The Gaza Strip is slowly and gingerly emerging from another full pandemic lockdown.
But the pain is far from over, especially for those suffering chronic illnesses in an area in which the health sector has been systematically undermined over 13 years of Israeli blockade and is now staggering under the weight of the coronavirus pandemic.
Over the past weeks, parts of the Gaza Strip were completely closed off by curfews that saw movement banned and health centers closed to prevent the spread of COVID-19.
But this has deprived chronically ill patients from accessing regular checkups and treatment.
In 2017, the last year for which statistics are available, there were more than 147,000 chronically ill patients in the Gaza Strip.
Samira Salem, 45, is diabetic. A resident of the Maghazi refugee camp in the central Gaza Strip, she gets her medicine regularly from the camp’s health center.
But when cases of coronavirus were discovered in the camp – the first in Gaza detected outside quarantine centers – the Ministry of Health in Gaza designated the area as an epicenter for the virus, locked down the camp, preventing residents from leaving, and closed the health center.
“I was really worried when I heard about the lockdown,” Samira said. “I know of course about the virus, but I never thought I would be cut off from getting treatment.”
Her husband and children were also not able to leave the house to bring her medicine.
“I was always worried her condition might deteriorate and I wouldn’t be able to take her to hospital,” said her husband, Muhammad Salem, 54.
Lockdowns and closures still prevail in many areas in the Gaza Strip. Some are becoming even more severe after newly reported cases were over 100 per day. The northern Gaza Strip is among the worst hit, reporting the highest daily caseload.
Curfews hit hard
Suad al-Amoudi, 47, from the Jabaliya refugee camp in the northern Gaza Strip, is a cancer patient who needs regular treatment at al-Rantisi hospital. But under the measures introduced as a result of coronavirus, she was unable to leave her home.
“There has been a cessation of security coordination, which has made it even more difficult to get to hospitals in the West Bank for treatment,” she said, referring to a May decision by the West Bank Palestinian Authority to end coordination with Israel’s military in response to Israeli government plans to annex large swaths of West Bank territory.
“And now they are closing off places within Gaza, preventing us even from going to hospitals for regular treatment.”
The end of security coordination has made it even harder for Palestinians to leave the Gaza Strip, a perennially difficult proposition.
Even with security coordination, patients from Gaza faced an onerous process to obtain a permit from the Israeli military to leave Gaza. In 2017, according to the WHO, 54 people from Gaza died after being refused permission by the Israeli military to travel for treatment.
Ali Jadallah’s mother needs kidney dialysis every three days at Gaza City’s al-Shifa hospital. Um Ali, 51, who would only be identified as such, was always deeply concerned about the risks of contracting coronavirus by visiting the hospital, but has little choice in the matter: Missing treatment can cause severe complications.
The worst did happen. When she went early last month to undergo treatment, she ended up not only contracting coronavirus (along with three other patients), but also transmitting it to her husband, daughter and son.
“I was shocked when I learned that my mother contracted Covid-19,” said Ali. His mother has stabilized, but her brush with COVID-19 has left her deeply anxious.
“Even though doctors say that her condition is stable, I am very worried about her.”
Usama Jamal, 36, from Khan Yunis in the south of Gaza, has been waiting to travel to the occupied West Bank for a heart operation.
But with a cessation of security cooperation between the PA and Israel since May, he has been unable to travel.
His operation was rescheduled for Gaza, but the outbreak of coronavirus in the coastal territory caused that appointment to be postponed too. He has not even been able to go to the hospital for a checkup since late August.
“My health is not good,” he told The Electronic Intifada. “I don’t know how I will survive the conditions imposed on us by the pandemic.”
Since community transmission was confirmed in late August, the number of coronavirus cases has risen dramatically along with the number of deaths.
Deaths have risen from three to over 30 in the same period.
Ashraf al-Qedra, a spokesman for the Ministry of Health in Gaza, said 13 years of Israeli blockade on Gaza has dramatically weakened the health service there and undercut the ability of the health sector to confront the pandemic.
“We had been expecting the community spread of coronavirus. But we are hampered by the ongoing siege on Gaza and the continued lack of support for us to overcome these crises,” al-Qedra told The Electronic Intifada.
The Ministry of Health in Gaza estimates that the area’s hospitals have just under half, the essential drugs they need, a direct result of a siege that has seen only emergency supplies make their way into the area.
“We have received very little support and we are working with simple means to overcome this crisis,” al-Qedra said, as he emphasized it was every Palestinian in Gaza’s right to secure decent healthcare.
Qatari funding is available for Gaza, but much depends on agreement between Hamas and Israel over a ceasefire.
The World Health Organization (WHO) has long warned that a full-blown pandemic could hit Gaza especially harshly in view of Israel’s blockade, its small area and the high population density, with more than 2 million people living in 365 square kilometers.
WHO has stepped in to facilitate permits for patients to receive treatment outside of the Gaza Strip.
In September, the UN’s special envoy, Nickolay Mladenov announced that agreement had been reached for the WHO to help coordinate with Israel for such travel.
But such emergency measures do not address the fundamental obstacles to delivering healthcare in Gaza. Human rights organizations in Gaza, which have rung the alarm bells repeatedly, are frustrated.
Samir Zaqout with Al-Mezan, a human rights group in Gaza, said his and other organizations have been asking repeatedly for assistance, but with “little response.”
“We issue many appeals for assistance to Gaza but there has been little response … We notice a clear silence toward the Gaza Strip, especially from the Arab world.”
Meanwhile, patients in Gaza continue to struggle, fearful in uncertain times.
“I hope this nightmare will end soon,” said Suad al-Amoudi. Those with chronic illnesses, she said, are very worried about their health during the pandemic.
“I do not see an end to the virus soon.”
Ruwaida Amer is a journalist based in Gaza.