Gaza’s health system close to collapse as electricity crisis threatens total blackout

World Health Organization warns hospitals could be plunged into darkness by end of February without fresh funding to keep emergency generators running

Hospitals in Gaza will face an almost total power blackout by the end of February unless funding is secured to keep emergency generators running, the World Health Organization has warned.

An ongoing electricity crisis in Gaza has left hospitals reliant on emergency generators for up to 20 hours a day, while medical staff have been forced to cut back on basic services such as equipment sterilisation and diagnostics. About 500,000 litres of fuel are required each month to sustain critical care in Gaza, but funding will only cover hospitals needs until the end of February.

Dr Mahmoud Daher, head of the WHOs Gaza sub-office, said the health system is on the edge of collapse. Without urgent fundraising, hospitals will face a disastrous situation, he said. There are at least 200 babies and people in intensive care units. It would be a really fatal situation for them. There are dozens of people who are going to surgical operations that would be affected.

Fears over the humanitarian situation intensified following a series of tweets by Donald Trump on Tuesday, in which he threatened to cut funding for the Palestinian Authority unless it recommences peace talks. The US ambassador to the UN, Nikki Haley, earlier said the US would cut funds to UNRWA, the UNs agency for Palestinian refugees, unless the authority went back to the negotiating table.

Dr Andy Ferguson, director of programmes for Medical Aid for Palestinians (Map), an organisation that works with hospitals and other healthcare providers across Gaza and the West Bank, said electricity outages in Gaza, combined with medical shortages and severe restrictions on freedom of movement, were creating a medical emergency.

Difficulties with sterilising equipment have caused a rise in hospital infections, he added, while power fluctuations have damaged sensitive medical equipment.

Worsening maternal malnutrition and increasing rates of premature and low-birthweight babies have led to instances of dangerous overcrowding in the neonatal intensive care unit in al-Shifa hosptial, said Ferguson.

Palestinian children do their homework by candlelight during a power cut in Gaza City. Photograph: Mahmud Hams/AFP/Getty Images

As a result, explained Ferguson, incubators designed to accommodate one baby were often occupied by several. Medical staff are having to look after as many as seven critically ill babies each at a time, compared to the UK standard of 1:1 or 1:2 care. Overcrowding of this type makes adequate monitoring and infection control impossible.

Generators are also in need maintenance, the WHO warned, but hospitals are unable to carry out repairs due to restrictions on moving goods into Gaza.

We have been told by doctors in a neonatal unit that there were periods when staff in the units were forced to make manual ventilation to patients in intensive care because the generators didnt function, said Daher. Its a matter of seconds sometimes.

The WHOs latest figures show hospitals are experiencing severe shortages of drugs and medical disposables. Of 516 medications on the essential drug list, 223 (43%) were at zero stock levels in November, which means central supplies will be totally depleted in less than a month. At the end of November, drugs used in the emergency departments and intensive care units were at 48% zero stock, while power shortages have made it harder for hospitals to collect and store large quantities of blood.

There are also dramatic decreases in the proportion of people securing permits to access healthcare outside Gaza, said Daher. In October, 45% of patients who applied to the Israeli authorities for such treatment were unsuccessful. Figures are expected to show that there were fewer exit permits granted in 2017 than in any year since the WHO began monitoring applications.

Map knows of at least 30 patients who died in 2017 after being either prevented from exiting by Israel or unable to secure financial coverage for their referral from the Palestine Authority, said Ferguson.

The Israeli government has yet to respond to a request for comment.

The UN will launch its humanitarian response plan for the occupied Palestinian territory later this month, and is expected to call for $374m (275m) to meet humanitarian needs in the Gaza Strip.

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Victims of Israeli attack on Gaza flotilla fear legal case will be dropped

Concern legal process being politically hijacked after deal to restore diplomatic relations between Israel and Turkey

A landmark case due to be heard by the high court in Istanbul over alleged crimes committed by Israel during the 2010 aid flotilla to Gaza could be dropped as a result of a bilateral agreement signed in June.

The Turkish court is expected to hold a hearing on Wednesday aimed at holding four Israeli generals to account for the alleged assault and unlawful detention of more than 700 activists. They were aboard a fleet of boats attempting to break Israels blockade of Gaza in May 2010. The case against the generals is due to be heard in absentia.

However, the activists fear the judge will dismiss the case following a deal reached between Israel and Turkey in the summer to restore diplomatic relations, which broke off following the violent interception of the flotilla.

Under the deal, Israel agreed to make an ex gratia payment of $20m (16m) to Turkey to compensate the families of 10 activists who were killed by Israeli forces aboard the flotillas lead ship, the Mavi Marmara.

The agreement specified that the two countries do not attribute legal or other liability to the other side or its agents, and agree that this understanding will not be construed as an admittance of or the placing of criminal or civil liability on any side or its agents.

The deal constituted full release from any liability of Israel, its agents and citizens with respect to any and all claims, civil or criminal, that have been or will be filed against them in Turkey, direct or indirect, by the Republic of Turkey or Turkish real and legal persons, in relation to the flotilla incident.

Israeli forces stormed the Mavi Marmara and five other ships in May 2010 to prevent them reaching Gaza, killing 10 people and injuring many more. The incident triggered international condemnation and a diplomatic crisis between Turkey and Israel.

The flotilla had set sail from Turkey, and nine of the 10 dead activists were Turkish. Its cargo included medical supplies, construction materials and paper for Gaza schools. Israel warned it would prevent the ships breaking its blockade on Gaza.

A United Nations investigation later backed Israels naval blockade of Gaza as legal but said its military assault on the flotilla was excessive and unreasonable.

In the case due to be heard in Istanbul this week, 740 activists from 37 countries including a number from the UK are being represented. The court has heard testimony over the past 18 months, and the judge is now due to decide how to proceed.

Alexandra Lort Phillips, a British activist who testified in earlier court hearings in Istanbul, said: The attack on the ships of the flotilla was a shocking event The actions of Israel were illegal, plain and simple.

She said the legal process was now at risk of being politically hijacked, adding: It is deeply upsetting. The legal process should not fall victim to power politics.

Ahsan Shamruk, another British activist, said he was shot in the head and stomach and left to die in the lethal military assault on the flotilla. I am still suffering from nightmares and many sleepless nights. I have permanent ear nerve damage and my eyesight has drastically deteriorated. Those responsible must be held to account for this criminal act.

The deal between Israel and Turkey was not enforceable as a matter of international law and under the European convention on human rights, said Rodney Dixon, a British QC who is part of the survivors legal team.

It would be unlawful for the Turkish court to terminate the criminal case and deprive the victims of justice and their day in court on account of an agreement made by two states, he said.

The victims and the families of the deceased were not consulted nor involved at all in these dealings that directly impinge on their fundamental rights.

Last week, an Israeli government minister visited Turkey for the first time since 2010 in a sign of restored diplomatic relations.

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