Occupied Palestinian Territories - Humanitarian Update, June 2010

Summary of monthly Humanitarian Monitor report produced by the UN Office for the Coordination of Humanitarian Affairs (OCHA).

JUNE OVERVIEW

On 20 June, the Israeli government announced a decision to ease its three-year blockade of Gaza, allowing the unrestricted import of goods intended for civilian use. Other items that Israeli authorities define as military or dual military/civilian items will remain restricted. Following the announcement, the volume of imports slightly increased, and some previously restricted consumer goods, mostly food and household items, were allowed into Gaza. While the decision is welcome, its humanitarian impact is likely to be limited as two key areas have not been addressed in the decision: restrictions on exports and movement of people. Without exports allowed out of Gaza, the potential economic impact of the partial removal of restrictions on imports will remain limited. Additionally, as most construction materials have been defined as 'dual use' items, housing needs are likely to remain largely unmet. Although these materials will be allowed for projects under UN or international supervision, the complexity and high cost of the monitoring requirements by the Israeli authorities make the implementation of a large number of such projects unsustainable.

Meanwhile, due to the blockade and the internal Palestinian rift, the level of services provided to the population of Gaza continued to deteriorate. This was particularly evident this month with regard to Gaza's healthcare sector. Following a seven-month decline in the amount of industrial fuel entering Gaza resulting from an ongoing funding dispute between the Gaza and Ramallah authorities, power cuts have increased up to 16 hours on some days in some parts of Gaza. Backup generators are incapable of making up for such a large shortfall; consequently, in order to reduce the load on these generators during power cuts, hospitals are forced to suspend or postpone elective surgery, diagnostic procedures and supportive services; sensitive medical equipment is regularly damaged as a result of these cuts. In addition, lack of internal coordination has resulted in the largest shortage of essential drugs at Gaza's Central Drug Store recorded since the beginning of the blockade in 2007: 114 out of 480 these drugs were out of stock as of the end of the month. While the full impact of these shortages has yet to be assessed, they may result in interruptions to life-saving treatments for cancer and heart disease.

Although the uninterrupted opening of Rafah Crossing since the beginning of the months made it easier for patients to seek specialized medical treatment in Egypt, access to medical facilities in the West Bank, Israel and Jordan continued to be limited by a restrictive permit regime implemented by the Israeli authorities. This month, 21 percent of the applications were either rejected or delayed, an improvement compared to 27 percent in the previous two months. However, while the percentage of delayed applications declined, the percentage of those rejected significantly increased from roughly two percent to over 12 percent.

Protection of the civilian population throughout the occupied Palestinian territory continued to be of concern. During June, 15 Palestinians were killed, another 104 Palestinians were injured in the context of Israeli-Palestinian conflict, along with one Israeli killed and 21 others injured. In the Gaza Strip, Israeli-Palestinian fighting and other activities along the borders and in sea areas resulted in the highest number of Palestinians fatalities in a single month since February 2009 - eleven Palestinians, including two civilians. Most of the violence and casualties in the West Bank occurred in East Jerusalem. Much of the tension in this area was triggered by current and expected Israeli activities in the neighbourhood of Silwan, including the initial approval, by a local planning body, of a development plan, which entails the demolition of tens of Palestinian buildings to make way for recreational areas and various commercial and residential structures. The possible implementation of this plan could result in the displacement of some 500 residents.

Also of concern are the living conditions of Palestinians living in Area C of the West Bank. The annual Movement and Access report release this month by OCHA revealed that while travel times between Palestinian cities and towns have declined due to measures adopted by the Israeli authorities, there was no parallel improvement regarding access to land and rural communities in Area C, particularly in the Jordan Valley. Access restrictions exacerbate the acute water shortage affecting Area C communities, particularly during the summer season, as a result of the lack of water infrastructure and previous years of drought. The water shortage has gradually eroded the herding livelihoods on which most of these communities rely. Humanitarian organizations seeking to address the needs of these vulnerable communities face considerable challenges due to the restrictive permit regime implemented by the Israeli authorities. An emergency response plan, which contains 15 water projects, was submitted to the Israeli authorities on behalf of the Humanitarian Country Team (HCT) in January 2010, however because of Israeli restrictions, none of the projects were implemented as of the end of June.

An additional threat to the agricultural livelihoods of thousands of families throughout the oPt has recently appeared in the form of a pest (named 'Tuta Absoluta') causing damage to tomato crops in greenhouses and agricultural fields. The UN Food and Agriculture Organization (FAO) is currently leading a collective response plan in the Gaza Strip, while in the West Bank, the Ministry of Agriculture has began to survey damage and provide farmers with relevant information.

While the easing of the blockade in the Gaza Strip and the facilitation of movement between towns and cities in the West Bank are welcome, additional steps are urgently required from the Israeli authorities to improve the humanitarian situation of the most vulnerable throughout the oPt. The opening of the Gaza crossings is necessary for the unrestricted import of constructions materials, for exports, and for the movement of people between Gaza and the West Bank. In the West Bank, access and building restrictions in Area C must be removed, and demolitions of homes in East Jerusalem should be permanently frozen. Additionally, to avoid further deterioration of services provided to Gaza's population, Hamas and the PA must overcome political differences and improve coordination.

LATEST DEVELOPMENT

On 5 July the Israeli authorities released the official list of military and 'dual-use' items, the import of which to Gaza will remain prohibited or restricted. 'Dual-use' items are specified in two separate lists. One list contains 15 categories of general items, including fertilizers, glass fiber-based raw materials, drilling equipment, vessels and water disinfectants, among others. The other list contain 19 types of construction materials (to be limited to projects under international supervision), including cement, aggregates (gravel), prepared concrete, concrete blocks, steel elements, asphalt, sealing materials, and construction vehicles, among others.

On 6 July, construction works began for the expansion of a second back-to-back platform and also to expand the connecting road between Rafah crossing and Kerem Shalom. The expansion is expected to increase the platform's capacity to 250-300 truckloads.

ISSUES IN FOCUS

Effects of fuel shortage and power cuts on health care in Gaza
The recurrent power cuts and unstable power supply severely affect medical care in Gaza: treatments are interrupted or have to be postponed, sensitive medical equipment is damaged, and supportive services have to be suspended. To cope with the power outages, hospitals have to function on back-up electricity generators for prolonged periods of time.

Gaza European, Shifa and Nasser hospitals all reported to the World Health Organisation (WHO) of the suspension of elective surgery and delays in other surgeries, as well as delays and repetitions of diagnostic procedures. While difficult to assess, the effects on patients are significant. For example, when an x-ray examination is repeated, patients are exposed to additional radiation levels; when power is cut during dialysis (each session lasts three hours) the patient has to be urgently disconnected from the machine to avoid blood clots, which is potentially fatal.

In order to sustain priority medical care during electricity cuts, supportive services like laundry, sterilization and kitchen suspend all or part of their work--to reduce the load on backup generators and save fuel. The same applies to routine diagnostics like x-ray, lab exams and dental. In addition, the computerized health information system at Shifa Hospital has been disrupted, resulting in delays in reporting.

Sophisticated medical equipment is highly sensitive not only to electricity cuts but also to low voltages, which are common in Gaza. As a result, a number of vital diagnostic equipment have ceased to function over the past months: mammography and x-ray machines at Shifa Hospital, cardiac monitors at Gaza European, Shifa, Dorrah and pediatric hospitals and UPS equipment at Shifa laboratory. Damaged machines often have to be abandoned as spare parts cannot be imported or only with great delays and specialized technicians are unable to enter Gaza to service the equipment.

According to WHO, only 26 out of 57 primary health centers in Gaza are equipped with generators - three of them are out of order due to lack of spare parts and eight have no fuel most of the time. All others operate at less than one third of their capacity due to limited fuel supplies. All of the 13 hospitals in Gaza have generators, but as of the end of June, the fuel available for their generators was at only 20 percent of requirements. The hospital power generators are designed to start up quickly in emergencies, but they are not built to run for extended periods of time, which increases maintenance requirements, and increases chances of breakdown.

Source: UN Office for the Coordination of Humanitarian Affairs

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