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What is life like in northern Gaza?

‘The most important aspect, I think, that the world has contributed to is taking away from us our dignity.’

Mahmoud and two MAP colleagues take a selfie during their distribution work in around Beit Lahia, northern Gaza. Mahmoud Shalabi/Medical Aid for Palestinians
Mahmoud Shalabi and colleagues from the NGO Medical Aid for Palestinians during an aid distribution around Beit Lahia in northern Gaza.

When the Israeli military issued evacuation orders on 13 October last year, telling 1.1 million Palestinians in the north of the Gaza Strip to head south, Mahmoud Shalabi decided he wasn’t going to leave.

“I would rather die in my home than in a tent,” Shalabi told The New Humanitarian in a recent interview, explaining his decision.

Shalabi, 39, lives in Beit Lahia, just a few kilometres from the Israeli border, with his wife, their three children, and his elderly parents. He is the deputy programme director in Gaza for the UK-based NGO Medical Aid for Palestinians.

Both of his parents were forced to flee their homes in the city of Ashdod during the war and campaign of ethnic cleansing that accompanied the creation of the state of Israel in 1948, referred to by Palestinians as al-Nakba – the catastrophe.

“I know that my mom and dad went through the same experience when they were children,” Shalabi said. “I believed that remaining in my home would be a form of resistance to whatever hidden agenda there is to kick Palestinians out of their land or to force them to immigrate or whatever.”

In addition to the principle, Shalabi’s parents are now elderly. “Even if I wanted to go, my parents are both above 80 years old,” he said. “I'm afraid that if they live in tents, or whatever, I will not be able to provide them with the minimal healthcare that they would need.”

When he made the decision, it was just a week after Hamas – the Palestinian political and militant group that governs Gaza – had launched an unprecedented attack into Israel, taking an estimated 250 hostages and killing around 1,200 people, many of them civilians. The Israeli military was already pounding Gaza with the opening salvos of a historically intense bombing and military campaign that has now gone on for over nine months.

Since then, the Israeli military has created a buffer zone dividing Gaza in two. For much of the past nine months, the north has been almost entirely cut off. Communication blackouts and the absence of electricity have often made it difficult to get information about what is happening. Very little aid has made it to the north, and those who fled at the beginning of the war have been blocked from returning.

We spoke to Shalabi about what life has been like over the past nine months, what conditions are currently like, the spread of malnutrition and disease, the state of the healthcare system, and more.

The conversation has been edited for length and clarity. A version of it will also be published on our podcast feed soon.

Mahmoud is pictured kneeling down and collecting water nearby where he was living in Beit Lahia, in the Jabalia region of Gaza.
Supplied/Medical Aid for Palestinians
Mahmoud Shalabi collecting water near his home in Beit Lahia, northern Gaza.

The New Humanitarian: Can you describe what is happening where you are in Gaza? What are conditions like? What does it look like outside your window? What does it sound like?

Mahmoud Shalabi: The situation is really difficult. Devastation is everywhere. What catches your eye? If you were someone who visited Gaza years ago and came back, you would be shocked by the level of destruction that you will see everywhere, on the streets, in the homes, and in any aspect of life.

And then you will be shocked by the sad reality of the sewage water, the garbage everywhere, the lack of transportation, how people are walking for long distances. You’ll also realise that there is no water on. You will see queues of people waiting for water trucks, for potable water, to bring water for their children, basically, and to be able to drink some water. 

The majority of the people are using like one or two jerry cans, each one is like 20 litres capacity. So you’re talking about 40 litres, maybe, for two days or three days until the car comes again.

In addition, there is no food right now in the north of Gaza. Whatever is available in the market is being provided by humanitarian organisations. And it's basically wheat flour and canned vegetables, like fava beans, chickpeas, and green peas. That's it.

There are no other aspects of life in the north. And every once in a while you hear the airstrikes, you hear the artillery shells, you hear the helicopters hovering near the eastern borders where currently there is an invasion taking place in Shujaiya and the eastern parts of Gaza City. So we hear this. Today, when I was travelling in the field, we saw a huge cloud of dust that was formed, probably, by [Israel] destroying many buildings in the eastern parts of Gaza, because it was really huge, the amount of dust clouds in the sky.

Every once in a while, we have F-16s hovering over our heads, there is an airstrike in X street or Y area or Z neighbourhood, and we could be targeted anytime by those.

The New Humanitarian: How many people are still in Beit Lahia? And what has life been like in the north for the past nine months?

Shalabi: I don’t have the exact number of people living in my town, but it’s almost empty. Maybe half of the population is there, I'm not sure. Statistics are talking about 400,000 to 600,000 people in the area of the north of Gaza and Gaza City still living here.

There are too many empty houses and destroyed houses. Even the people who remained, many of them don’t have anywhere to go. If you go to UNRWA schools, health centres, or gymnasiums, you will find them full of internally displaced people. The majority of them had their houses destroyed and they have nowhere else to go except for these public spaces.

It’s really difficult. There is no water access, there is no infrastructure. There are no electricity poles in the street, no telephone poles, no lights, no electricity since the fourth or fifth day of the war. You are talking about nine months with no electricity.

The food situation is really difficult. Famine and starvation is imminent. And every day you hear about a child who has suffered from severe acute malnutrition and has died. A child was announced today, eight years old, who died from malnutrition.

The sad part is the faces of the people when they are walking: They are exhausted. I am exhausted. Everyone in Gaza is exhausted. The mental toll that we have is extreme, and I'm not sure we will recover from it for ages to come.

The most important aspect, I think, that the world has contributed to is taking away from us our dignity. And us Palestinians, we are dignified people. This is a very important word in our life.

However, the international support for the war, and the way that the aid has been entering Gaza – the flour massacre, if you remember, in March; the air drops falling in some areas and not others, falling in the sea – it's really not a dignifying way to help the people of Gaza.

The New Humanitarian: What is the state of the healthcare system in the north of Gaza? 

Shalabi: Seventy percent of the health system facilities have been out of service, and only 30% are remaining functional. Even with those that are remaining functional, it’s extremely difficult for them to operate.

If you want to buy something to help the health facilities that are still functioning, you have to bring items from Jordan into the north of Gaza directly. This route only opened to organisations last month, and not many organisations managed to get the hang of it. We managed to bring in our first medical shipment on Thursday (4 July). We are happy because I think this will enable us and many other organisations to bring more medical items in.

The human resources [of the health system] are really exhausted. The majority of the people have left to the south of Gaza. The number of subspecialties and the people working inside those subspecialities is becoming even more scarce and more rare, and these people are not getting paid. They don't even get proper food to eat in the hospitals and the primary healthcare clinics where they are working, and the demand is very high.

The influx of injuries and the fatalities that come daily to these health facilities is unprecedented in comparison to other wars and offensives waged against Gaza. There is no equipment. There are no X-ray machines. And the list goes on.

The New Humanitarian: What does the caseload look like? And how does it compare to what a normal caseload would look like?

Shalabi: Normally, just to give you a glimpse, when we are talking about al-Shifa, which was the largest trauma hospital in the Occupied Palestinian Territories, it had a bed capacity of almost – if I recall correctly – like 720 beds, and the bed occupancy rate was almost 100 to 110%. So it was always, continuously occupied by patients.

Imagine now that this hospital is out of service and 70% of the facilities in all of the Gaza Strip are out of service and you want to jam everything in the remaining 30%.

The hospital right now functioning as a subspecialities hospital in Gaza City is called al-Ahli Arab Hospital. It’s very small. It's a hospital that belongs to a local non-governmental organisation. This hospital has a church and has a mini-mosque and a library. All of those have been utilised as spaces for patients to sleep while they are provided with bed care. There are not even beds inside the church and the little mosque and the library. The patients are sleeping on top of the benches of the church, the wooden benches.

I remember a school being targeted in Jabalia refugee camp. I was taking my mother for an issue that she had to Kamal Adwan Hospital. I remember seeing people lying on the ground waiting for someone to take care of them. No one was taking care of them because the load was humongous.

I remember seeing dead bodies in the corridors. It was like, this person is dead, leave him there. We can't do anything right now. There weren't refrigerators working; they couldn't put the dead bodies inside the refrigerator.

I also remember at the Indonesian Hospital during the massacre that happened [last November] in al-Faluja (north of Gaza city). When I went to check on my friend and his family, the number of dead bodies was overwhelming. The injured people were everywhere on the pavement outside of the hospital because there was no space available inside the emergency room.

Some of them, like elderly people, were bleeding from their heads, and [the healthcare workers] couldn't do anything. People just put a blanket on them and left them. That's the only care that they could provide at that stage.

Another person who had their guts outside of their belly – sorry for the graphic images – but their guts were spilled all over their body. You know what they did? At one stage, they said, “Khalas, this person is going to die. Let’s read al-fatiha (the Muslim prayer said before someone dies), and may God bless his soul”. That’s it.

That's what's happening right now. The load has eased off a bit because the military offensives in the north have dropped in rate in comparison to months ago. But still the hospitals are not coping with the huge number of people that get injured and targeted directly by the Israeli forces, specifically right now in the east of Gaza City. 

The New Humanitarian: Can you talk more about the situation when it comes to malnutrition?

Shalabi: Malnutrition is a ghost that is haunting everybody. Whatever amounts of food that are being brought in by organisations now, they are not enough.

Maybe once a month, some families will receive a carton containing 30 to 40 cans of the vegetables I told you about and one bag of wheat flour. How long is this going to be sufficient for? It’s not going to be insufficient, and people will not have anything to eat for the remaining time.

There are also now people eating leaves from trees – things that we have never eaten before, like the leaves of wild berries. We've never eaten these things before, and some people are eating them.

There are vulnerable groups also that are suffering the most. We’re talking about [non-communicable disease] patients, like people with diabetes, people with hypertension, people who have specific dietary requirements like celiac patients. They have nothing. 

You're talking about children, specifically the young ones who need their mothers to breastfeed them.Their mothers have been malnourished, so how are they going to give milk to their children when they don't have anything to eat?

At one time, there was nothing in the market. Not even canned food. There were just some spices and tomato paste and cooking oil. These three items were available in the market.

The New Humanitarian: What about the spread of disease?

Shalabi: When you are talking about diseases, if you don't have a healthy body then your immune system is going to collapse. And there is overcrowding and sewage water and garbage everywhere, specifically in front of internally displaced people centres. I mean, there are piles and piles of trash.

Diseases were spreading like fire. We're talking about scabies. You're talking about hepatitis A. You're talking about lice and diarrhoea for the children, many pulmonary diseases. There weren't even the simplest of medicines, and there are still no medicines available right now. I wanted to buy some medicine for my father, and I couldn’t find it in the majority of the pharmacies that are still open in Gaza.

There are also cancer patients that have not been getting their chemotherapy for nine months now. Some of them have died. One of them was my neighbour. He wasn't able to get referred to outside of Gaza during the war to continue his chemotherapy, and he wasn't getting anything while he was still here, so he died. As simple as that.

That's the sad reality we are living in.

The New Humanitarian: What would it take for the healthcare system in Gaza to get back up and running at anything close to the capacity needed to meet the scale of people's needs? And do you have any hope that that will happen?

Shalabi: Number one, a ceasefire needs to happen immediately. That's one thing. Because we need to be safe when we are conducting our work and when the health workers are conducting their very important work inside the hospitals.

After there's a ceasefire, you need unconditional funding from everywhere, with huge amounts of money, to be able to bounce back to the previous status quo.

But I reckon that, even if there were open faucets of money pouring all over the Gaza Strip – which will never be the case, I imagine – then it's going to take at least five years to recover.

Having worked in this field and knowing that there are always hidden agendas and that funding is going to be conditional, it's going to take more than five years: It's going to take maybe five to 10 years for the health system to bounce back to what it was. Knowing that there will always be occupation looming over our heads and the Gaza Strip, then I'm afraid this is even going to take longer and longer.

So once the occupation ends, then there is hope that we might be able to retrieve our dignity and provide Palestinians with the healthcare that they need. Until then, it's going to be a long journey of suffering.

Edited by Andrew Gully.

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