Gaza: a never-ending effort to relieve suffering

For four years, Gazans have been living in a closed environment, in which the movement of goods and people are subject to severe restrictions. The ICRC is involved in an array of activities intended to ease their hardship. This is an update on its activities.

All 1.6 million Gazans, packed in to a narrow tract of land barely 360 square kilometres in area, yearn to live normal lives. That there is little prospect of doing so as long as the closure remains in place weighs heavily on them, especially the young. Exports are almost nonexistent and imports remain severely limited. In a recent assessment, the ICRC found that the easing of the closure by Israel in June 2010 was not enough to revive the local economy. The Egypt-Rafah Crossing Point, vitally important to Gazans, since it is the Gaza Strip's only crossing with a country other than Israel, started operating – with some restrictions – at the end of May 2011 on a permanent basis for the first time in four years.

While the ICRC does not question Israel's right to impose measures of control and security, it emphasizes that those measures must not have a disproportionate effect on the civilian population. The same principle applies to the naval blockade, which is prohibited under international humanitarian law if the damage to the civilian population is, or may be expected to be, excessive in relation to the concrete and direct military advantage anticipated. Israel has an obligation to ensure that the population continues to have access to basic goods and services such as food, water, medical care and shelter.

A listing economy, desperate for growth

In these times of crisis, when even the world's most robust economies are facing serious challenges, Gaza is having to contend with the additional constraints imposed by restrictions on the movement of people and goods and by the naval blockade. The result is an unemployment rate of nearly 40 per cent, and people and businesses forced to rely on coping strategies for their very survival. Unless the conditions are created for a significant reduction in the unemployment rate and an increase in purchasing power, the coping strategies will become increasingly futile.

Despite the fact that about a quarter of the population earn a living through agriculture, many Gazans still rely on food aid. Along the fence with Israel – mainly an agricultural area – lands extending 300 metres into the Gaza Strip have been declared off limits by the Israel Defense Forces, and those extending nearly one kilometre into the territory are considered dangerous and, therefore, practically unusable. Even the sea can scarcely be used: the fishing industry has almost disappeared since Gaza's fishermen have been prohibited from fishing beyond three nautical miles from the shore.

To help people develop new ways of earning a living, and to bring other lasting benefits to the community, the ICRC runs a cash-for-work programme under which small roads are improved, household waste is recycled, speech disorders in small children are detected and many other useful services are performed.

The ICRC has also been surveying the needs of farmers working in the area close to the border between Gaza and Israel. For the coming agricultural season it will provide some 200 of the farmers with vegetable seedlings, fruit-tree seedlings and irrigation systems. In addition, it will upgrade farmland affected by military operations.

Concern for the well-being of civilians

Israeli attacks on the Gaza Strip in March and April reportedly resulted in a number of civilian casualties and in the destruction of private property. Attacks by rockets fired from the Gaza Strip into Israeli territory, which reached a peak at about the same time, are also reported to have caused widespread damage and injuries to civilians. "Civilians on both sides must be spared," said Juan Pedro Schaerer, the head of the ICRC delegation in Tel Aviv. "They must be able to go about their daily lives in safety."

The ICRC continues to monitor the effects of military operations and attacks on the civilian population and on civilian objects in both Gaza and Israel. The organization is in regular contact with the affected population on both sides. It documents incidents and presents its findings to the authorities responsible. The ICRC places great emphasis on maintaining bilateral dialogue on the rules concerning the conduct of hostilities and the use of force. It urges the Israeli and Hamas authorities to comply with the rules of international humanitarian law applicable to the conduct of hostilities and to refrain from using excessive force in law enforcement operations. When houses are destroyed in military operations, the ICRC works closely with the Palestine Red Crescent Society's volunteer network to help meet some of the immediate basic needs of the people affected.

Visiting detainees and restoring contact between family members

ICRC delegates carry out frequent visits to people held in prisons or by the security forces in Gaza. The delegates' findings and recommendations on conditions of detention and the treatment of detainees are submitted confidentially to the authorities. The visits also give the detainees the opportunity to exchange messages, containing brief family news, with their relatives.

ICRC delegates also conduct regular visits to people detained in Israel, including in particular detainees from Gaza affected by Israel's 2007 decision to suspend family visits between Israel and Gaza. The lack of face-to-face visits causes great hardship for the detainees and all members of their families, but especially for children, who risk losing a precious bond with a parent, and for elderly or sick parents, who may be approaching the end of their lives. The ICRC sees to it that the ties between these detainees and their families in Gaza are maintained via Red Cross messages and "safe and well" messages – even though these can never replace direct contact. In addition, the ICRC sometimes seeks out family members in the Gaza Strip to give them direct news of their detained relatives. The ICRC has repeatedly called for the resumption of family visits, which are an important lifeline for detainees and their families provided for under international humanitarian law.

Families torn apart

The movement of people from Gaza through the Erez crossing continues to be restricted to those in urgent need of life-saving medical attention, a few businessmen, and employees of international organizations. The impact of the restrictions is felt in everyday life: members of families split between Gaza and the West Bank are cut off from one another, and people requiring medical care must fulfil strict security criteria to obtain permits, some of which are granted too late or denied outright.

The Israeli soldier Gilad Shalit has been held incommunicado for five years. The ICRC has called on Hamas repeatedly, but unsuccessfully, to allow Mr Shalit to exchange family news with his loved ones. On several occasions it has also reiterated its request for access to Mr Shalit, but Hamas has never acquiesced. Because there has been no sign of life from the Israeli soldier for almost two years, the ICRC has now demanded that Hamas prove that he is alive.

Water services

The closure is directly affecting basic services relied upon by all Gaza residents. Because the necessary equipment, supplies and spare parts, and access to technology, are all but impossible to obtain, services such as water and sanitation cannot be improved or even properly maintained.

"Water supplies and wastewater systems cannot be properly managed without access to standard technology," said Marco Albertini, an ICRC engineer working in Gaza. "The closure leaves only limited options for dealing with Gaza's water problems."

To make matters even worse, power supplies needed to run facilities are not always reliable. Standard equipment, such as pumps, and ordinary chemicals, such as chlorine (used to purify water), are unavailable or can be obtained only with great difficulty. The aquifer is over-exploited and too salty. In some places, wastewater is discharged without treatment, polluting the Mediterranean. There is not a proper water network functioning for all residents.

The ICRC is continuing its efforts to improve sanitary conditions, in particular by upgrading the Rafah wastewater treatment plant, where the treated wastewater can be used for agricultural purposes such as irrigating trees. The 150,000 residents of Rafah now live in a more sanitary environment. Their wastewater is disposed of more safely, since it is discharged into the Mediterranean Sea in a less polluted state and runs through a proper pipeline.

Health care

The health sector in Gaza is constantly beset by shortages of essential drugs and disposable items. This year, the situation has been worse than ever. The lack of a reliable system for delivering drugs and disposables to Gaza has a direct impact on patient care. Drugs used in the treatment of cancer, kidney-transplant and haemodialysis patients have been out of stock for the past three months. Recently, the ICRC had to urgently transfer a supply of fentanyl, an anaesthetic, into the Gaza Strip.

"Better cooperation between the health ministries in Ramallah and Gaza is needed to organize a predictable and reliable supply of essential drugs and disposables for Gaza," said Morven Murchison, an ICRC health coordinator. "It is unacceptable for patients to be the victims of a political impasse," she added.

Another problem, not resolved by the easing of the closure, is the lack of spare parts and supplies for medical equipment. X-ray film developers that were ready to enter the Strip last September have yet to make it in. Magnetic resonance imaging tests have ceased altogether, which has resulted in a sharp increase in medical referrals abroad. Even many of the most basic of diagnostic services cannot now be provided in Gaza health-care facilities.

The ICRC monitors the situation in close cooperation with the health ministry in Gaza and it conducts an open-ended dialogue with the health ministry in Ramallah. Every quarter, the ICRC delivers a supply of drugs and disposables to the ministry in Gaza. This year, exceptionally, it has also provided a vast quantity of additional drugs and other items. In total, the ICRC has donated 122 tonnes of drugs and medical consumables to Gaza Ministry of Health hospitals so far this year to respond to emergencies and has arranged for the transfer of 69 pallets of goods from the health ministry in Ramallah to Gaza.

Interruptions in the supply of electrical power to hospitals, another very worrying issue, continue to occur for six to eight hours per day on average. The shortage of fuel and the lack of a stable electricity supply are having a direct impact on the hospitals' ability to provide an adequate and reliable service, particularly for patients receiving dialysis treatment. Power cuts affect all kinds of hospital services, from the sterilization of instruments to the laundering of sheets and towels, from the ventilation of patients to the operation of elevators. Makeshift solutions have so far been found, but with World Bank financing of hospital fuel coming to an end there is considerable concern for the safety and well-being of future patients.

Because it is vital that patients receive the best possible care prior to their arrival at hospital, the ICRC provides financial and technical support for Palestine Red Crescent emergency medical services. The Red Crescent, which is responsible for pre-hospital emergency care, including the evacuation of the sick, wounded and dead from the area within one kilometre of the fence separating the Gaza Strip from Israel, does not have a direct channel of communication with the Israeli authorities. It therefore relies on the ICRC to coordinate its movements in the area with the Israeli authorities. The ICRC also provides financial support for continuing education programmes and workshops organized by Palestine Red Crescent medical institutes.

The ICRC continues to support the Artificial Limb and Polio Centre in Gaza, the only facility of its kind in the territory, which caters for patients requiring prosthetics and orthotics, and provides physical rehabilitation services. The ICRC has completed an extension and renovation of the centre making it more easily accessible for disabled people. During the first quarter of 2011, the facility provided treatment for 880 patients, including 104 who were fitted with new devices.

Spreading knowledge of international humanitarian law

The ICRC explains its work to various groups, from community leaders to youth groups, from media professionals to religious leaders. Because the majority of Gaza's population is under 18, schools are an important place in which to explain the role of humanitarian organizations and to promote a culture of respect for human rights.

The ICRC also spreads knowledge of international humanitarian law within civil society, government bodies and the armed forces. Whenever possible, the ICRC and the Palestine Red Crescent conduct joint information sessions on the International Red Cross and Red Crescent Movement and on international humanitarian law.

The ICRC maintains an ongoing dialogue with the Palestinian security forces and armed groups with the aim of facilitating humanitarian activities, enhancing understanding of international humanitarian law and promoting compliance with international human rights law.