortages of food, water, hygiene, shelter and social support, has made survival almost impossible.” This situation will take years to reverse, despite the entry of humanitarian aid that had been permitted under the ceasefire until last Sunday.

Even before Israel’s announcement, organizations like Juzoor and MSF had been warning of the lasting effects of a war and blockade that has left many Gazans sick — from malnutrition, hypothermia, or infectious diseases — or killed them by eliminating the possibility of chronic patients, survivors of previous attacks, or simply sick elderly people like Sami Mushtaha, from receiving treatment. Doctors “could only give Mushtaha a few pills” for his heart attack, laments his daughter-in-law Malak, when he went to the Al Shifa hospital, the largest in the Strip before the war.

Ruth Conde has witnessed how the Israeli offensive is killing in the Strip in many ways. The nurse recalls a “striking” fact: of the children admitted to the pediatric ICU at the Nasser hospital in Khan Younis, “70% or 80%” were in palliative care. Some had been admitted there directly, either because they lacked “therapeutic options” or because their diagnosis had arrived when little could be done for them.

The humanitarian worker recalls the case of a child of about two years of age. He suffered from abdominal neuroblastoma — a type of childhood cancer — diagnosed in the terminal phase. The medical staff were only able to sedate him and help him die with the pain “controlled.”

Other children were waiting for Israeli permission for medical evacuation. Habiba, also two, developed bruises whose cause could not be identified in isolated northern Gaza. The Gazan Ministry of Health requested her transfer, but Israeli authorization was delayed. When she arrived at Nasser hospital, the girl’s limbs — she had a history of coagulation deficiency — were “suitable for amputation,” says the MSF official. Habiba was evacuated to Jordan during the ceasefire. She has lost both hands and a foot.

Between 12,000 and 14,000 Gazans are in need of urgent medical evacuation, according to the United Nations. Some 4,500 of them are children. As of February 24, only 851 had obtained Israeli permission.

“More than catastrophic” conditions

Dr. Khammash confirms that the ceasefire in Gaza has not stopped these silent deaths, which will continue “for a long time.” On the contrary, the Palestinian doctor fears that these victims will be joined by many others — “more than one can imagine,” he says — resulting from “a multitude of indirect causes,” which will become known “as the full extent of the destruction is revealed.” Living conditions “continue to be more than catastrophic, resources remain critically scarce, and the health system remains shattered”, says the founder of Juzoor.

In a report released Wednesday, the United Nations Humanitarian Coordination Office (OCHA) said that, as of March 1, “15 of the 35 hospitals, 82 of the 145 public health centers and 194 of the 360 medical points in the Gaza Strip were still not functioning.” This is in a place where the number of war wounded alone totals more than 111,000.

In the six weeks since the first phase of the ceasefire ended last Saturday, and with it the now-halted entry of aid, Israel has also partially breached the terms of the agreement. Not only with sporadic attacks that have killed around 100 people, according to the Gaza Ministry of Health, but also by preventing or restricting the entry of certain supplies. In its latest report, OCHA denounces how, since January 19, “the restrictions by the Israeli authorities on the import of certain items, such as generators, spare parts, oxygen plants, medical equipment, reagents and laboratory material” have persisted.

Of the 60,000 prefabricated huts whose entry into Gaza was required under the terms of the ceasefire, none are known to have entered, while of the 200,000 tents whose delivery to the Strip was stipulated in the agreement, only 130,000 are confirmed to have been brought in by OCHA. Another 59,000 are awaiting Israeli permission to cross the border.

With these vital goods stranded at the gates of Gaza, the Israeli decision to completely block the entry of humanitarian aid again could represent a reversal of the partial progress achieved during the ceasefire, such as the distribution of food, which has reached some two million people in the Palestinian territory, according to the UN.

Meanwhile, Gazans are still struggling against the oblivion that often accompanies their dead. Conde saw something in Gaza that “doesn’t happen in other conflicts.” After an attack, it’s not just the wounded who arrive at the hospital. “People also bring the dead bodies there.” They know, says the humanitarian worker, that only in this way are they included directly on the official list of war victims.

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