The recent explosion at the Al-Ahli al-Arabi Hospital in the north of the Gaza Strip emphasizes the risks to the delivery of safe emergency medical care in Gaza.
In other conflicts of recent decades, such as Afghanistan, Iraq, Sudan and Ethiopia, there has been ample space to deploy aid, but this is not the case in Gaza today.
Israel’s civilians have been caught up in the conflict, as hostages and victims of Hamas’s attacks. However, it is anticipated that Israel’s health service has the capacity to manage its own casualties from this conflict. The country has one of the most technologically advanced healthcare systems in the world.
Gaza is clearly not in a state to deliver effective health care to its two million Palestinian citizens. The territory has sustained 136 attacks on healthcare installations since hostilities escalated on 7 October according to the World Health Organisation (WHO). Access to external aid is limited, with delays and constraints on aid convoys coming across the Rafah crossing from Egypt.
The WHO said of the first shipment passing the Rafah Crossing on 21 October ‘The supplies currently heading into Gaza will barely begin to address the escalating health needs as hostilities continue to grow’.
The UN must now provide leadership for non-governmental organizations (NGOs) and states to deliver the healthcare and aid to which all civilians caught up in conflict are entitled.
Existing health stress in Gaza
The additional demands of large-scale conflict trauma and war-damaged infrastructure provides for no capacity to manage an explosion in health demands.
The weaponization of healthcare and healthcare facilities, not unique to this conflict, further complicates the provision of medical aid in Gaza. A blockade by Israel cut off access to food, water, electricity and fuel and a humanitarian corridor is yet to be negotiated.
Healthcare services in Gaza, including a Jordanian military field hospital which has maintained its presence for two decades, are in a state of collapse awaiting necessary medical supplies.
Attempts to get agreement on a UN Security Council Resolution to create a ‘humanitarian pause’ to allow aid into Gaza, have so far failed.
A unique situation
Deploying a safe and secure aid hospital into Gaza is currently unrealistic due to the severe security risks. This is especially problematic when civilians cannot leave the territory.
As Martin Griffiths of UNOCHA pointed out: ‘in most crises around the world, whether you are talking about Ukraine or Sudan, people run away from conflict, and run out of the country if necessary; in Gaza that’s not possible.’
The Rafah border crossing into Egypt is the only crossing not controlled by Israel and has been out of normal action since the first days of the conflict. The international community, particularly the US, have negotiated with Egypt to reopen the crossing to allow some limited aid, including medical supplies, to enter southern Gaza on the basis that the convoys do not contain ammunition for Hamas.
Egypt has agreed to help deliver aid to Gaza but will not accept a large number of Palestinians into its bordering Sinai region.
Field hospitals in adjacent territory
If Palestinians cannot escape the fighting, and if hospitals cannot be located in Gaza, then the immediate geographic vicinity must provide alternatives.
Israel could emphasize its humanitarian credentials by accepting evacuated Palestinian casualties to field hospitals within its territory. Egypt could offer to do the same in Sinai.
These could not be military field hospitals: however capable and well equipped, they would have significant political implications for the parties involved.
Instead, these facilities should be independently operated by NGOs such as The Red Cross (ICRC) and Medicins Sans Frontieres (MSF) – probably the most acceptable providers amidst the highly charged politics of the conflict.
Capable nations could augment that effort by deploying designated hospital ships in the waters off Gaza, which are protected by the Geneva Convention.
The US currently has the greatest hospital ship capability – the USNS Mercy and Comfort have 1000 bed, fully equipped facilities on board.
The Royal Navy’s RFA (Royal Fleet Auxiliary) Argus is already deployed in the Middle East region, not designated as a hospital ship, but a ‘Primary Casualty Receiving Ship’, with a highly capable 100 bed facility. All of these craft have helicopter landing decks for receiving casualties by air.
However, it is yet to be seen how these facilities could be utilized. It’s uncertain whether US and UK solidarity with Israel would create a political barrier to the transport of civilians from Gaza to their ships.
There is potential for others to provide hospital ships. The Chinese have a number, notably the Daishan Dao, smaller than US ships at 300 beds but as well-equipped.
Turkey has announced that it is ready to send hospital ships and set up field hospitals in Gaza or near the Rafah border.
Coordinating the effort
It is now time for the UN and its agencies to coordinate and help deploy these facilities to avoid a humanitarian catastrophe.
All options are achievable, but time is the pressing issue – and the UN and WHO are best placed to lead the coordination effort.
Recent disputes with Israel may complicate matters, but do not alter the facts on the ground, or the UN’s essential prominence.
The immediate despatch and deployment of hospital ships, operating under the Geneva Convention, and delivery of NGO-operated hospitals on protected land near to Gaza would provide vital humanitarian support and provide a beacon of hope – showing that the world can respond to those in need, in whatever circumstances exist.
Dr Lionel Jarvis, Associate Fellow, Centre for Universal Health.