When people began posting the following note on their Facebook wall, I immediately felt an intense sense of unease.
Although those who circulated the message wanted to elicit empathy toward close to 2 million imprisoned Palestinians, the attempt to compare the lockdown many Westerners are currently experiencing with the 13-year siege on the Gaza Strip is farcical. Indeed, now that the coronavirus has managed to cross the military checkpoints into that coastal enclave, with two people testing positive, the fallacy of this comparison is likely to become tragically apparent. The intensity of their suffering will not be due to natural causes, but because the military siege has put the people of Gaza at an immense disadvantage in all three categories that are considered vital for combating the virus’s dissemination: health services, social determinants of health, and physical distancing.
For the past few weeks we have been inundated with information about the preparedness of health care systems and how they affect mortality rates. Giving South Korea as an example, experts suggest that testing for Covid-19 is essential for saving lives, comparing that country favorably with Italy and Spain. Yet in Gaza, there are currently very few test kits (about 200), and, according to Ghada Majadli of Physicians for Human Rights, Israel, as of March 23, only 99 people have been tested.
We also know that people are dying in many countries because hospitals are overwhelmed, unable to cope with the mass influx of new patients in need of ventilators. Doctors are warning that with 52 and 40 ventilators per 100,000 people in the United States and Israel, respectively, stocks are simply insufficient. In the Gaza Strip, by contrast, there are three ventilators per 100,000 people. This will undoubtedly become a death sentence for many.
More generally, Gaza has around 30 hospitals and major clinics, providing an average of 1.3 beds for every 1,000 people, while Israel has more than double this, with an average of 3.3 beds per 1,000, while the European Union averages 5.4 per 1,000. The contrast with Israel, which directly occupied the Gaza Strip for 40 years and continues to control its borders, is not only striking but also a manifestation of what Harvard University Professor Sara Roy has called de-development: the intentional weakening of the economic and social capacities of Gaza’s population.
Social Detriments of Health
But a narrow analysis of a county’s medical capacity to cope with the virus provides a very skewed perspective. Indeed, one of the first things I emphasize in my course “Human Rights and Public Health,” which I teach at the Global Health Program at Queen Mary University of London, is that the conditions people are born into, and grow up, live, and work in, are no less significant than the quality of the health care system they have access to.
For example, in order to explain the gap between Gaza’s infant mortality rate of 19.6 deaths for every 1,000 births with Israel’s rate of 2.6 deaths for every 1,000 births, or to understand why Israelis live on average 10 years more than their counterparts in the Gaza Strip, we need to look at the kind of health services accessible to each population as well as the factors that serve as social determinants of health.
The fact that a staggering 53 percent of the population—around 1.01 million people, including over 400,000 children—earn less than the international poverty line of $4.60 a day helps explain why lives in Gaza are shorter. The rising poverty, aligned with widespread food insecurity, means that most residents cannot meet their daily caloric requirements, even as over 90 percent of the water in Gaza has been deemed unfit for human consumption.
So while our governments emphasize the significance of washing hands many times a day, Gazans are worried about having enough water to drink. The fact that most Palestinians are living literally from hand to mouth suggests that the coronavirus’s impact in Gaza will be exponentially harsher than in many other countries.
Nowhere to Quarantine
The history of plagues suggests that quarantine is one of the most efficient ways to contain the spread of a disease. But how can the 113,990 refugees living in Jabalia camp, which covers an area of only 0.54 square miles, maintain physical distance from one another?
In Beach camp, the density is even worse, with 85,628 refugees residing in an area of 0.2 square miles. Beach camp has only one health center—which serves as the first point of call for the sick—and only one food distribution center servicing the entire population. In other words, within Gaza’s eight refugee camps, the systems organized to save lives—health care and food supply—will undoubtedly become lethal bottlenecks, petri dishes for the deadly virus.
The Hamas government is well aware of the looming dangers, but its options are severely limited. It has begun converting schools into quarantine quarters, with eight people per classroom and about 200 men and women sharing a bathroom. It’s like confining a group of prisoners within an isolated cell in the hope that they will not spread the disease.
All experts know that prisons are breeding grounds for the virus. In the wake of the outbreak, Iran immediately released 70,000 prisoners, while other countries are following suit. The problem for Gaza, of course, is that Gaza itself is a prison, and, after years of siege, it is an extremely dilapidated one at that.
The Palestinians of Gaza have no room to practice the social distancing recommended by public health experts, and their health care system, which for decades has been starved of resources, will be unable to cope. It is also very unlikely that other countries will reach out to help, given their own virus crisis and the unfolding global economic meltdown.
How many Palestinians will end up dying is unclear, but it is obvious that the lockdown we are experiencing, and the one the population in Gaza has experienced for years, are completely different. For us, the lockdown is a mechanism deployed to save lives. In Gaza, the corona lockdown will simply kill.
This article first appeared in The Nation.