`Dis­eases have be­come a way of life in Gaza'

Born and raised in a refugee camp in Gaza, IZZELDIN ABUE­LAISH is a Pales­tinian doc­tor who has worked for rec­on­cil­i­a­tion be­tween Is­rael and Pales­tine. In Jan­uary 2009 he lost three of his daugh­ters in an air strike by Is­rael. In­stead of sink­ing into ha­tred

Down to Earth - - INTERVIEW -

Gaza is re­cov­er­ing from 50 days of con­flict be­tween Is­rael and the rul­ing Pales­tine au­thor­ity. What is the sit­u­a­tion there? It’s ter­ri­ble.No one can be­lieve what is go­ing on here.How can they? Most peo­ple do not even know what the Gaza Strip is like.

This 40-km-long, 9-km-wide re­gion has a pop­u­la­tion of 1.8 mil­lion.This is one of the most densely pop­u­lated and im­pov­er­ished ar­eas in the world. Most peo­ple here are refugees, dis­placed from their home­land in 1948 (after Is­rael was formed). Half of the pop­u­la­tion is un­der 15 and about 20 per cent of women of re­pro­duc­tive age. But their life is un­der siege.

The re­gion has faced three wars in the past six years. Over 2,000 civil­ians were killed and another 11,000 wounded in the re­cent con­flict in July and Au­gust. In­fras­truc­tures like hos­pi­tals were tar­geted and dam­aged dur­ing the con­flict. It has cre­ated a rub­ble of over 2 mil­lion tonnes. The pro­jec­tion is that re­build­ing Gaza will take at least 20 years. Chil­dren dis­abled by the war will re­main dis­abled for­ever, mak­ing Gaza one of the most densely pop­u­lated places with dis­abled peo­ple.

The Gazans and Pales­tini­ans want to live like peo­ple in other

coun­tries. But dis­eases and in­fer­til­ity have be­come a way of life here. How does a war-like sit­u­a­tion af­fect pub­lic health? War is a tor­ture on hu­man­ity. It kills peo­ple, da­m­ages in­fra­struc­ture, trees, stones and ev­ery­thing that is cru­cial for en­sur­ing food, clean wa­ter, health and em­ploy­ment. Noth­ing is left for peo­ple after the war is over. Con­sider this. The win­ter is ap­proach­ing but many Pales­tini­ans are home­less. How can we ex­pect a home­less per­son to be healthy? Wa­ter here is no more safe to drink and will soon spread in­fec­tious dis­eases.

Non­com­mu­ni­ca­ble dis­eases are also on the rise.Many peo­ple in Gaza now suf­fer from stress and hyper­ten­sion.This is lead­ing to sev­eral other chronic dis­eases. Stress and in­fec­tious dis­eases are in­duc­ing pre­ma­ture labour among women. Chil­dren trau­ma­tised by the con­flicts are suf­fer­ing from nightmares. Vi­o­lence and ha­tred have be­come pre­dom­i­nant pub­lic health is­sues in Gaza. What kind of chal­lenges do health­care providers face in Gaza? Are they dif­fer­ent from those in other war-torn ar­eas like Syria and Afghanistan? In Gaza,the scale of car­nage is un­prece­dented.This poses a chal­lenge for health­care providers. The sit­u­a­tion is more chal­leng­ing be­cause they have to han­dle an emer­gency sit­u­a­tion with­out ba­sic fa­cil­i­ties like elec­tric­ity, which is a must for con­duct­ing surg­eries on the wounded, drugs for med­i­ca­tion and ad­vance med­i­cal care and equip­ment. Even ba­sic re­quire­ments like blood and anaesth­sia are in short­sup­ply. And then comes the cru­cial as­pect: one needs safety while evac­u­at­ing wounded civil­ians. But no one is safe here. Are in­ter­na­tional agen­cies like the UN, WHO, Medecins Sans Fron­tieres and Red Cross able to bring about changes on the ground? Many in­ter­na­tional com­mu­ni­ties and or­gan­i­sa­tions are work­ing in Gaza.I am sure they are do­ing their part. Yet, the sit­u­a­tion re­mains bad.This is be­cause one needs to be pro-ac­tive in pro­vid­ing care even after the war. Most or­gan­i­sa­tions ex­tend their help dur­ing the emer­gency sit­u­a­tion but leave there­after. This is like par­tial heal­ing of a wound.It is im­por­tant for th­ese or­gan­i­sa­tions to re­ha­bil­i­tate the af­fected peo­ple. But re­ha­bil­i­ta­tion takes years. How chal­leng­ing is it to per­form se­ri­ous surg­eries on con­flict vic­tims? Is the ex­ist­ing health­care sys­tem equipped enough to tackle the chal­lenges? It is dif­fi­cult to man­age such pa­tients in Gaza where means and re­sources are limited. This is the rea­son many coun­tries are try­ing to help wounded civil­ians by evac­u­at­ing them and shift­ing them to Egypt or Turkey or the West Bank or other parts of the world. But those who are se­verely in­jured can­not be trans­ported, and we do not have enough fa­cil­i­ties to treat them.

Gaza has one ma­jor hos­pi­tal, which has only 700 beds. The re­main­ing are sec­ondary health­care cen­tres that can­not pro­vide ter­tiary med­i­cal care. Be­sides, no hos­pi­tal can han­dle such huge num­ber of pa­tients who ar­rive in groups of 15, 20 or 30. In each group, there would be at least two to three se­verely in­jured peo­ple. One may have a crushed arm while the other may have a crushed leg. They need a team of doc­tors who can per­form lengthy, metic­u­lous surg­eries. It takes 10-15 hours to re-fix an arm. In the ab­sence of fa­cil­i­ties and due to lack of time, the eas­i­est op­tion be­fore doc­tors is am­pu­ta­tion. What needs to be done to im­prove the sit­u­a­tion? To be­gin with, the gov­ern­ment should pro­vide safe drink­ing wa­ter and elec­tric­ity to peo­ple. It should open the bor­der in ac­cor­dance with the cease­fire deal. It also needs to re­build houses and schools. But pro­vid­ing safety to peo­ple should be the top pri­or­ity of the gov­ern­ment.

The gov­ern­ment also needs to re­build the crum­bled pub­lic health­care fa­cil­i­ties and ar­range for re­con­struc­tive surg­eries of peo­ple who have sus­tained grave in­juries in the con­flict. It should also ini­ti­ate re­ha­bil­i­ta­tion pro­grammes for those suf­fer­ing from men­tal health prob­lems.

Stress and hyper­ten­sion are af­fect­ing the men­tal health of many peo­ple in Gaza and caus­ing chronic dis­eases among them. Stress is also in­duc­ing pre­ma­ture labour in women. Vi­o­lence and ha­tred have now be­come pre­dom­i­nant pub­lic health is­sues in the re­gion

How do you find In­dia's re­sponse in help­ing con­flict-torn coun­tries man­age their health cri­sis sit­u­a­tion? In­dia is a great coun­try.Peo­ple in the coun­try have faced many calami­ties and dis­as­ters,and they have the ex­pe­ri­ence to deal with such emer­gency sit­u­a­tion.We can learn from each other’s ex­pe­ri­ences. How­ever, health cri­sis can­not be man­aged only by health pro­fes­sion­als. It de­pends on sev­eral other stake­hold­ers in con­flict­ing par­ties.There is a need for in­ter­na­tional com­mu­nity to come to­gether and think how this cri­sis can be man­aged. How­ever, we do not want to man­age health cri­sis. We want to pre­vent it. If some­thing dis­as­trous is go­ing to hap­pen, pre­vent­ing it is the best way to tackle it, not man­ag­ing it.

Mem­oir by Abue­laish after he lost three daugh­ters in an air strike on Gaza by Is­rael

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