Palestinians Brace for an Outbreak in One of the World’s Most Densely Populated Territories

TEL AVIV, Israel—For years, international organizations, Palestinian officials, and even some Israelis have warned that the Gaza Strip was verging on a humanitarian meltdown.

The arrival of the coronavirus pandemic to Gaza this week might well trigger that nightmare scenario, leaving untold dead and unleashing the kind of civil unrest that could threaten Hamas’s rule in Gaza and sow chaos at the border with Israel.

The coastal strip, which has long suffered from Israeli and Egyptian blockades, a beleaguered economy, and a population density nearly unrivaled in the world, saw its first two cases of the new coronavirus early in the week. By Thursday, the number jumped to nine.

The crisis there and across the border in Israel underscored the de facto one-state reality that prevails, despite years of negotiations aimed at separating Israel from the Palestinians. While Palestinians in the West Bank and Gaza both have limited autonomy, Israel wields decisive decision-making power over these territories, and Israel alone has the resources to cope with a crisis of this magnitude.

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“This could be a tipping point. Gaza is in very dire straits. The health system has been in shocking state for a long time,” said Jamie McGoldrick, who chairs the United Nations’ COVID-19 task force for the West Bank and Gaza Strip. “We’ve been lucky enough up until now with all the resilience … but you know it doesn’t take much to turn the system, which is coping, into something that really struggles.”

Avoiding such an implosion will require an unprecedented level of cooperation and singularity of purpose among sworn enemies, according to experts. It would also require the active participation of the Palestinian Authority in the West Bank—which has been mired in a rift with Hamas for over a decade—along with international organizations such as the U.N. and the World Health Organization.

Israel already faces international censure over the humanitarian crisis in Gaza despite withdrawing its army from the territory 15 years ago. Rights organizations are calling on Israel to relax its blockade—imposed by land, sea, and air for years, in part as a response to rocket attacks by Palestinians—to allow more medical supplies into Gaza. Others are urging Israel to be ready to step up with emergency field hospitals.

“Israel has taken measures that have systematically crippled the health system in Gaza and paralyzed the economy, so that there are no resources to deal with this disease,” said Sari Bashi, a human rights lawyer and the founder of Gisha, an Israeli nongovernmental organization that advocates for access rights for Palestinians. “Israel exercises control. It must protect their right to health, to the same extent that it protects the right to health of the Israeli citizens.”

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Tareq Baconi, an analyst for the International Crisis Group, said the notion that Israel and Palestine are currently two distinct entities was being upended by the crisis. “In reality, there’s really just one sovereign in the entire territory, and they are the ones who are able to provide the necessary health care and this kind of necessary response to the epidemic,” he said.

Israel imposes restrictions on Gaza that limit border crossings to several thousand people per month, which explains the delayed arrival of the virus in the territory. It was first detected on Sunday, when officials said that the first two cases of COVID-19 were workers who returned to the enclave from Egypt via the Rafah crossing. The government in Gaza had already begun work on a field isolation center on the southern border, reportedly with 500 rooms. Currently, some 1,500 people are staying in quarantine facilities around the Gaza Strip and another 1,200 are in quarantine at home, according to the Gaza health ministry.

But the territory lacks the basic resources required to fight an outbreak: There are only about 70 intensive care unit beds and about 50 ventilators in Gaza—many of which are in disrepair. Israel has sent about 200 virus testing kits and the United Nations has supplied another 1,000. Gaza’s hospitals lack protective gear and cleaning materials. Other grim statistics compound the problem: More than half of Gazans live under the poverty rate, and just one in 10 households has direct access to safe water. Much of Gaza’s sewage spills untreated into the sea or flows into Israel. Electricity cuts are part of everyday life.

On Monday, Hamas’s second-in-command in Gaza, Khalil al-Hayya, called for foreign assistance and threatened that Israel would “bear the consequences” in the case of an outbreak.

Bracing for a public health crisis, Hamas recently called off a mass demonstration at the border with Israel. Muezzins in Gaza mosques have called on worshippers to stay home. Many Gazans have already started to keep off the streets.

“If there is an outbreak in Gaza it will be a catastrophe, nobody can imagine how the situation can be,” said Omar Shaban, the director of the Gaza-based PalThink for Strategic Studies. “On one hand, the health system is not in good shape. On the other hand, who is to blame for this? Is it Hamas and the Palestinian Authority? Is it the people? Is it the lack of [outside] support? Is it the siege? All of these elements come together to make Gaza’s situation very vulnerable.”

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In the West Bank, where the virus has infected several dozen Palestinians, public health infrastructure is relatively better-equipped to cope with an outbreak. The virus claimed its first Palestinian death on Wednesday, reportedly a family member of a laborer who crossed into Israel along with hundreds of thousands of other workers who rely on jobs there.

Since the first Palestinian cases were discovered in Bethlehem earlier in March, Israel has assisted the Palestinian Authority with test kits, lab analysis, contact tracing, and training. Despite years of enmity and a virtual freeze in ties between the two governments, the threat of COVID-19 has revived close cooperation on public health—a sort of coronavirus diplomacy.

Inside Israel, officials are increasingly worried that the health system will become overwhelmed. The number of cases has soared exponentially in the last two weeks to some 2,500. The virus claimed the first five victims this week. Prime Minister Benjamin Netanyahu warned on Wednesday that there might be thousands of patients in critical condition within days and that all Israelis would likely be placed in a full lockdown. On Thursday, the Ministry of Health reported to a parliamentary committee that there were some 1,500 ventilators available to handle the crisis.

The crisis faced by Israel would be further compounded by an outbreak in Gaza. On the other hand, if Israel, together with the United Nations, the Palestinian Authority, and Arab countries, can help slow the spread of the virus by offering humanitarian assistance and setting up field hospitals, it might even provide an opportunity to reach an elusive long-term cease-fire with Hamas, said Eitan Dangot, a former Israeli military official who helped steer policy in the West Bank.

“It’s money time,” Dangot said. “I think Israel by itself will do more. You have to deploy field hospitals. You have to give Gaza the tools to lower the surge of people who are sick.”

The humanitarian alarms go back to 2012, when the U.N. first warned that Gaza would cease to be livable by 2020. In 2017, a U.N. report predicted there would be a shortage of 1,000 hospital beds and 1,000 doctors by this year, and an official described Gaza’s deterioration as gradual “de-development.”

Already, thousands of patients from Gaza get special permission to cross the border to receive treatment for various maladies in Israeli hospitals. A coronavirus outbreak in Israel could likely shut that passage. And if the coronavirus can be transmitted through sewage, a public health crisis could also rebound on Israel.

“Gaza, from a health perspective, is a ticking bomb,” said Gidon Bromberg, the Israel director for EcoPeace Middle East, which last year suggested in a report that an environmental crisis could spur panic among Gazans and send masses headed toward the borders with Israel and Egypt.

“People will no longer have faith in the systems protecting them, the concern is that people will start moving toward the fences to get out. It’s of absolute urgency for all sides to cooperate,” Bromberg said. “The failure to deepen cooperation in the past … is making the likelihood of disaster the more likely scenario.”