A Year Since The Assault On Gaza ("Pillar of Defence")

8/13/2019 A Year Since The Assault On Gaza ("Pillar of Defence")

1/13

() A year since the assault on Gaza (Pillar of Defense))""(

Physicians for Human Rights

Israel

Activest

ills.org

|


2/13


Israel

Operation Pillar of Cloud was a military operation conducted by the Israeli army

in the Gaza strip.The operation started on November 14th and lasted through

November 21st. Over the eight days of the attack, thousands of individual attacks

were made against targets in the Gaza Strip, and simultaneously, thousands of

rockets were shot toward towns in Israel. The operation ended a week later with a

ceasere declaration.The attack cost lives and caused a great deal of damage to property and civilian

infrastructure. A Btselem investigation (in May 2013) shows that in the course

of the operation, 167 Palestinians were killed by the Israeli army. Six residents of

Israel were killed as a result of the shooting from the Gaza Strip. The numerical gap

between the casualties could indeed indicate the vulnerability of each side, as well

as the extent of force exercised. Important though this discussion is, however,

the depressing, segregated, and discriminatory reality that continues to exist

for each of the populations, on both sides, is a subject which must not be viewed

separately from an analysis of the causes and the results of that military offensive.Among these causes, it is impossible to refrain from naming rst and foremost

the occupation that Israel has exercised over the Gaza Strip since 1967, and which

has not come to an end with the disengagement in 2005, along with the policy of

disempowerment and discrimination by successive Israeli governments, over the

generations, toward the southern periphery towns.

As Operation Pillar of Cloud proceeded, Physicians for Human Rights monitored the

casualties both in Gaza and in the south of Israel, and tried to offer assistance for as

much as possible to each of the populations, while speaking out against the assault

on Gaza and against the perception that warfare would lead to any kind of solution.

Time and again, members of the Occupied Territories Team found themselves

trying to provide assistance to Gaza civilians whose homes had been bombarded and

whose relatives had been killed or wounded, and medical teams helplessly faced the

fact that the bombardments had made it impossible for them to provide medical

assistance and to save lives.

Is this what it will be like in the next military operation again?

As always, Physicians for Human Rights issued a warning about the violation of

International Law, which requires protection of civilian populations in the course

of armed conict. But as an organization that ghts for human rights in generaland the right to health in particular from an understanding that the right to health,

Opening Comments


3/13

which is the foundation for the exercise of other human rights from which it is

derived, we see the very existence of combat situations, occupation, militarycontrol of civilians and their disempowerment as situations that do not permit a true

protection of the right to health or an adequate implementation thereof.

We want to prevent the next attack in which, as in the previous ones, those

who pay the price will be civilians; innocent women, children, and elderly

persons.

Preventing the continued warlike relationship with Gaza will not be accomplished

by repeated bombardments every few years. This warlike relationship will onlyend when the oppressor and oppressed relationship is brought to an end. Israel

must stop its comprehensive control over the Gaza Strip, which limits the lives of

Palestinians, as individuals and as a society.


4/13


Israel

As far as we are concerned, the formula is simple: Ending the military control over

the Gaza Strip and ending the discrimination against the populations controlled by

Israel, in Gaza as well as in the south of the country itself, would bring about the

creation of political conditions that would make it possible for both communities

to be independent and take an independent, true and equal role in determining thepolitical actions that affect their lives and their futures. In contrast, the continued

control over the Gaza Strip and the continued discrimination against the residents

of the south makes possible the control of these people, a control which serves the

interests of those who believe that it is possible and right to trample the rights of

one group in order to guarantee the rights of another group.

The policy of oppression does not end at the border with the Palestinians; it exists

in full force inside Israel too. However, as long as there is no determined demand

to stop the ongoing occupation in the Gaza Strip in particular and in the Occupied

Palestinian Territories in general, it will not be possible to produce a more just andequitable situation for the citizens of Israel.

Israeli Occupation of Gaza, IsraeliDiscrimination in the Periphery


5/13

Conditions in Gaza:

About 1.6 million people live in Gaza, and the population density is 4583 people per

square kilometer. Gaza is considered to have one of the highest population densities

in the world. 38% of the residents of Gaza live in poverty, 34.5% are unemployed,

and the daily water consumption per person in Gaza is in the range of 80-90

liters, where the standard average by the World Health Organization comes to 100

liters per person per day (Data from the Ocha report for December 2011 and the

Palestinian Central Bureau Of Statistics.) In Israel, daily water consumption per

person stands at 200 liters.

Israels control over Gaza:

On August 15th, 2005, Israel withdrew its civilian and military presence from the

Gaza Strip in what is sometimes referred to as Disengagement, and pulled back

its military forces. At the same time, Israel retained full military control over the

airways and sea, and over the land-based border crossings into Gaza. Since the fallof the Mubarak regime in Egypt in 2011, movement through the Rafah Crossing has

been frequently disrupted as well, and in recent months, the crossing has often

closed down entirely, thereby preventing patients, students, merchants, and other

people to leave and cross into Egypt and/or travel through Egypt to a third country.

The siege conditions that Israel imposes on Gaza have a far-reaching effect on

the ability of authorities there to conduct themselves independently and develop

appropriate institutions of economics, society, and education, in light of the great

dependence on Israel.

In 2011, 1 out of 10 patients from the Gaza Strip could not use the referral they

received from the Palestinian Authority to obtain appropriate medical treatment,

because their application for a departure permit was refused or detained by Israel.

In 2012, 1 out of 13 patients in the Gaza Strip could not use their medical referral, for

the same reasons.

According to data for 2010 from the Palestinian Ministry of Health, there is a

shortage of doctors in general and of specialists in particular. The Gaza strip has

0.37 specialists for every 1000 people. By way of comparison, in Israel there are 2.2

specialist doctors for every 1000 people.

The World Health Organization has considered the health situation in the Gaza Strip


6/13

in a special report, including on the conditions of morbidity in two primary areas:

oncology and cardiology, and the availability of treatment for them in the GazaHospitals (a review that considers conditions in 2010).

Among other data on cardiology in Gaza, it was found that there is a great shortage

of specialist physicians in the eld, as well as a lack of equipment.

Cardiology surgery is performed only in Al-Shifa Hospital. There are facilities for

only about one third of current requirements, which are estimated at approximately

1,000 cardiac surgeries per year.

There is one catheterization unit at the European Hospital in Khan Younes,which was established in 2006. The catheterization unit has a capacity for 220

catheterizations per month, which is less than the current requirement which is

estimated at 3,000 diagnostic and 300 therapeutic catheterizations per year.

Among the data for the eld of oncology in Gaza, it was found that:

Only two hospitals in the Gaza Strip treat cancer in adults: Al-Shifa hospital, and

the European Hospital in Khan Younes. Pediatric oncology patients are treated at

the Al-Nasser Childrens Hospital. These hospitals have serious problems relating to

equipment availability and functionality.

There are no trained specialist surgeons for several types of cancer, such as

esophageal, pancreatic, and lung cancer. Doctors have no possibility of obtaining

specialization in these elds due to the limitations on travel imposed by the State of

Israel on physicians who wish to leave the Gaza Strip for training.

Conditions in the Towns of the Southern Periphery:

As we see it, the safety of the residents of the south will not be guaranteed either

by repeated bombardment of the residents of Gaza, who are located only a few

kilometers from them. The safety of the residents of the south will come as a

result of strengthening the economic and social infrastructure, which will provide an

appropriate response to needs in the area, especially in light of the fact that most

of the municipal authorities in the south have a lower socioeconomic standing than

most of the municipal authorities in the center of the country.


7/13

Health Gaps:

Per 1,000 people, 2006-2008

Profession

Total

Physicians

Dentists

Other medical professionals

Nurses - RN & PN

Para-medical professions

14.9

3.3

0.8

2.7

5.1

3.0

14.8

2.6

0.6

2.8

5.6

3.1

10.1

1.6

0.9

2.1

3.8

1.7

17.5

3.8

0.7

2.6

6.7

3.7

16.3

3.8

0.7

3.1

5.5

3.1

21.1

5.5

1.3

3.4

6.3

4.7

10.4

2.1

0.5

1.9

3.7

2.1

SouthTel-AvivCenterHaifaNorthJerusalemTotal

The total includes the West Bank and employees whose workplace is unknown.( ) sample error above 25%.


8/13

Number of nurses employed, in a comparison of districts

(average for 2008-2010):

District South Tel-Aviv Center Haifa North Jerusalem National

1,9332,2391,4832,5802,0122,5031,384

7

6

5

4

3

2

1

0

As of 2011, the south needs: 134 nurses and 133.8 FTE positions for Well Baby clinics

in the Negev. Current conditions: 126.6 FTE positions, 90.2 nurses, actual presence

of 85.6 nurses. In other words, 41-48 nurses are lacking.

Health Gaps:

General hospitalization bed per 1,000 people, 2009 (from: Hospitalizing

Institutions in Israel, 2009. Israeli Ministry of Health. Published: January 2011)


9/13


Israel

During the attack on Gaza, the vulnerability of medical emergency teams came to

the fore in full force. Despite the gaps in vulnerability, it is impossible to function

under bombardment conditions, and this is all the more correct when the reality is

already one of political disempowerment.

The Occupied Territories Team and the Israeli Residents Team maintained constant

communication with residents and medical teams, in Gaza as well as in the southern

Israeli towns, and have managed to document a reality that did not penetrate public

awareness.

Testimony of a Red Crescent emergency services physician in Gaza:Whilethere is no direct bombardment or direct hit on the emergency services or centers,the great proximity to bombardments, especially those in the open spaces in thesouth of the Jabaliyah Emergency Center, cause great damage. Heavy and sharppieces of metal shrapnel, sometimes weighing as much as 5 kg, have hit the center.We get no advance warning or request to evacuate before the bombardment.

Red Crescent rescue teams and emergency medical centers and their clinics have

absorbed a great deal of damage due to the ongoing bombardments, most of it

being of light to medium severity, especially in the Tel Al-Hawa area, the Al-Qudshospital, and in other places. Windows were broken, some roofs and internal ceilings

Medical Teams Under Attack A Special Perspective


10/13

collapsed or were partially damaged due to the blast waves (not as the result of a

direct hit). The Jabaliyah emergency and rescue building was also damaged, includingclinical rooms and the emergency communication center and its ofces. All the

windows broke, and the building was damaged on the outside [...]. Many patients

feel threatened and are concerned about being hurt at the very place where they

should be cared for and feel safe. Damage to infrastructure such as roads causes

difculties and delays in reaching wounded persons. Sometimes, due to road

blockages caused by bomb craters or debris from destroyed buildings on the streets,

ambulances cannot get through. That means that paramedics must reach the site

on foot, and carry out wounded people, which increases the risk to their lives, and

of course, the time it takes them to reach the wounded, when every minute maymean the difference between life and death. One of the greatest dangers is when

a location is bombed successively for a second time, after rescue personnel arrived

on site to take care of the wounded from the rst bombing. There have been cases

where the same spot was bombed twice within an interval of a few minutes to one

hour, which endangers the rescue teams. There was a case where two paramedics

were lightly wounded while trying to evacuate wounded citizens, and another bomb

was dropped onto the same building shortly after evacuations had started. They

were wounded by shrapnel and by the blast.

The testimony of an emergency unit doctor of Al-Shifa hospital in Gaza:

Due to the deterioration over the last few days, we were ready for an attack, but

if things keep going as they are, well run out of basic equipment - gloves, sheets,

pads, and so forth. Since yesterday, some 60 to 65 wounded people have come toShifa, in addition to ve people who died and were transferred here. Most of them


11/13

were in light to medium condition, but some were badly wounded. One of the cases

is a boy of nine months old, who just came in recently in a very serious condition.Another is a 17 year old youth with a serious head wound.

A physician at one of the surgical wards of the Soroka Hospital in Beersheba:

Our ward is reinforced and protected, but we get transfer patients from another

ward that is not reinforced, and theres a mess. Ive been writing discharge letters

for patients since this morning, because the instructions are that we only keep the

people who absolutely have to be in the hospital. Our surgical program for the non-

reinforced operating theater was canceled. We also were instructed by the ICU not

to put any load on them and not to perform any surgery where patients might needintensive care afterwards.

There were many warning sirens all morning and all night. I heard the rockets

ying over my house. There is fear in the hospital. People feel relatively safe in the

hospital, but the problem is getting from home to the hospital and back. In principle,

were working as usual, but most of the patients didnt come to the clinics today.

A Soroka hospital physician, resident of the south, who volunteers with

Physicians for Human Rights: The atmosphere in the hospital is unpleasant: they

have canceled surgeries and moved wards around, because some of the wards are

not reinforced. They have also canceled studies, and every few minutes you have to

go into the protected spaces, which may or may not actually protected, and it is an

unpleasant feeling. I have three children, aged 3, 11, and 15. Its very hard to explain

whats going on here. The anxiety is not something you can control, and its very

hard with these things.


12/13


Israel

International law grants civilians a broad spectrum of protections in wartime, and the

violation of these protections requires a material, impartial investigation. Protection

of civilians and wounded persons in wartime, the obligation to allow them access to

medical care, and the prohibition on causing damage to medical facilities - these

are all fundamental principles of humanitarian international law. Causing damage tohospitals or drop bombs in their vicinity endangers the lives of medical teams and

of hospitalized patients, they are violations of the rules of medical neutrality, and

ignore the special protection granted to these teams by force of their position and

their vital role.

Documentation of damage caused to medical centers and to the work of the

medical teams:

The Khan Younes hospital was damaged as a result of bombing raids close to it;

shrapnel ew into the hospital; the damage hampers hospital function and makes it

impossible to treat patients fully;

A United Nations Relief and Works Agency center in Jabaliyah was damaged in an

aerial strike;

The Al-Quds hospital in Gaza City was damaged by blast waves and shrapnel due

to bombardments;

In the northern part of the strip, a Tawam neighborhood clinic was damaged byblast waves and shrapnel; two ambulances that were parked near the clinic were

damaged;

The Tel Al-Hawa Red Crescent Emergency Center in the northern part of the

strip was damaged;

Three ambulances belonging to the Ministry of Healths Rescue and Emergency

Center, in the center of Gaza City, near the Falastin stadium, were damaged;

Protecting medical teams during warfare -International Law:


13/13

A Medical Relief clinic in the Khan Younes Abu Taima village was damaged;

electricity and water in various parts of Khan Younes were disconnected, and thesame thing happened at the clinic. As a result of the damage to the communication

networks, there was no access to the Internet or to landline telephony;

in addition to damaging medical facilities, the activity of medical teams was

hampered due to infrastructural damage which delayed access to wounded persons;

the same happened as a result of roads being blocked due to bomb craters in the

road or debris from destroyed buildings, which made it impossible for ambulances

to get through, wherefore rescue forces were required to reach the wounded

people on foot, and carry them out, increasing the risks to their lives and extending

the time it took to reach and evacuate them. Moreover, road destruction made itimpossible for many Gaza Strip residents to travel, and to have access vital products

to such as food and medications.

On 11 April 2013, the Israeli Chief Military Prosecutor issued a communiqu

stating that there was no cause to initiate a criminal investigation into 65 events,

out of the 80 events that occurred in the course of the assault, with regard to which

complaints about the violation of the laws of war under international law had been

led, including events that involved damage to medical facilities.

From the World Health Organization 2011 Report: Referral of Patients from Gaza,

Date and Commentary for 2010. World Health Organization oPT, 2011. Pp. 21-25.

Documents

A Year Since The Assault On Gaza ("Pillar of Defence")