The Fight Against COVID-19 in the Gaza Strip (Updated to May 10, 2020)

Overview

• There are currently twenty active cases of COVID-19 in the Gaza Strip (three more than last week). So far the spread of the disease is under control. The small number of new cases, according to reports from Hamas, were all detected at the Rafah Crossing and not inside the Strip.
• Nevertheless, senior Hamas figures involved with fighting the disease continue expressing concern over an uncontrolled outbreak. In such a scenario, based on global experience, according to the deputy minister of health the number of cases could be expected to reach 8,000 for every million Gazans. Dealing with such an incidence of the disease, according to the director of the WHO’s regional office in Gaza, would be beyond the capabilities of Gaza’s public health system.
• Senior figures in the Hamas administration are trying to enlist sources of local influence (mukhtars and clan elders) to change social behavior. That is because Gazans at large are not obeying health instructions or taking preventive measures. (They hold large Ramadan fast-breaking meals, visit relatives, hold mass prayers outside the mosques, crowd into the markets, do not practice social distancing or wear masks, and hold funerals with many mourners.)
• Sources in the Hamas administration continue blaming the [so-called] Israeli “siege” for the shortage of medical resources, and issued veiled threats of an “explosion” if the public health system in Gaza collapses.^[1]

The Extent of COVID-19 Infection

So far, as of May 9, 2020, twenty cases of COVID-19 have been reported in the Gaza Strip, after three new cases were diagnosed on May 6, 2020. According to reports from the public health system in Gaza, all the cases were diagnosed at the Rafah Crossing and so far no case has been detected inside the Strip. Fourteen patients have recovered. Eleven of them are still quarantined at home, three are in the quarantine center at the Rafah Crossing and six are hospitalized at the Crossing (report from the ministry of health according to Shehab, al-Ra’i, May 9, 2020).

• There are still 445 Gazans in quarantine centers, compared with 1,963 last week. Among them are 149 Gazans who returned from Jordan and entered the Strip through the Erez Crossing (al-Ra’i, Shehab, May 7 and 9, 2020).

Entrance of Gazans from Egypt

• Salameh Maarouf, in charge of the administration’s information bureau, said that on May 12, 2020, the Rafah Crossing would open to allow another group of Gazans, between 1,000 and 1,500 people, to return to the Strip from Egypt. They will be quarantined for 21 days (al-Aqsa, May 9, 2020). The Palestinian legation in Cairo reported they had received information from the Egyptian authorities that the Rafah Crossing would be open between May 12 and May 14, 2020 (Shehab, May 9, 2020). Iyad al-Buzum, spokesman for the ministry of the interior in Gaza, said it would be open only for the return of Palestinians who were stuck on the Egyptian side of the Crossing. He added that the Crossing would be closed to Palestinians leaving the Strip, and that there were no plans to open it at the current time (website of the ministry of the interior in Gaza, May 7, 2020).

   

    
Preventive measures on the Gazan side of the Erez Crossing for the Palestinians returning from Jordan, and their transfer to quarantine centers (Twitter account of the ministry of the interior in the Gaza Strip, May 5, 2020).

Fear of a COVID-19 Outbreak

Enlisting mukhtars and clan elders to fight the disease

• Despite the small number of COVID-19 patients in Gaza and the lack of infection inside the Strip, figures in the Hamas administration continue expressing their fear of an outbreak of the disease. Their concern in accompanied by the fact that in many instances Gazans do not comply with preventive measures (see below). Senior administrative figures participating in the fight against the disease repeatedly warn the public not to become complacent, and call for instructions to be obeyed. Yusuf Abu al-Rish, deputy minister of health, Muhammad Awad, chairman of the Hamas administrative monitoring committee, and Tawfiq Abu Na’im, deputy minister of the interior, held a meeting with mukhtars and clan elders. They called on them to use their influence to make people change their social behavior in view of the danger of the spread of the virus (Shehab, al-Ra’i, May 3, 2020).

    
The meeting of senior figures in the Hamas administration with mukhtars and clan leaders to fight coronavirus (al-Ra’i, May 3, 2020).

• The main points made by the senior Hamas figures at the meeting were the following:
  • Yusuf Abu al-Rish, deputy minister of health, said that alongside the optimistic scenarios (a continuing small number of infections, no spread of the disease inside Gaza), there was also a scenario in which the disease did spread inside the Strip. In that case, he said, the number of cases could reach eight per one thousand residents, that is, 8,000 per million. He said the numbers were not meant to be frightening, but were the result of information accumulated in other countries around the globe.
  • Yusuf Abu al-Rish added that the ministry of health had succeeded, to a certain extent, in keeping the pandemic from infecting the population at large and that so far no case had been detected inside the Strip. However, he said, that should not lead to complacency or to the detriment of further preventive measures. He said that the outcome of the fight against the disease would be determined by the strictness of the preventive measures taken, on the one hand, and general commitment to follow them, on the other. He warned that if Gazans did not act properly, losses would be great and the results would be very serious.
  • Muhammad Awad, chairman of the Hamas administrative monitoring committee, said that lifting the limitations and preventive measures would necessitate having residents change their social behavior, that is, they would have to practice social distancing, wear face masks and implement the preventive measures. He stressed that changing social behavior would determine the rate of lifting of the preventive measures.
• Tawfiq Abu Na’im, deputy minister of the interior, said the degree to which residents implemented the preventive measures was the key. He said the fact that there were no COVID-19 patients inside the Strip did not mean Gazans could be complacent or ignore the preventive measures. He added that the administration was aware of the great danger of the virus, given the crowding inside the Strip. He said the detection of one COVID-19 patient inside Gaza would mean a rapid spread of the disease (Shehab, al-Ra’i, May 3, 2020).

Warning from the director of the WHO regional office in Gaza

• Dr. Abd al-Nasser Sabah, director of the WHO regional office in Gaza, said it would be impossible to prevent the spread of the coronavirus in the Gaza Strip. He said the WHO was deeply worried by the way some of the residents of Gaza disregarded the preventive measures, especially in places where they congregated. He said there was no justification for such behavior, which would quickly lead to the extensive spread of the virus throughout the Strip. He stressed that dealing with such a situation would be beyond the capabilities of Gaza’s ministry of health (al-Ra’i, May 6, 2020).

Gazans disregard preventive measures

• According to reports from Gaza, despite warnings to the public, many families eat their Ramadan fast-breaking meals on the beach, apparently in the same numbers as in previous years (al-Araby al-Jadeed, May 5, 2020). According to another report, many persist in social customs such as kissing, visiting relatives and eating together [during Ramadan]. Closing the mosques (a measure still in force) has not prevented Gazans from holding mass public prayers on the roofs of their houses and in side streets (al-Majala, May 2, 2020).

   
Right: Families eat their Ramadan fast-breaking meals on the beach (al-Araby al-Jadeed, May 5, 2020). Left: A group of vendors hold a public prayer on the sidewalk in a market (al-Majala, May 2, 2020).

•  Social distancing was ignored during the funeral of senior Hamas figure Ahmed al-Kader, who was a member of Hamas’ political bureau (May 10, 2020). Senior Hamas figures in the Gaza Strip participated, among them Yahya al-Sinwar. As shown by the pictures below, the funeral service was massively attended, social distancing was ignored and there were very few people wearing face masks.

   
The funeral held for Ahmed al-Kader
(Palinfo Twitter account, May 10, 2020).

Public Health Preventive Measures and Outlook for the Future

Procedures for dealing with Gazans returning from Egypt

• Dr. Abd al-Salam Sabah, head of the hospital department in the ministry of health in Gaza, elaborated on the procedures regulating the reception of Gazans returning to the Strip through the crossings (Facebook page of the ministry of health in the Gaza Strip, May 5, 2020):
  • The Rafah Crossing: Entering Gazans suspected of having the virus are quarantined in isolation rooms at the Crossing, where tests are conducted. If the test results are negative, the person continues to quarantine with the group he arrived with. If the test results are positive, he is transferred to the field hospital at the Rafah Crossing.
  • The Beit Hanoun Crossing (the Gazan side of the Erez Crossing): Entering Gazans suspected of having the virus are quarantined in the Beit Hanoun hospital. Tests are conducted, and if the results are positive the individual is transferred to the hospital at the Rafah Crossing.
  • Quarantine centers: Gazans suspected of having the virus are transferred to quarantine centers (schools, hotels and medical centers). Tests are conducted, and if the results are positive, the individual continues quarantine under medical supervision. If his condition becomes serious or critical he is transferred to the hospital at the Rafah Crossing. In the meantime, all those who entered the Strip with him are quarantined for 14 additional days.
  • Hospitals: COVID-19 patients are hospitalized in quarantine rooms under the supervision of male nurses who monitor their condition and prevent them from coming into contact with anyone else. They are transferred to the hospital at the Rafah Crossing in coordination with the relevant agencies.
• The center for the treatment of COVID-19 patients is located at the Rafah Crossing, and if its beds become filled another hospital will open for epidemiology (the European Gaza Hospital in Khan Yunis, along with the nearby school). Critical cases will be treated in hospitals and patients with mild conditions will be sent to schools made ready for use as quarantine centers. If the disease spreads and thousands of cases are diagnosed, all the hospitals in the Gaza Strip will open designated wards and an ICU will be prepared for critical cases. Mild cases will remain at home. In such a scenario it will be possible to declare the Gaza Strip a disaster area (Facebook page of the ministry of health in the Gaza Strip, May 5, 2020).

Training medical, administrative and support teams

• The general department for developing human resources of the ministry of health in Gaza, in collaboration with the French organization Médecins du monde, developed a program to train 250 medical personnel for treating COVID-19 (doctors, male nurses, radiologists, paramedics), as well as administrators and service and support personnel. A senior figure said that participants in the program will be trained at five centers for receiving patients. The six-week program will include both theory and practice (al-Ra’i, May 7, 2020).

Foreign Aid for the Gaza Strip

• Figures in the Hamas administration continue declaring that there is a severe shortage of medical resources, which will make it difficult to treat patients if the disease spreads. According to Dr. Ashraf al-Qidra, spokesman for the ministry of health in Gaza, the ministry suffers from a serious shortage following the depletion of 44% of its drugs, 29% of its disposable medical equipment and 56% of its laboratory equipment and blood banks. He reiterated his complaint that from the beginning of the year the ministry of health in the Palestinian Authority sent drugs and medical equipment worth $2.25 million, as part of its routine shipments. That, he claimed, was only about 5% of the Gaza Strip’s annual need for drugs, disposable medical equipment and laboratory equipment. He said the ministry of health in Gaza had not received some of the medical aid that arrived in Ramallah from donor states and institutions for dealing with the COVID-19 pandemic.
• Ashraf al-Qidra said that according to the program of the Gaza ministry of health to cope with the virus, it needed $59 million. He said that so far aid worth only $1.7 million had arrived from various institutions. He called on UN and other agencies to take responsibility for lifting the [so-called Israeli] “siege” of the Gaza Strip and to be quick to rescue its public health situation. That could be done by responding to its urgent need for drugs, disposable medical equipment, sufficient materials for laboratory testing, ICU beds and ventilators (al-Ra’i, May 4 and 7, 2020).
• Suhair Zaqout, spokesman for the International Red Cross in Gaza, said that in response to request of the authorities in Gaza the Red Cross had supplied aid to the quarantine centers. She said it was sufficient for 1,500 people and included 1,500 blankets, 1,000 mattresses, and 300 personal hygiene kits. She added that the organization also provided aid to the Palestinian Red Crescent, which is responsible for ambulance services in Gaza. The shipment contained PPE for Red Crescent workers, including 20,000 masks, gloves and shoe protectors, drugs and other equipment (al-Andalou News, May 7, 2020).
• Salameh Maarouf, in charge of the Hamas administration’s information bureau, said the Gaza Strip had not yet received the expected funds from the Turkish donation. He added that they had reduced some of the expenditures of several ministries and the funds were transferred to the account of the ministry of health. He said the central hospital for treating COVID-19 patients (the European Gaza Hospital in Khan Yunis) needed $17 million to prepare it for the simultaneous reception of 2,000 COVID-19 patients (al-Aqsa, May 9, 2020).

Blaming Israel and Making Veiled Threats

• Tawfiq Abu Na’im, deputy minister of the interior, speaking at the graduation ceremony of al-Ribat University, said the COVID-19 pandemic added an additional siege to the [so-called Israeli] “siege.” He warned of the collapse of services in Gaza as a result of the “siege” and threatened that the influence of the collapse of the public health system would not stop at the border. He warned that the Gaza Strip would become a force with a mighty explosion no one could assess. He threatened that if the Gaza Strip were left alone to deal with the pandemic and the “siege,” and aid was prevented from reaching it, it would have extreme results in the near future (website of the ministry of the interior in Gaza, May 7, 2020).

^[1] For further information, see the April 23, 2020 bulletin, "What is the real reason for the weakness of the public health system in the Gaza Strip?" ↑

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