Gaza and the COVID-19 “Crisis”: Breaking the cycle of structural vulnerability first

Co-authored by Haim Yacobi, Michelle Pace, Ziad Abu Mustafa and Manal Massalha

Part of our Post COVID-19 Urban Futures series.

While writing this blog, 12 people in the Gaza Strip have tested positive for COVID-19. This number may look miniscule when compared to the shocking figures in China, the US, Spain or Italy. However, as we argue here, in light of the rapid spread of this global pandemic on the one hand, and the ongoing violence and destruction caused by Israel on the other, the conditions in Gaza will lead to a human catastrophe. This will not be a natural disaster, but rather a product of decades of Israeli settler colonial policy that has been consciously designed to achieve the dismantling of Gaza.

Our research, supported by the Wellcome Trust, started eight months ago with the aim of examining how violence and health are entangled in conflict. Throughout the last few months we documented and analysed the effect of infrastructure destruction on health in Gaza. During these exceptional times when most of the people in the world are in lockdown, our research becomes more salient for understanding the outcome of what Rob Nixon defines as slow violence. That is, what “occurs gradually and out of sight, a violence of delayed destruction that is dispersed across time and space, an attritional violence that is typically not viewed as violence at all.” Through Nixon’s perspective we argue that the current COVID-19 “crisis” exposes the politics of slow violence as operated by Israel’s settler colonial enterprise and its damaging effects on the lives of Gazans.

We suggest that the health system in Gaza – even before the outbreak of COVID-19 – is evidently not able to cope with the needs of the almost two million people living in the Strip. With the Israeli blockade and its restrictions on the movement of goods and people remaining intact since 2007, the Palestinian divide unresolved, the chronic disruption of electricity and fuel supplies, and recurring hostilities always looming, the conditions on the ground in Gaza have deteriorated to deplorable proportions. In less than six years Gaza experienced three devastating wars which not only inflicted human losses (3,808 dead) and left thousands injured and displaced; but which also targeted key infrastructures, including Gaza’s sole power plant, sewage facilities, hospitals, schools, factories, agricultural farms and local industries.

In Gaza’s case, the Social Determinants of Health as defined by the WHO, that is, the systems that produce and reproduce the health conditions in places where people are born, live and work, must be politicized in a settler colonial context. Some might argue that Gaza is no longer under a settler colonial regime since Israel withdrew from the Strip in 2005. We contest such claims and argue that the withdrawal from Gaza marks not only a continuation but even a radicalisation of settler colonialism in Gaza. More specifically we propose that settler colonialism without (the physical presence of) settlers (inside Gaza) is at the core of the transformation of the Strip into a frontier, where Israel has fewer and weaker moral obligations over Gaza’s population and hence the possibility of manipulating destructive violent practices.

In the face of the situation in Gaza, it is time to acknowledge that the “COVID-19 crisis” in Gaza must be understood within the context of settler colonialism’s ongoing political history, ideology and geography which prioritises territorial and demographic control, and the will of erasure over everyday life and the basic rights of Gazans.

Our argument is well illustrated by the gloomy 2012 UN report that casts doubt over Gaza’s liveability by 2020. Revisiting the same indicators five years later, in 2017 the UN in its report entitled ‘Gaza: Ten Years Later’ reported that “life for the average Palestinian in Gaza is getting more and more wretched.” Most of the projections for 2020 “have in fact deteriorated even further and faster than anticipated”. Provision of hospital beds, doctors and nurses have not only not been met but have actually declined, relative to Gaza’s population growth. The housing shortage increased from 71,000 units in 2012 to 120,000 in 2017. With the outbreak of COVID-19, Gaza has only 56 ventilators and 40 intensive care unit (ICU) beds for a population of two million. By comparison, Germany has 29.2 ICU beds per 100,000; Belgium 22; Italy 12.5; France 11.6, and the UK six and a half: Gaza has two. During the last two years Gaza has also witnessed a dramatic immigration, of around 30,000 people, among them around 80 medical personnel who are desperately needed:

“We have a lack of doctors in Gaza… our doctors are studying abroad or they went to complete their speciality – they did not return to Gaza for the following reasons: the lack of salaries in Gaza, life’s difficult circumstances in Gaza, and the journey hurdles while travelling to Gaza…” (Interview 19 with a Medical Doctor 23/09/2019)

Although we are witnessing the relatively early stages of the outbreak of the pandemic, we are well aware that it disproportionately harms vulnerable individuals and communities including people of colour, the poor, undocumented migrants, refugees and indigenous communities. The WHO recommends that people all over the world self-isolate, wash their hands frequently and keep a safe social distance from others. However, can one take these precautionary measures in one of the most crowded places on earth? Social distancing is a privilege open only to those who live in secure and large enough housing conditions that allow for the practice of this restrictive measure. Social distancing in Gaza assumes some control over density, distances and spatial regulations. Yet the massive destruction of Gaza’s housing, public buildings and infrastructure by Israel’s recurrent attacks means that many Gazans live in dense and overcrowded conditions. Some who are homeless live in temporary shelters without basic services, as one of our interviewees put it:

“Our situation with coronavirus is different from the world… Israelis will not allow the respirators and medicine to come through and they will wait until half of Gazans are going to die before they allow for the medicine to come in as their policy is aiming to get rid of Gazans… I think the corona doesn’t make big difference for us in Gaza, as the corona takes the life and stop all life aspects and we already do not have life in Gaza” (Interview 2/04/2020).

More than half of the Gazan population is unemployed and, with chronic power shortages lasting at least eight hours a day, it is very challenging for Gazans to stay inside their homes:

“The families prioritise purchasing bread and fundamental items not sterilisation materials… our children do not have entertainment places, they are playing with each other outside and not follow the self-isolation procedures… if the corona spread will kill a lot of people as we go out, as our houses is narrow [sic] as you know that I live at refugee camp and can’t bear to be home all the time” (Interview 2/04/2020).

The quality and availability of water for hand washing on a regular basis is poor due to the over-extraction of its coastal aquifer which, being almost the only source of water, leads to sea-water penetration and increased saline contamination. This, along with the infiltration of raw sewage and nitrates from fertilisers, has rendered over 96 per cent of Gaza’s groundwater unfit for human consumption. In less than 15 years, access to safe drinking water through the public water network has plummeted from 98.3 per cent in 2000 to a mere 10.5 per cent in 2014, as a Gazan engineer informed us:

“In the north of Gaza, they attacked the sewage water and we were not able to stop the line and this led to the mix up of the drinking water and the sewage water and I think that future generations will discover the amount of damage to their health” (Interview 25 14/10/2019)

As a result, nine out of ten people rely on desalinated water, 81 per cent of which is provided by the private sector, less than a third of which is licensed. Drinking water is purchased at prices 15-20 times more expensive than piped water, costing Gazans on average 33 per cent of their income, compared to 0.7 per cent in the Western world. Although the quality of desalinated water is better than piped water, desalination does not necessarily remove all pollutants as desalination points do not function at full capacity. A third of cases of illness, and more than twelve per cent of child mortality rates are linked to contaminated water. Poor quality water also means compromised hygiene in hospitals and, as reported by UN OCHA, surgeons at Shifa Hospital are unable to sterilise their hands prior to surgery.

The chronic disruption of the electricity supply has compromised the functionality of sewage treatment plants. On a daily basis between 100,000 CM to 108,000 CM untreated or partially treated sewage, the size of 43 Olympic-size swimming pools, is released into the Mediterranean. It is within this context that a 2018 study by the US-based RAND Corporation warned that if the chronic state of emergency in Gaza’s water and sewage remains unaddressed, an endemic disease outbreak and other public health crises are imminent, with the risk of them spreading to neighbouring Israel and Egypt.

Many of us have the privilege of working from our safe and secure homes during the current lockdown. Most of us still have a secure job because we can convert our work to a virtual platform, knowing that internet access and a reliable power supply can be taken for granted. We can still buy clean water and have sufficient nutritious food supplies at home. If we feel any symptoms, we can safely call a specially designated number and our healthcare systems can take care of us.

There is already strong evidence that isolation, following the COVID-19 outbreak, exposed women and children to domestic violence across China, the UK and the USA as well as in other countries all over the world. Looking through these lenses, the current situation in Gaza is alarming since there already exists a high rate of (a growing) gender-based violence. In 2016 more than 148,000 women were subjected to psychological and physical abuse. Studies show a link between violence against women and the worsening living conditions.

As Dr. Ghada Al Jadba, Chief of the Health Programme in the Gaza Strip, UNRWA, stipulated: “Gaza is like the Japanese cruise ship that became a coronavirus breeding ground”. Such a metaphorical image that isolates Gazans as abnormal and outside of the normal social order echoes Foucault’s discussion of heterotopias of deviation, namely institutions that locate individuals “… whose behaviour is deviant in relation to the required means or norms in place. Cases of this are rest homes and psychiatric hospitals, and of course prisons…”. Indeed, in the last two decades Israel’s control over the Gaza Strip transformed it into an heterotopian space; an isolated territory monitored by Israel and inhabited by a population which is pathologized and demonised.

This heterotopian image links to our main argument that there is an urgent necessity to move from the social determinants of health to the political determinants that led to the current conditions in the Gaza Strip occurring, as well as to the emerging coronavirus “crisis”. It is an outcome of Israeli policies and its settler colonial violence. This move is necessary if we are to nuance how social determinants of health translate into severe and fragile health outcomes in contexts such as those faced by Gazans. Breaking the cycle of structural vulnerability resulting from power relationships and global hierarchies of power is the foundation for helping those who face a greater exposure to risk. It means, practically, stopping the blockade on Gaza and enabling the flow of medical equipment and personnel, food and medicines. It also means restoring coordination between Hamas, the PA and Israel, and immediately establishing a coordination committee of representatives that includes governments, NGOs and community leaders to prioritise emergency budgets, upgrade existing water infrastructures, and to arrange emergency provision of cheap and clean water.