It was only a matter of time. Everyone knew that COVID-19 is going to reach Gaza, but when and how was the question. The local authorities did their best in order to maintain the Gaza Strip as a COVID-19 free area. That worked well for almost six months.
The realities of blockade, movement restrictions and above all the occupation, already kept Gaza disconnected from the world. Additional movement restrictions on the borders were made in mid-March. This time by the local authority and aiming at controlling people who enter Gaza and upon arrival sent them to quarantine centers. Returnees stayed in isolation for two to three weeks until they tested negative for COVID-19. Those that tested positive stayed in quarantine until they recovered from symptoms and tested negative.
That was the only and best solution given the realities of Gaza.
Our underdeveloped health system is paralyzed by the division between the Palestinian governments in the West Bank and Gaza and the lack of medical staffing. There is continued pressure on the system from airstrikes and casualties and injuries at the Great March of Return over the last two years.
The reality is that 2 million people live in a small geographical area of 141 square miles where two-thirds of the population are refugees; the reality is that the poverty rate is 53% and the unemployment rate is 54%; the reality is that more than 95% of the water in Gaza is not potable and electricity is available for five hours per day in its best circumstances.
There were other safety measures made by the authorities in order to stop possible spread of the virus employed over the past few months. These were similar to measures taken by other governments including social distancing, stopping the education system, closing open markets, forbidding large gatherings. Restrictions were place on funerals and mourning houses, weddings, and mosques and churches. Wherever it was possible, sanitizing measures were applied.
Some of those measures caused a sharp increase in poverty and unemployment. Mostly those already working hand to mouth disproportionally impacted. To mitigate, the ministry of social development added 10,000 families to its beneficiaries. Yet in Gaza, economics pressures are compounded by historical pressures from trauma and loss. There were three wars during the last12 years and over 200 casualties from the Great March of Return during the last two years. The continuous blockade, started in 2007, has had intense psychological and social repercussions on the population.
In April the organization I head, the Gaza Community Mental Health Programme, or GCMHP, issued a factsheet in cooperation with the Palestinian nonprofit umbrella organization PNGO describing the mental health conditions in Gaza Strip in the shadow of COVID-19. The document highlighted the need to pay special attention to vulnerable groups including children, older people, patients with serious illnesses (cancer and injuries from the GMR) and above all people with economic hardship. The main psychological implications were anxiety, the fear of infection, isolation, and worries about addressing the needs of children. People in quarantine centers and their families were mostly affected. The factsheet also highlighted an increase in domestic violence against women and children.
The conditions in the strip guided GCMHP to modify its plan for 2020. In agreement with the core donors, GCMHP started a crisis response plan covering the period of April to September 2020. The plan includes scaling up activities related to awareness over the restrictions on public gatherings and workshops. Our toll-free telephone counseling service was also expanded to work 12 hours a day, seven days a week. Activities planned inside of schools and kindergartens were postponed and replaced with awareness campaigns using social media and other media platforms that targeted parents. Therapeutic interventions were modified in order to ensure social distancing, avoid crowded clinics and ensure continuity of therapy. Our capacity building activities were moved online or (if not possible) rescheduled.
Monday August 24, 2020 dramatic news to the population in the Gaza Strip. Earlier that day, Makassed Hospital in Jerusalem informed the health officials that a woman from Gaza who was present at the hospital tested positive for COVID-19. The woman was there as a companion of her sick daughter who had received a permit to exit Gaza on humanitarian grounds. They arrived in Jerusalem six days prior. The ministry of health in Gaza reached the woman’s family who lives in the Maghazi refugee camp in the middle of the Strip and tested her family members. Four among them tested positive, of whom one owns a supermarket. Another relative works in a school.
Just before leaving Gaza, the woman who tested positive in Jerusalem had attended a wedding. Larges celebrations had been banned, but a few weeks earlier the local authorities took several measures easing restrictions. This was based on the fact that Gaza was considered COVID free. Mosques were reopened. Gatherings were permissible and the students went back to schools in the first week of August.
The news was a big shock to everyone. Next, an arbitrary sample group from Shifa hospital, the biggest hospital in Gaza, was made to test some patients for COVID-19. Two tested positive. They are not related at all to the family from Maghazi camp. As of now, the afternoon of Thursday the September 3, five people have passed away in Gaza due to COVID-19 and 581 have tested positive. Overwhelmingly most of the new cases are from the community and not from the quarantine centers.
The ministry of health now says that it’s most likely COVID-19 was already in the community as of early August.
In response, an immediate lockdown was imposed on Gaza Strip by the local authority. The lockdown was initially for 48 hours, then it was extended for another 72 hours. People could move around by walking and only in their districts. Many were not prepared for the restrictions. Bakeries and some grocery shops remained open. The authorities said that there would not be a problem with the availability of food. But let us not forget the people’s living conditions. Poverty, problems with water, electricity and even access to healthcare are rampant. The latest developments were surprising to the overcrowded community who are still in shock. People are following the news minute to minute. More fear and anxiety and more worries about how to survive.
Tuesday morning during the lockdown, we contacted the ministry of health asking if we could open our three community centers. The request was not accepted. The ministry closed all primary health care services, postponed all surgical operations and is open only for emergency procedures. They are working to identify foci of COVID-19 in the community and control further spread.
However, we kept operating our toll-free line and intensified our media campaigns. Among those who call into the hotline are our patients, many asking how and when they can pick their prescriptions. Now our plan is to run three mobile clinics to reach our patients and distribute medications, and connect them with their therapists through mobile phones.
One could imagine that these are enough troubles for people in Gaza. Unfortunately, other stressful developments took place during the last couple of weeks. Launches of balloons with incendiary devices attached to them into Israel resumed. Palestinians in the Gaza Strip live in despair and demand an end of the blockade. Balloons, of recent, are used as a means to add pressure on Israel to ease the siege. However, Israel responded with airstrikes, usually during the night, which terrified the population. Israel also stopped fuel from entering Gaza. For the last two weeks or so, we have electricity for around four hours a day as the only power plant shut down from lack of fuel. If there were an escalation in the Gaza strip in the coming few days or weeks, it would bring trauma and losses to people who live in frustration and despair.
A version of this post was originally published by the Gaza Community Mental Health Programme and is reprinted here with permission.