WHO cannot reach displaced people in Lebanon and Gaza

London

Owen Dyer

Civilians, hospitals, and infrastructure vital to public health have not been spared by any of the parties to the escalating conflict in the Middle East, according to reports from international aid agencies.

As the BMJ went to press, casualties stood at approximately 50 dead in the Gaza Strip, most of them reportedly Hamas militants. Israel had 24 dead, half of them civilians, and almost all of the 220 dead in Lebanon were reported to be civilians.

Roads, bridges, and the power grid have been extensively targeted by Israeli airstrikes in Lebanon and Gaza, while in Israel, several medical facilities have been hit in an indiscriminate rain of unguided rocket fire, including a hospital in Nahariya.

In Lebanon, international relief agencies have intensified efforts to ensure essential humanitarian aid reaches civilians caught up in the fighting.

By Tuesday, the United Nations had sent in advance teams to evaluate needs and coordinate relief efforts. But the situation was so precarious that the UN itself had decided to evacuate non-essential staff from the area in conflict.

In light of the heightened insecurity "it is not possible to transfer casualties to hospitals or medical supplies to areas where the population has relocated," a dispatch from the World Health Organization’s regional office said. The first week of conflict in Lebanon is estimated to have displaced about 400 000 people.

WHO’s dispatch concludes that, according to Lebanese health authorities, "access to medical supplies from primary healthcare centres and hospitals is cut off because of the existing security situation."

Although Lebanon has "sufficient" medical supplies available there are no means to transport them to locations in need. Cuts in power supplies were also affecting operations in both public and private hospitals, said WHO.

With all five major crossings of the Litani river broken by Israeli aircraft, the south of Lebanon was practically cut off. Shops were already running low on food, according to several reports, possibly as a result of the Lebanese habit of stocking up at the outset of fighting.

Although Israel has extensively bombed the airport and the port of Beirut, a foreign ministry spokeswoman denied that Israeli forces were trying to impose a blockade on the country.

Israel has declared that its goal is to "neutralise Hezbollah," but the spokeswoman said that Israeli attacks would only target the armed wings of Hezbollah and Hamas, not the numerous schools and clinics operated by the two parties. "That would be inhumane," she said.

With the situation spiralling out of control and the number killed or injured rising fast, international agencies were in full swing activating contingency plans.

This includes the positioning of emergency health kits, water tanks and water purification material, generators, fuel, and 25 000 tons of biscuits for the displaced population, for when needed.

In the Gaza Strip, where an estimated 1.4 million Palestinians are caught in the crossfire, UN officials fear further hostilities, with widespread destruction of civilian infrastructure and shortages of food and water and deteriorating health and sanitation, could cause the region to slide into a humanitarian disaster.

The UN urged donors to commit more aid funds to the 2006 emergency appeal, which is underfunded.

UN officials told the BMJ that at present medical supplies are sufficient in Gaza for about 4-6 weeks, but stressed there were concerns about power supplies to hospitals, many of which are operating on backup generators.

Al Nasser Paediatric Hospital in Gaza reported insufficient quantities of water for its daily needs, and the Palestinian Red Crescent Society Hospital in Khan Yunis is running low on generator fuel.

The International Committee of the Red Cross has provided kits to treat war wounded and basic hospital supplies and medicines, its officials said. But the shortage of fuel continues to pose a serious problem, they warned, and with sewage facilities barely functioning "the risk of cross contamination is increasing."

Local WHO officials reported that cases of diarrhoea in Gaza are up 160% from this month last year.

A survey of 1000 patients in 15 Gaza medical centres by the aid agency Médecins du Monde found that access to food, water, and medical care has been sharply restricted since the Israeli incursion began on 27 June. Although 70% of respondents questioned before the incursion said that they had access to running water, only 43% of those questioned afterwards did.

William Dufourcq, head of the Jerusalem mission of Médecins du Monde, speaking from Gaza, said that the average time to reach health services in Gaza is now two hours, four times longer than before the incursion. Although the number of trauma cases has climbed steeply, hospitals are seeing fewer patients with chronic illness, suggesting that the fighting is preventing many from receiving needed treatment, he said.

On 13 July, the Israeli foreign ministry said that water supplies into the Gaza Strip continued uninterrupted. But on 17 July a ministry spokesperson was unable to confirm if the supply was still flowing. Power stations across Gaza have been hit, hindering water pumping, said Mr Dufourcq.

Three quarters of the Gaza patients interviewed in the survey after the incursion presented with signs of psychological trauma, he added. "We are seeing many signs of post-traumatic stress disorder. Eighty four per cent of those questioned said they relive recent violent experiences in their dreams, and 85% said they cannot concentrate on daily activities."