Six weeks after Israel completely destroyed the al-Wafa rehabilitation and geriatric hospital east of Gaza City, hospital director Dr. Basman Alashi says that his staff are still able to receive and treat patients every day.
With only 50 beds set up in a temporary location, and without the specialized physical therapy machines that severely injured patients depend on to regain mobility, Alashi said that his team of expert medical workers are busy treating patients "by hand."
Israel's onslaught in July and August, which ended in a cease-fire agreement signed on August 26, killed more than 2,100 Palestinians, including more than 520 children, and injured over 11,000. Approximately 1,000 injured children will be permanently disabled, according to statistics provided by the United Nations. More than 64,000 Palestinians remain internally displaced, as their homes were completely destroyed in Israeli attacks, and are being sheltered at 20 UN-run schools.
Basic medications, supplies and construction materials have been banned or severely restricted by the blockade, and nearly all Gaza-produced exports have been tightly-controlled or outright prohibited by Israel.
The United Nations also reported that Israel has violated the cease-fire agreement at least four separate times between August 26 and September 15. Israeli naval forces fired warning shots towards Palestinian fishing boats off the Gaza coast, the UN report says, and "in one of the incidents, five Palestinian fishermen were arrested and their boat was confiscated west of Beit Lahia." Israeli soldiers also invaded areas of the Gaza Strip "and conducted land clearing operations" as well as fired "toward a Palestinian who was attempting to enter Israel."
On September 16, a deal between the UN, Israel and the Ramallah-based Palestinian Authority was reached to start reconstruction work in Gaza under UN supervision. Israeli newspaper Haaretz reported that "The Palestinian Authority said in a study recently that the reconstruction work would cost $7.8 billion, two and a half times Gaza's gross domestic product, including $2.5 billion for the reconstruction of homes and $250 million for energy."
However, despite this concerted agreement to rebuild Gaza, the seven year-long Israeli-imposed blockade - supported and enforced by Egypt - remains in place. Since the blockade began in 2007, Gaza's economy and infrastructure have been degraded on a multitude of levels. Basic medications, supplies and construction materials have been banned or severely restricted by the blockade, and nearly all Gaza-produced exports have been tightly-controlled or outright prohibited by Israel.
Chris Gunness, spokesperson for UNRWA, the UN agency for Palestinian refugees, told Truthout that although the UN welcomes the agreement as a step in the right direction, "of course there's much further to go. It has not lifted the blockade," he said.
"And if we are going to escape from the pattern of blockade, rockets and mass destruction, then we have to address the underlying causes of the conflict - and that includes lifting the blockade," Gunness said. "Gaza must have its freedom - freedom of access to goods in and out of Gaza, and that means exports as well."
Alashi, the al-Wafa hospital director, said that critical medical equipment, including prosthetic limbs and specialized machines to treat physical and neurological disabilities, are being blocked by Egypt as the siege continues.
An international aid organization purchased an ambulance to replace the one that Israel destroyed, Alashi said. It was brought all the way through Egypt, but it remains stuck at the border. "They are waiting for the Egyptians to give them permission to enter Gaza," he said.
"It has been more than 30 days and they have not heard a reply from [Egypt]. So the Egyptians are not letting in any medicines. The Israelis are letting some basic medicines coming in because of the international pressure on them, but in terms of who allows medicines and prosthetics and all that's needed to the hospital . . . the Egyptians are really zero tolerance. They are not allowing anything in," Alashi said.
According to a September 6 report from the World Health Organization, a total of $12.6 million in basic medications, medical equipment and hospital supplies "from 39 donor agencies, governments, humanitarian organizations and other donors has been delivered to the health sector in Gaza."
On August 13, Abu Murad and several other munitions experts were killed when an unexploded 500-kilogram missile blew up during an attempt to diffuse the weapon. Because of the blockade, Abu Murad and his team were not able to access protective gear and robotic equipment that is necessary to do their dangerous job safely.
But, as Alashi points out, much more is needed to mitigate and treat the level of injuries in Gaza - and to provide the kind of long-term care that thousands of patients now require. As his staff wait for specialized physical rehabilitation machines and medical equipment, destroyed by Israel, to be replaced, he said he was proud of his doctors and nurses. "These patients are young, old, women and men. They come [in] crawling or in a wheelchair, but they leave walking from the hospital," Alashi told Truthout. "We are able bring them back as functioning citizens."
However, Gunness said that there also has to be a concerted effort to deal with the tens of thousands of unexploded munitions left behind by Israel's military - which, if not found and diffused, can lead to countless more injuries or deaths.
"The UN estimates that 80,000 projectiles flew into Gaza during the 51 days of the conflict, and classically, in such situations, about 10 percent of it remains unexploded," he said. "Before recovery and reconstruction can begin in earnest, we have to clear all of this unexploded ordnance, and that also is a huge undertaking. People can't go back to their homes, children can't go back to their neighborhoods where they run the risk of being killed or maimed because of unexploded ordnances."
Hazem Abu Murad, the head of field operations for Gaza's bomb squad, estimated in early August that there were more than 1,000 unexploded munitions scattered across Gaza already - a number he calculated nearly a month before the attacks stopped. On August 13, Abu Murad and several other munitions experts were killed when an unexploded 500-kilogram missile blew up during an attempt to diffuse the weapon. Because of the blockade, Abu Murad and his team were not able to access protective gear and robotic equipment that is necessary to do their dangerous job safely.
Although Alashi is hopeful that his staff will be able to treat some of the immediate needs of the Palestinians facing debilitating injuries in Gaza - as plans for reconstructing the al-Wafa hospital are underway - deeper impacts of Israel's attacks on Gaza are now being assessed.
Though the Israeli missiles have stopped destroying Gaza - for now - human rights workers and community leaders are concerned about the long-lasting psychological effects of Israel's attacks.
Impact on Children
According to the UN, 373,000 children - about one-fifth of Gaza's entire population - are in immediate need of critical psychological treatment, as deep-seated trauma from not just these latest attacks, but from recurring traumas from earlier wars on Gaza, surface and intensify.
"An average of 12 children were killed and 77 were injured every day - 25 of whom were left with permanent disabilities," according to a report from international aid agency Save the Children. "On a daily basis, an average of six schools were shelled, 435 families lost their homes, and 37 children were orphaned."
"If you're 6 years old in Gaza, it would have been the third terrifying conflict you would have lived through in your short and fragile life."
Even at the very beginning of the latest round of attacks on Gaza, Al Jazeera America reported, "The latest wave of bombardments has made it impossible for child psychologists to finish the delicate task of rebuilding the mental health of kids suffering post-traumatic stress disorder (PTSD) from previous waves of conflict, according to a children's rights group on the ground."
Symptoms of chronic trauma - including bedwetting, nightmares, behavioral regressions, an inability to focus and selective mutism - are prevalent in Gaza, according to UNICEF.
Gunness told Truthout that the long-term impact of the attacks on Gaza's children could be incalculable.
"One of the consequences of not lifting the blockade and addressing the underlying causes is that there is this mass trauma - and that what happened in the last couple of months will be reignited, and that would be absolutely disastrous," Gunness said.
"You're seeing the cumulative effects of the conflict, especially on children. Because if you're 6 years old in Gaza, it would have been the third terrifying conflict you would have lived through in your short and fragile life. There was [Operation Cast Lead in] 2008-09, [the attacks in] November 2012, and now."
Gunness added that the trauma and terror brought on by their most recent experience living through an Israeli bombing campaign is layered on top of the memories and traumatizing experiences of the previous wars. "The children are traumatized and then re-traumatized - and then further time re-traumatized. So it has a dreadful cumulative effect," he said.
Much of the immediate trauma therapy is happening at UNRWA-run schools, Gunness explained, because that's where children come. "But these schools have the most appalling references and memories for children in Gaza, because they were hit during the war. There were these high-profile hits by the Israeli army on UNRWA shelters, where children had taken refuge with their parents . . . in designated, so-called 'safe areas.'"
Four Million Tons of Rubble
Entire neighborhoods were wiped out by Israeli warplanes and shelling, at a level not seen in previous aggressions. Aerial footage, published by the BBC, of the Shejaiya neighborhood east of Gaza City, for example, shows the shock of Israel's onslaught.
A West Bank-based environmental group indicated that it will take six to eight months to clear the approximately 4 million tons of rubble Israel left in the wake of its bombing campaigns.
Khalil Abu Shammala, the director of the Gaza-based Al Dameer Association for Human Rights, told Truthout that "every hundred meters in Gaza, you will find [different] types of destruction as a result of Israel's bombs."
Abu Shammala said that his organization is part of a coalition of human rights groups in Gaza and the occupied West Bank who are gathering data on the various humanitarian, environmental and psychological impacts of Israel's latest series of attacks.
"We have a hundred field workers who started [data collection] a day after the cease-fire, and we are in the process to document the results, the impact of the war, the violations," Abu Shammala said. He explained that the data reports will be submitted to a special fact-finding committee of the UN Human Rights Council that will be visiting Gaza in early October.
With the data and detailed reports, Abu Shammala and his colleagues in the human rights sector in Gaza say they will be able to establish a legal file "in order to follow the Israeli war criminals [to] the international court."
On September 12, Al Jazeera revealed that the Ramallah-based Palestinian Authority president, Mahmoud Abbas - who once declared that the PA's collaboration with Israel is "sacred" - has "so far prevented the launch of a formal investigation into the alleged war crimes committed by Israel and Palestinian factions . . . according to officials at the International Criminal Court."
Abu Shammala said that the human rights coalition will be working "very hard to pressure [Abbas]" to make it possible for the International Criminal Court to begin legal proceedings against Israel's alleged war crimes in Gaza.
Alashi says that as he waits for the blockade to end, and for the open flow of desperately needed equipment and medicines to treat the thousands of injured in Gaza, his staff has created a mobile outreach program. Traveling door to door in some of the most besieged areas of the Gaza Strip, carrying basic medications and medical supplies, al-Wafa's staff can attend to patients and train family members how to take care of their injured or ill relatives at home.
"We assess that those who need medical rehabilitation are more than 50 percent of the injured [in Gaza]. None of the hospitals here in Gaza would be able to handle all [those people]," he said.
"[Our] outreach program has taken a lot from al-Wafa hospital in terms of financial ability, but since our mission is a mercy mission and a mission to help the Palestinians in Gaza, we have pushed ourselves to the limit," he added. The program, he said, "gives medical rehabilitation, medical supplies, wheelchairs, walkers, waterbeds or airbeds, so we can reach as many people as we can."
Meanwhile, for human rights worker Khalil Abu Shammala, seeing the trauma build inside his children, along with so many other children in Gaza, has been overwhelming.
Abu Shammala recounted the conversation that he and his wife and children had as the sole remaining family inside their apartment building on the last night of Israel's attacks. "[Everyone else] left their apartments because they were worrying about Israel destroying our building, after Israel started a campaign against the [apartment] towers," he said.
"I came home late in the afternoon that day, and I looked at my family's eyes. My youngest daughter, Nisma, said to me, 'Look, Dad, we don't want to leave our apartment. Because if we will die, we'll die anywhere. So there is no reason or justification, and no secure place to go here or there.'" So I decided to stay with them that night. They slept, but I continued to be up until 6 in the morning, following and monitoring, and waiting and expecting the worst."
Abu Shammala paused. "As a husband, as a father, I had the same feeling of any father in Gaza. . . . we don't need our [children] to continue paying the price."