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Thousands of displaced Palestinians are taking refuge in Nasser Hospital, Khan Yunis, Gaza. Alamy Stock Photo
War on gaza

'They're not living, they're surviving': Disease, thirst and hunger threaten displaced Gazans

The Journal spoke to Doctors Without Borders’ chief medical coordinator for Palestine about the dire humanitarian situation.

GUILLEMETTE THOMAS IS the Doctors Without Borders (MSF) medical coordinator for Palestine, with responsibility for the occupied territories of the Gaza Strip and the West Bank. Speaking to The Journal by phone from her base in Jerusalem, Thomas said she has never seen anything like the current conflict. 

“It’s the first time I’m exposed to such a horrific situation, with such intense violence, and for such a long period of time,” she says. 

MSF (Médecins Sans Frontières) is an NGO that provides humanitarian medical care to people in conflict zones and countries with endemic diseases.  

Thomas told The Journal about the dire conditions for displaced people in the Gaza Strip, as well as the Israeli forces’ repeated attacks on hospitals, ambulances and healthcare workers since the beginning of the conflict sparked by Hamas’ attacks on 7 October, which left over 1,000 people dead.  

The ensuing bombardment and ground invasion of Gaza by the Israeli Defence Forces (IDF) has killed at least 20,000 people and displaced around 2 million, the vast majority of the population. 

A total siege of Gaza was implemented following the Hamas attacks, with Israel shutting off all food, water, fuel and electricity from the already blockaded and impoverished territory. Precious little humanitarian aid has entered Gaza since then. 

The number of dead reported by the Gaza Ministry of Health, however, is likely an underestimate because there are so many people under the rubble of destroyed buildings. 

The United Nations aid chief Martin Griffiths said as much in a recent statement, in which he cited the example of the earthquake that struck Turkey in February, where the death toll doubled after excavating the rubble. 

Thomas agrees that the death toll from Israel’s assault on Gaza is likely higher than what has been officially reported. 

“We can assume that many, many, many people are still under the rubble, dead, most of them, so definitely the numbers that we have are probably underestimated,” she says. 

Another factor that may contribute to an underestimated death toll is the presence of pre-existing health conditions among the Gazan population, which have gone largely untreated since the siege began, Thomas explains. 

“We can assume that a lot of them can die from these complications. This is something that we cannot see in the numbers.”

gaza-al-aqsa-hospital A patient receiving a new dressing at Al Aqsa hospital. 29 November 2023, Middle Area, Gaza. MOHAMMED ABED MOHAMMED ABED


‘They’re not living, they’re surviving’ 

MSF’s  latest report on the situation in Gaza said displaced people are sleeping in rough conditions, with “dangerously little levels of food and water”.

It also said people have been drinking salty water and that “some shelters have one toilet for every 600 people”. 

Thomas describes the conditions as “dire” and says that this is leading to a significant rise in diseases, infections and dehydration. 

“We are already seeing many, many diseases related to the living conditions and related to the absence of hygiene and access to basic accommodation like showers and toilets,” she says.  

“The kind of diseases that we are seeing are, first, diarrhoea because they have no access to clean water. So diarrhoea and dehydration are really, really increasing significantly.”

gaza-al-aqsa-hospital Razan Samer Shabet, the young girl, lost her whole family in the bombing while she was injured. She has been in the hospital ever since. A distant uncle looks after her. She doesn't know her family have been killed. MOHAMMED ABED MOHAMMED ABED

Another danger is the number of infected wounds among survivors, which she says are also rising. 

“A high number of people with wounds have infections… because they have no way to have proper hygiene conditions, no access to healthcare, and so even the most basic ones are getting infected. 

“Another thing that we can consider related to the living conditions are the respiratory tract infections, which are really increasing because they are living outside and the places where they are living are overcrowded and that’s also a factor that leads to this kind of infection, also skin infections.” 

Such conditions are typical of conflicts that displace so many people, she explains. However, the major difference for the people of Gaza is that they are unable to flee the violence because Gaza is completely fenced off. 

“They’re not living, they’re surviving. And they are living in exactly the same conditions that unfortunately many, many displaced people are facing around the world. 

“The thing that is really increasing the atrocity of what’s happening is that they have no way to flee the bombing, the shelling, the violence, and that’s very specific to this conflict. People are in a vulnerable, very difficult situation due to the living conditions, but also due to the constant violence and threats to their lives,” Thomas explains. 


Hospitals under siege 

Since the onset of the Israeli bombardment and subsequent ground invasion of Gaza, MSF staff have witnessed attacks on hospitals, ambulances, patients and healthcare workers. 

“What I can tell you is that since the beginning of the conflict, what we can see is that the IDF are targeting directly the health facilities, either hospitals or ambulances or other health facilities, which is totally unacceptable and which is against all humanitarian law,” Thomas says. 

“They are doing that on a regular basis. Even now they are doing that in the north of Gaza, surrounding hospitals, targeting the people inside, shooting the people inside.”

Thomas says this is something they have seen almost daily since fighting began.  

She says that in the north of Gaza, no healthcare facilities are currently able to receive any patients “because they are surrounded by tanks, because they have no fuel, no supply, no nothing, no staff able to provide any care due to the total siege that the army are doing around the hospitals”. 

This cannot be alleviated because of the restriction of any access to the north of Gaza, she explains. 

In one incident, Thomas says that Israeli forces “directly targeted” the maternity ward of the Nasser hospital in the southern city of Khan Yunis, where MSF staff are working. 

“One patient, one little girl, died following this incident. So what we can see since the beginning of the conflict is that for the Israeli army, the hospitals are targets and they are not respecting at all humanitarian laws.” 

On Tuesday, the IDF told CNN that “upon receiving the reports about damage to Al-Nasser hospital, an initial review was carried out. At this stage, it is not possible to determine with certainty what was the source of the damage to the hospital”. 

Israel’s stated reasons for targeting hospitals, as well as refugee camps, schools and residential buildings in Gaza, is that they believe Hamas militants are operating from within them. 

Asked if MSF staff have ever seen Hamas fighters operating from hospitals in Gaza, Thomas replies, “No, never”. 

The most high-profile incident in which the IDF assaulted and raided a hospital in the last few months was the case of Al Shifa hospital, the largest in Gaza, which the IDF said was hiding Hamas’ command centre in tunnels below the facility. 

No evidence of such a command centre has been produced by the IDF since that assault in mid-November.

The IDF did release footage of what it said were tunnels under the hospital grounds, but a Washington Post investigation has found that evidence provided by the IDF does not support its claims of an extensive military complex. 

In fact, a tunnel system was built by Israel at the hospital while it occupied Gaza during the 1980s. 

“We’ve been working in Shifa for many years and we have never seen any fighters inside Shifa hospital. MSF has never witnessed this kind of thing,” Thomas says. 

“What we can see in the hospitals are patients, are health workers, that’s what we see in the hospitals.”


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