The Gaza Strip – State of Disaster

September 2006

"Decent folks must be allowed to sleep easy o'nights, mustn't

they? Really it would be shockingly bad taste to linger on such
details, that's common knowledge. But personally I've never been
able to sleep well since then. The bad taste remained in my mouth
and I've kept lingering on the detail, brooding over them."
Albert Camus, The Plague (1947).

[This report contains photographs that may be difficult for

some audiences to view. Your discretion is advised.]

Introduction:
Over the past several months, changes have taken place in the management
of the occupation by the Israeli government and the Israeli army.
Since the second Intifada, Israel has exercised its power over the Palestinian
population in the Occupied Territories through nearly absolute control over
day-to-day life. This is expressed most prominently in Israeli control over
Palestinians' movement, through a system of sieges, roadblocks, closures,
and an arbitrary permit regime. Direct violence, e.g., Operation "Defensive
Shield" and the policy of assassinations and arrests, comprises a substantial
part, but not all of the means through which Israel perpetuates the regime of
occupation.
The illusion of unilateral moves in order to “get rid” of the Israeli-Palestinian
conflict - the self deception which promoted the belief that the removal of
Israeli settlements in the Gaza Strip is equivalent to the end of the occupation-
the firing of Qassam rockets on the Israeli towns near the Gaza border and
the capture of Gilad Shalit, are amongst the circumstances that led in the
recent period to a change in the management of the occupation. Now more
than ever, emphasis is placed on control by means of killing and destruction.

In recent months, more than 200 people have been killed, half of them
civilians and one-quarter of them children. The numbers bear clear witness
that the entire Palestinian population is a target for Israeli army strikes.
Intentional destruction of civilian infrastructures, as in the case of the bombing
of electric turbines; indifference regarding the ability of essential civil systems,
such as the health care system, to function; the fatal blow dealt to the
Palestinian economy, inevitably resulting in poverty and malnutrition, all
indicate an escalation in the inclination to use violence as a means to
perpetuate the occupation. This policy has not resulted in "the unconditional
release of Gilad Shalit". Rather, its result, whether conscious or unintended,
is the elimination of any option for a just, agreed-upon solution to the Israeli-
Palestinian conflict. We are ourselves fulfilling the prophecy that we shall
forever live by the sword.

The policy of wreaking havoc necessarily brings the occupation's internal logic
to an end. Past illusions about an enlightened occupation have been replaced
by routine killing and destruction, to the almost utter indifference of Israeli
society. Whereas in the past, many sectors within Israeli society have
opposed and protested the oppression of the Palestinians, in recent months
the Israeli public has become indifferent at best, and supportive, at worst.

The media is silent on these cases; the public chooses to remain ignorant, as
though the killing is caused by some natural disaster out of anyone's control,
rather than by government and military policy.

In this report, a PHR-Israel delegation of physicians presents findings from its

visit to the Gaza Strip, where it met with health care and non-governmental
organization personnel. The report's text and photos paint a harsh picture, for
which we, the Israeli public, carry responsibility. We submit this report in the
hopes that it may contribute towards producing a wave of opposition to
current policy, that will make clear to the government and senior military ranks
that they are not acting in our name. This report serves as a mirror that
reflects the occupation's ugly face. The desire to perpetuate the occupation
will only increase the intensity of the killing and the destruction. We must
understand that only ending the occupation will allow us and our daughters
and sons, and the sons and daughters of our daughters and sons, to live in a
worthy society. Only negotiation will return Gilad Shalit to his loved ones. Only
negotiation that ends the occupation and creates a peace agreement based
on justice, will offer both peoples a chance for a future.

Dr. Dani Filc, Chairperson, Physicians for Human Rights-Israel

On September 1st and 2nd, 2006, a delegation of physicians from PHR-

Israel visited the Gaza Strip. This undertaking was finally permitted, after
the Israeli government had prohibited the entry of PHR-Israel's Jewish
members for the past six years. The purpose of the visit was to assess
the critical medical and economic situation reported by various sources
from the Gaza Strip and abroad, and to investigate recurring claims
regarding Israel's use of an unknown, particularly violent kind of
weapon.

On June 26, 2006, Israeli soldier Gilad Shalit was abducted. From the
moment of his abduction, pressure was put on the Palestinian civilian
population and political system to facilitate his release, by barraging the Gaza
Strip day and night and flying in the skies of the Strip, producing sonic booms.
Israeli infantry has carried out massive house demolitions in a series of
incursions, where civilian homes have been taken over and their inhabitants
jailed in for hours, not unlike the practice long seen in the West Bank.
 In the course of this activity, Israeli forces have killed 226 people, including
114 civilians,
46 of them are children.

Testimony from various sources reports the use of an unknown, particularly

malevolent weapon against the civilian population. Physicians in Gaza
hospitals report obstacles to treating and saving lives of the wounded.

The Israeli air force has bombarded central bridges and major roads, and has
destroyed six electric turbines that provided 40% of the Gaza Strip's power
supply. As a result, the power supply to residents and essential institutions
such as hospitals has been severely disrupted. Moreover, Israel's closure of
Nahal Oz passage has cut off the supply of gasoline to the Strip and impaired
the ability to operate alternative power systems, such as generators, that use
gas and diesel fuel.

Economic assault: In March, Hamas was democratically elected to control the

Palestinian Authority. Immediately afterwards, Israel froze the transfer of tax
revenues to the PA; following pressure by Israel and the US, other states and
international donors stopped transferring fonds to the PA as well. The
economic crisis ensued. PA employees constitute as much as 57% of the
Palestinian health workers and supply 64% of health needs: especially
advanced secondary and tertiary treatment. These workers have not received
their salaries for the past six months, and the various systems are only
partially functioning. The Palestinian Health Ministry, nearly 100% of whose
current operating budget (not including salaries) depends upon donations and
revenues from taxes imposed by Israel, found itself in an impossible position:
its employees are not being paid, and the empty treasury does not allow for
the buying of medications and perishables. As a result, all elective surgeries
have been postponed. Cancer patients who require expensive medications
have not received them for months, and patient referrals are no longer made
to Israel and to other service providers for expensive treatmentsthat are
unavailable in the Palestinian system, such as bone marrow transplants
amongst others.

Restriction on movement: Moreover, Israel has hermetically sealed off the

Gaza Strip, prohibiting the opening of Rafah crossing, which is Strip residents'
only gate to the rest of the world. Karni passage, through which goods,
including all medical equipment, enter and exit the Gaza Strip, is also closed
for long periods of time, operating on a very limited basis. Karni passage
opens for a limited number of hours at a time, on an irregular basis. A
shortage of cancer drugs and medications for chronic illnesses in the Gaza
Strip has resulted.

PHR-Israel delegation's visit:

Northern Gaza Strip

Since June 26, 2006, 95 civilians have been killed in the northern Gaza Strip;
30% of those injured and killed are minors under 18.

Kamal Adwan hospital serves the 30,000 residents of Beit Lahia and the
northern Gaza Strip. The Beit Lahia area, from which Qassam rockets are
fired on adjacent Israeli towns, has been heavily barraged. Since Gilad
Shalit's capture, the area has been hit even harder, by air, ground and artillery
strikes.

Hospital director, Dr. Mahmoud al-Asali:

The hospital carries out an average of 170 surgeries per month. Some 300
patients are seen in its out-patient clinics daily. Since June 26, 2006, the
hospital has received some 260 injured, 60% via emergency transfer, some
critically injured. In recent months, the hospital has been forced to deal with a
large number of injured who require immediate surgical procedures (at times
20 patients concurrently), with only two operating rooms in the facility.
Dr. Muhammad Sultan, a senior physician at the hospital:
In many cases, the bodies arrive naked, with injuries of about 5 cm in
diameter surrounded by a burn of about 10 cm in diameter. In some cases,
no shrapnel or metal shards have been found on or in the bodies. The means
of fatal injury that caused the death is unclear.

Sheja'ieh neighborhood: Ground incursion – killing and house

demolition

The delegation observed the serious damage caused by Israeli tanks

throughout the neighborhood. Armored corps and infantry forces retreated
from the neighborhood two days before our visit. On the main street leading to
the neighborhood, four four-story homes were demolished and the area was
completely flattened. After the forces' withdrawal, 25 Palestinian fatalities
were reported by the Israeli army.

Ruins of a home in Sheja'ieh, Photo: Ibrahim Habib

Destruction of civilian infrastructure: electric power and bridges

On June 26, 2006, the Israeli air force bombed the six electric turbines,
bringing Gaza's only electric power station to a standstill

Electric power only twelve hours a day: The Gazan electric power station,
which was constructed with Norwegian funding, began operation a year and a
half ago, with the goal of supplying power to the entire Strip and minimizing
dependence on Israeli electric power. Until its destruction, this station
supplied 40% of the Strip's power supply. Its destruction severely disrupted
the power supply, as Israel provides only 60% of the power required.

Implications of disruption of the power supply

-The supply of running water to homes is disrupted, because the water is
pumped onto containers on the roofs.
-As it cannot be stored in refrigerators, food spoils in the severe heat of the
season, as do medications requiring refrigeration such as insulin, milk for
infants, special foods for ill persons, etc.
-Operation of home medical equipment, such as inhalers, is disrupted,
causing some patients to become hospitalized. In hospitals, equipment is
operated via generators during stoppages in the power supply.

The hospitals operate 12 hours a day via generators. During closure of the
Nahal Oz Crossing, supply of gas and diesel oil was disrupted and a real
concern arose that the existing supply would be depleted. Consequently, all
non-emergency medical procedures and elective surgeries were canceled. At
Kamal Adwan Hospital, surgeries are hurried due to the concern that oxygen
and resuscitation systems may be disrupted during the procedures.
Four destroyed electric turbines. Photo: Ibrahim Habib

Restrictions on movement - Bombing of bridges: The Israeli air force

destroyed three bridges over Gaza Stream that connected the northern and
southern sections of the strip, paralyzing movement on the strip's central
Salah a-Din road. Security forces claimed that the bombing of the central
bridge was intended to prevent the transfer of Gilad Shalit, but in fact
residents reverted to using the alternate road at the foot of the bridge.
However, during the rainy season, the stream will overflow and traffic on the
road will be restricted. While the bombing of the bridge did not achieve its
declared end, that is, impeding travel between parts of the Strip, it is collective
punishment of the population, destruction of infrastructure that costs millions
of dollars.

Destroyed main bridge on Salah a-Din road, Photo: REUTERS/Mohammed

Salem.

Hunger in Gaza

The Ard el-Insan organization operates four clinics for women and children
throughout Gaza Strip. The organization's director, A'Ihtidal Khatib, and Dr.
'Adnan Alwahidi, described to PHR-Israel's delegation the state of affairs in
their center: :We see the weakest population, the poorest and most needy.
The situation is getting worse and worse. Women are unable to pay for their
clinic visit, and we have to give them money for transportation to get here. Our
patients suffer from dire hunger and subsist mainly on tea and sugar. Women
refuse to take their babies home from here because they have no food to give
them at home. The women themselves also suffer. They are last to eat.
There are women who eat one small meal a day, and even this is the most
meager, poor meal you can imagine. There are families in which five children
are all suffering from malnutrition and women suffer malnutrition and anemia.
Children who complete our feeding program return shortly afterwards,
suffering from diarrhea and malnutrition. The situation is very grave, and we
cannot respond adequately to the growing need."

Shifa Hospital, Gaza

"We can no longer save the injured"

Shifa Hospital is the Strip's main governmental hospital, with 600 beds and
1400 employees. The delegation met with the hospital's senior staff, including
Dr. Jumaa`Al-Saqqa, Dr. Hassan Abu Tawila, Dr. Subhi Al-Skeik and other
senior physicians.

The hospital's physicians reported the difficulties they encounter in treating

the seriously injured patients who are arriving following the recent wave of
shelling. The medical staff is experienced in treating injuries from gunfire and
bombardment, but is struggling to treat injuries of an unfamiliar type, where
conventional treatment methods fail. The staff presented the delegation with
photos that illustrated some of the claims:

-More than the usual number of injured arriving with amputated upper and
lower extremities.
-Injured people burst into flames even after the fire has been extinguished.
-Totally burned, unidentifiable bodies, at times charred remains.
-Bodies appearing as if they have "melted".
-Some of the bodies have no visible exterior injury, but upon abdominal
exploration, the internal organs appear to be completely crushed in a manner
that does not correspond with conventional blast wounds.
-Similar cases, but in which the internal inner organs appear burnt and
crumbled.
-Some of the injured are operated on and stabilized, only to pass away two
days later for no clear reason.
-Imaging tests do not detect fragments; nonetheless the patient dies.
-In some cases, instead of metal pieces, fragments that appear to be plastic,
undetectable by x-ray, are found.
-Patients with a gangrenous organ which is removed surgically then develop
advanced gangrene at the site of removal. Even after the area is removed,
gangrene continues to develop.

Remains of a man killed by Israeli bombardment. Photo: Palestinian MoH

Obstacles to saving lives

Also present at the meeting at the hospital was director of emergency medical
services in Gaza Strip, Mr. Marwan Baker. He and his colleagues reported
that in many cases the army delays ambulances' access to the injured,
sometimes for two hours. These delays may cause a decline in the injured's
condition, and at times, their death. Medical staff have also been the target of
the army's fire: Red Crescent ambulance driver Anwar Abu Holi lost his leg
after being shot during evacuation of patients in the al-Maghazi refugee camp.
Lack of basic medical services
Dr. Al-Saqqa gave a detailed survey of the hospital's departments and the
services it provides. He described the services that Shifa and other Gazan
hospitals cannot provide for Gaza Strip residents, which include radiation
therapy for cancer patients, imaging tests, catheterization, bypass and heart
surgery.

The delegation toured the hospital's departments and was impressed with the
level of care and quality of medical treatment provided under such difficult
conditions. Professor Zvi Bentwich examined two seriously ill patients who
were denied entry into Israel for medical treatment:

1. An AIDS patient whose request to receive treatment in Israel was denied

by the security services as well as by the Israeli High Court of Justice.

2. A patient with serious gall bladder disease. Her entry into Israel was
denied on security grounds, but a day following Professor Bentwich's
assessment and another request on her behalf by PHR-Israel, backed up by
the results of his examination, she entered Israel for medical treatment.

The Palestinian Health Ministry's central medication warehouse:

Working under conditions of uncertainty and shortage

The Health Ministry's head pharmacist Dr. Ziad Shaath and the ministry's
staff, met with PHR-Israel's delegation. Dr. Shaath reported that the ministry
required an annual medication budget of 26 million dollars, but that due to the
budget crisis, it is entirely dependent upon donations, of which only 2 million
dollars has arrived this year. He also told of pledges by international donors
for emergency assistance that have not yet been realized.

Lacking a regular, guaranteed budget, a yearly, or even weekly program

cannot be created in order to operate the eight governmental hospitals and
fifty Health Ministry clinics and pharmacies in the Gaza Strip.
Dr. Shaath reported that shipments of medications donated by Egypt and
Yemen are "stuck" in Al-Arish, as Israel, for unknown reasons, is barring their
entry into Gaza Strip. As for the shortage in specific medications, Dr. Shaath
made clear that there is no real shortage yet, but that quantities of some
medications are very limited and may be depleted soon, such as cancer drugs
and drugs for kidney and diabetes patients.

Palestinian Health Minister, Dr. Bassem Na'im:

"Stop the Collective Punishment"

PHR-Israel's team met with the Palestinian Health Minister a second time,
after our representatives met with him during their previous Gaza Strip visit on
June 5, 2006. The delegation heard from the minister about the humanitarian
hardship in the Gaza Strip and the challenges facing the Health Ministry.
While Israel holds 450 million dollars in tax revenues that it owes the PA, the
ministry's cash box is
completely empty.

Shipments of medications and immunizations from Egypt, which Israel has

refused to let in, have been transferred to Jordan and from there to the West
Bank, but they have not reached the Gaza Strip.

The delegation spoke with the Health Minister about the PA's need to accept
alternative solutions, even if they are unsatisfactory, concurrently with the
struggle for permanent solutions, such as transferring patients from Kerem
Shalom when Rafah crossing is closed.

Summary:
The PHR-Israel delegation returned from the visit in the Gaza Strip shocked
by the grave humanitarian, medical and economic situation it witnessed.
Taking advantage of the Israeli public's indifference, Israel is waging a harsh
battle, bringing the Gaza Strip to the brink of a humanitarian crisis. Human
injury, a bleak economic situation which critically harms the weakest people,
intensifying the military attacks in parallel to militarization of the Gaza Strip ,
the governmental anarchy, the hatred and frustration- these will all ultimately
destroy both the Palestinian and Israeli societies.

Today, a year after the unilateral disengagement, the violence on both sides
is intensifying. Qassam barrages on the one side, and wanton killing and
destruction on the other, allow nearly no room for building a non-violent
alternative. Indeed, Israel is obligated to defend its citizens, but its response
to the firing of Qassam rockets is not only reckless violence, but also harms
its own citizens as it willingly forfeits any moral inhibition. Israel's claims that it
attempts to prevent civilian casualties are shattered in the face of the large
number of civilians who have lost their lives. When 46 children die violent
deaths as a matter of routine, it is clear that the crimes which lead to this,
must be stopped.

Being that Isarel is the occupying power in the Gaza Strip and the West Bank,
the state has obligations towards the civilian population in the Occupied
Territories according to international law and basic moral codes. Therefore,
Physicians for Human Rights-Israel demands that Israel:
Open the borders of the Gaza Strip immediately;allow without delay the entry
of goods, especially medications; and
facilitate provision of civilian services that the Palestinian Authority is unable
to provide due to the economic crisis, which is caused among other factors by
the freezing of tax revenues.

"The day after. Keep in mind that every war is temporary and ends at
some point. Therefore, it is wise to consider the stage after the end of
hostilities […]acts of cruelty during war are engraved in the victims'
memories, perpetuating the conflict and making it difficult to conduct a
peace process"

From the Laws of War on the Battlefield, published by the Israeli JAG
Command and School of Martial Law.

Photo: Remains of a child killed by Israeli bombing. Photo: Palestinian MoH

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